Using drama, true-life stories and photos depicting everyday activities such as shopping in the bazaar, attending a wedding and drinking tea with friends, we tell of the suffering, isolation and shame of a woman with a fistula. We want to convince these health workers that this is a condition that needs to be eradicated. We teach about how a fistula is caused, the symptoms and prevention. Teaching on how to avoid obstructed labour starts at the beginning of life with the importance of good childhood nutrition and avoidance of early marriage and pregnancy. Family planning and good antenatal care with counselling on birth preparedness; supervised delivery by skilled birth attendants and timely referral when labour is not progressing normally; use of prophylactic catheterisation, when a macerated baby is delivered after a long labour all lie within the skills and responsibility of the health post workers.
Pauri (pictured) was catheterised for six weeks after delivery because three days in labour led to a ruptured uterus and obstetric fistula. The fistula healed spontaneously.
If health workers understand the importance of what they do in preventive health, what may often seem routine and uninspiring work becomes life saving. We will never know how many women’s lives are saved or fistulae are prevented because a health worker takes the time to help their clients plan for a safe delivery.
Shirley Heywood, Gynaecologist, NGO International Nepalese Fellowship, Nepal