Dhaka, December 22
They are among the most unwanted and vulnerable women in Bangladesh. Living with fistula, a devastating injury that occurs during childbirth and causes urinary and faecal incontinence, these women face unimaginable trauma and social discrimination.

Abandoned by their loved ones, women suffering from fistula are mostly childless and have nowhere to go. They are denied conjugal rights and compelled to sleep in the verandah or the cowshed.

Years of neglect turn them into wrecks. After coping with prolonged, unassisted labour, the delivery of a stillborn child, constant dribbling of urine and desertion by their husbands, they suffer in silence as social outcasts. The few, who are able to seek medical help, count their blessings.

Kohinoor, a 45-year-old woman from Chatpur district in Dhaka division had been suffering for 18 years till she sought help at the National Centre for Management of Fistula patients in the Dhaka Medical College Hospital.

Dalimon, a 20-year-old woman from Tangail district, had a stillborn child a year back. Her husband left her. Brought to the centre by her father and brother, Dalimon is awaiting a surgery for a very difficult fistula.

Dr Hasina Afroz at the hospital says fistula is seen more in teenagers and after multiple pregnancies in women.

“Fistula patients are not treated like human beings by their families. They are sent back to their parents leaking and sick. They have an identity problem,” says Tahera Ahmed, assistant representative, UNFPA, Dhaka.

The Bangladesh government and the UNFPA took the initiative to develop the first National Fistula Centre in South Asia. The centre began functioning on September 29, 2003, from the premises of the Gynaecology and Obstetric Department of the Dhaka Medical College Hospital (DMCH). The 16-bedded centre conducts surgeries three days a week and offers treatment free of cost. Patients are paid normal train fare from their home to the centre.

The UNFPA has supported the training of surgeons for fistula repair, anaesthetists, nurses and physiotherapists with technical support of Hamlin Hospital, Ethiopia.

Prof Kohinoor Begum, Head of the Department of Gynaecology at the Dhaka Medical College Hospital, told The Tribune that the centre had so far treated 1,300 patients. Of these, 158 patients have been treated this year. Unfortunately, some patients who come for treatment have lived with fistula for more than a decade.

The centre gets difficult cases from 10 medical colleges, private hospitals and clinics run by non-government organisations. In 1996, the number of fistula patients in Bangladesh was estimated to be 400,000. A 2003 survey estimated that 71,000 women were living with fistula. The Dhaka Medical College Hospital is planning a nationwide survey to know the number of fistula patients.