Too Long to Wait: Obstetric Fistula and the Sociopolitical Dynamics of the Fourth Delay in Soroti, Uganda

Abstract

Uganda has one of the highest obstetric fistula rates in the world with approximately 200,000 women currently suffering. Surgical closure successfully treats fistula in the majority of cases, yet there is a severe shortage of facilities and trained surgeons in low-resource countries. The purpose of this study was to examine Ugandan women's experiences of obstetric fistula with the aim of adding narrative depth to the clinical literature on this devastating birth injury. Data were collected through semistructured interviews, focus groups, and participant observation. Resulting narratives were consensus coded, and key themes were member-checked using reciprocal ethnography. Women who suffered from fistula described barriers in accessing essential obstetric care during labor-barriers that are consistent with the three delays framework developed by Thaddeus and Maine. In this article, we extend this scholarship to discuss a fourth, critical delay experienced by fistula survivors-the delay in the diagnosis and treatment of their birth injury.

Obstetric fistulas in Uganda: scoping review using a determinant of health approach to provide a framework for health policy improvement

“…Additionally, even though the earlier mentioned delays suggest that the damage might already be done before hospital arrival, a substantial part of the observed fistula is due to injuries created by the surgeon [17]. Also, women experienced delays in receiving care when at a health centre, due to shortages of supplies and severe shortages in the number of medical staff [37,55].…”

Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria

“…The differences in stigmatization experiences from extreme to minimal might be context related, as differences in culture and beliefs in relating with persons with debilitating conditions such as fistula could be responsible. For instance, the challenging harsh treatment reported with respect to seeking cure in a study in Uganda (Ruder et al, 2018). According to Charmaz (2000), how, when, and whether people acknowledge and behave in illness is culturally and contextually specific.…”

“…Successful return to life meant having children, but anxiety and pain were evident from women who suffered child loss and remained childless after repairs. Stigmatization, following fistula development, as a consequence of the change in identity are widely discussed in studies on experiences of women before and after fistula treatment, particularly with respect to its effect on relationships (Bangser, 2006;Gebresilase, 2014;Jarvis, Richter, & Vallianatos, 2017;Khisa, Wakasiaka, McGowan, Campbell, & Lavender, 2017;Muleta, Hamlin, Fantahun, Kennedy, & Tafesse, 2008;Pope et al, 2011;Ruder, Cheyney, & Emasu, 2018;Turan et al, 2007). Stigma is a generally known consequence of chronic illness and threatens individuals' perception of their illness experiences (Charmaz, 2000).…”

The Promise and Neglect of Follow-up Care in Obstetric Fistula Treatment in Uganda

“…The two-week surgical camps are usually hosted at public hospitals and are offered several times a year at different locations throughout the country with either a foreign surgeon and/or one or more Ugandan surgeons. Promoted via radio announcements, it is common for 50 or more women to receive treatment during this two-week period, though sometimes many more women turn up, resulting in overcrowding, long surgical days that stress support staff at the hospital, and women being turned away when time or funding runs out (Ruder et al, 2018). Routine treatment at referral hospitals has been introduced in Uganda, yet is still not available in most areas of the country.…”