Although women in Southern Sudan suffered terrifying levels of physical and mental brutality, for the last five years, government has not provided sufficient healthcare services for the survivors of Africa’s longest conflict.
South Sudan has the worst health indicators in the world. For instance, a household survey in 2006 placed the maternal mortality rate at 2,054 per 100,000 live births, while infant mortality rate stood at 102 per 1,000 live births. For every woman who dies while giving birth, six survive but with chronic and debilitating ill health, including obstetric fistula.
The survey estimated that there are 55,000 cases of women with obstetric fistula. In simple terms, fistula is a condition where a woman loses ability to control her flow of urine and/or faeces. According to UNFPA, it is usually caused by several days of obstructed labour, without timely medical intervention.
This requires a lot of support from partners, particularly those with expertise in women’s sexual and reproductive health. In April, Isis-WICCE, a women’s NGO, in partnership with Totto Chan Centre for Child Trauma (TCCT), the ministry of Health, and Central Equatorial State organised surgical operations for women with fistula, prolapsed uterus and fibroids.
“Maternal health of women in South Sudan is currently at stake,” noted a health worker at Juba Referral Hospital who was trained by Isis-WICCE medical experts and helped as a surgical assistant.
“The long distances patients have to travel to access health services are worrying.”
South Sudan’s population is scattered over close to 700,000 square kilometres and save for a few urban areas, the country lacks all manner of infrastructure. In the new nation, the health worker noted, the government should try to extend health services closer to where people can easily access them. Dr Gamal, the director of primary healthcare in Central Equatorial State, and Dr Emmanuel Ija Baya, the state’s health minister agree.
“For now we are dreaming,” noted Dr Gamal. “We need to establish sufficient health facilities in all the counties as well as in other areas like education and other aspects. We will be able to do it eventually.”
According to Dr Baya, the government is struggling with its partners to build more hospitals and have sufficient referral facilities for emergencies.
“I believe that with the coming of the new status of the state, we are going to be able to raise more resources to support the reconstruction of the infrastructure so that the health facilities can easily reach all the people and address the reproductive needs of women.”
But as all this is planned, there’s need to campaign against regressive cultural practices that prohibit people from seeking better health services and those that marry off young girls unable to deliver safely. A young woman only identified as Adam got married at 18 and immediately got pregnant.
“When it was time to deliver, I had to go to my parents’ home because that is the custom. After a long labour lasting [three] days, I lost the baby but developed fistula.”
For two years, Adam passed urine uncontrollably and she lost her husband.
“I am happy I have been operated and if my condition improves, I will continue to live with my parents. I am not interested in marriage anymore.”
According to Dr Tom Otim, a senior gynaecological consultant who oversaw the operations, many women, especially young girls, in conflict and post-conflict settings, suffer from fistula after undergoing prolonged labour, a prevalent phenomenon.
“Over 80% of the patients get it from obstructed labour or through gynaecological [complications], but operations are difficult when it is too late to address their condition,” he explained.
Health professionals believe that early marriages escalate the incidences of fistula, to say nothing of despicable conditions caused by war and conflict. As Dr Fred Kirya, another senior gynaecological surgeon, explained, “When a girl marries early, she is young and her body is not fully developed to give a baby. In post-conflict South Sudan, chances are high that she has not gone to school and chances are also high that she is living far off in the village where the healthcare system is poor and, therefore, accessibility is also difficult.
“So, these are risks. In addition, conflict and post-conflict settings are actually ripe ground for fistula because of the apparent social economic difficulties, the poor healthcare [and referral] systems, lack of education, and lack of infrastructure.”
For the new nation that emerges on July 9, its work in the field of women and reproductive health couldn’t be more clearly cut out.
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