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Posted on Categories Article, Featured, General News

The fight against Obstetric Fistula in Uganda: Progress made but challenges remain 

According to the United Nations, Obstetric fistula is a hole between the birth canal and bladder or rectum, caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. This abnormal opening leaves women and girls with a constant leakage of urine, stool or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. Ninety percent of pregnancies involving fistula end in stillbirth.  

Obstetric fistula continues to affect the lives of thousands of women in Uganda. This debilitating condition leaves affected individuals with chronic incontinence and often social isolation.  

The National Library of Medicine (National center for Biometric information) highlights that in Uganda, the current lifetime prevalence of vaginal fistula symptoms is estimated to be between 16.3-22.5 per 1,000 women of reproductive age. This translates to an estimated 140,000 – 200,000 women and girls living with fistula in the country, with over 1,900 new cases occurring annually. 

The United Nations estimates that at least two million women live with fistula in developing countries, with 50,000 to 100,000 new cases occurring each year and these numbers represent only those seeking treatment. Women and girls in Africa, south of the Sahara, are mostly affected by fistula as well as other illnesses from sexual and reproductive health causes. 

The Ugandan government has taken important steps to address this issue. In 2011, the country enacted the National Obstetric Fistula Strategy (2011/12-2015/16) which aims to guide the implementation of prevention, treatment and re-integration activities for obstetric fistula. This has led to increased awareness, training of specialized fistula surgeons, and the establishment of dedicated fistula repair centers across the country.  

Strategic partners in Uganda have also followed suit and have been seen to implement the government’s strategy. The Kingdom of Buganda forexample is also dedicated to raising awareness about obstetric fistula among mothers in the central region. To achieve this, the kingdom collaborates with key hospitals in Buganda, such as Kitovu Hospital in Masaka District, to establish necessary infrastructure and provide support. The Kabaka Foundation, a prominent organization within the kingdom, actively participates in these efforts by organizing an annual Kabaka Birthday run which focuses on fistula awareness, among others. These events serve as a platform to educate the community and garner support from both local and international sources to fund initiatives aimed at preventing and treating obstetric fistula. 

The Terrewode Women Community Hospital – Soroti District, under the leadership of Executive Director Ms. Alice Emasu, has made a significant difference as well by saving the lives of more than two thousand (2,000) women suffering from fistula over a span of five years. We need to see more of such initiatives to create a significant impact. 

However, despite these efforts, challenges remain. The New Vision publication by Umar Kashaka on 8th May 2024 highlights the worry of the Uganda Ministry of Health on the rising backlog of fistula cases. In this article, the Assistant Commissioner of Clinical Services in the Ministry of Health Dr Alex Wasomoke is quoted to have revealed that approximately 1500 fistula operations are carried out in a year but 1,900 new cases are reported annually, leaving a backlog of over 400 cases unattended to. He also noted that each fistula patient needs $400 (1.5m) to undergo surgery and this is a direct affordability concern and a barrier to access of quality care services. 

An article authored by Ndyaye and published in the Daily Monitor on May 20th, 2024, reveals that Uganda currently only has 25 surgeons specializing in fistula repair, a shocking revelation considering the immense demand for such services. These skilled providers have successfully treated thousands of fistula cases, restoring dignity and hope to women and girls who had lost all. However, the demand for fistula treatment remains largely unmet, leaving countless women unable to access these life-changing services. 

Women living with obstetric fistula encounter a multitude of challenges across various aspects of their lives. Physically, they struggle with urinary and/or fecal incontinence, which can lead to skin issues such as rashes and sores, as well as complications like foot drop. Fertility concerns, post repair surgery often plague these women, with uncertainties about their reproductive capabilities and fears of recurrence during future pregnancies. Psychologically, they face disruptions in social relationships, potential divorce, and the potential heart-wrenching loss of their babies through neonatal death. 

The stigma, discrimination, and resultant isolation from their communities contribute to feelings of depression and low self-esteem. Economically, women with fistula experience a loss of livelihood, becoming heavily reliant on family members for support, and struggle to afford necessary treatment and transportation to healthcare facilities. Socially, they encounter challenges such as impaired marital status and responsibilities, limited participation in community activities, and various forms of discrimination based on health, disability, marital status, education, and socioeconomic standing.  

Despite these hurdles, many women can successfully reintegrate into their communities post-repair, although relationship issues and fertility anxieties often persist. It is important to address the holistic needs of women with fistula, encompassing physical, psychological, social, and economic support, to facilitate their complete recovery and successful reintegration into society. 

Underlying social factors such as poverty, gender inequality, child marriage, and limited access to quality maternal healthcare continue to drive the persistence of obstetric fistula in Uganda.  Addressing these social factors through multi-sectoral interventions is crucial to achieving the goal of ending fistula by 2030. 

On this International Day to End Obstetric Fistula, we therefore call upon the government and all actors to renew its strength towards this cause. Increased investment in prevention, treatment, and rehabilitation services is needed, along with empowering women and girls, challenging harmful social norms, and strengthening the overall healthcare system. Employing a comprehensive rights-based and multisectoral approach, at large, can finally place obstetric fistula to the history books in Uganda and beyond.  

It is very possible to change the status quo and impact society positively. 

 Compiled by Jacqueline Twemanye, Communications Department, Center for Health, Human Rights and Development (CEHURD). 

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Embracing Women’s Health, Navigating Menopause in the Workplace

In Uganda, the pursuit of gender equality has seen significant strides in recent years through several initiatives aimed at empowering women in various aspects of life. Initiatives such as the Gender and Equity Certification Program and the National Gender Policy underscore the commitment to addressing gender disparities. However, it is noteworthy that there is a gap in policies explicitly targeting menopause as a workplace challenge.

It is thus essential to shed light on the often-overlooked journey of women in the workplace, especially as they navigate the unique challenges posed by menopause. Contrary to common belief, menopause isn’t exclusively an issue for older women, it can impact women below the age of 40 (pre-mature menopause), significantly affecting their professional and personal lives. This silent transition demands understanding, support, and an inclusive workplace environment to empower women during this critical phase. 

The Hidden Struggles: Menopause brings forth a myriad of challenges that can impact a woman’s physical and mental well-being, potentially influencing her overall job satisfaction and performance. Common symptoms include hot flashes, mood swings, sleep disturbances, and cognitive changes. These challenges not only undermine a woman’s confidence but also disrupt concentration and impact her ability to handle stress effectively. 

The Working Woman’s Dilemma: The workplace, traditionally structured without considering the specific needs of women experiencing menopause, can inadvertently amplify these challenges. Despite the prevalence of menopause among women, it remains a topic often shrouded in silence and stigma. Many women feel hesitant to openly discuss their experiences, fearing judgment or discrimination in the workplace. This lack of awareness and support perpetuates a culture of silence, hindering women from seeking the help and accommodation they need. As women increasingly play multifaceted roles, balancing career aspirations with societal expectations, the impact of menopause on their professional lives becomes a pertinent aspect to consider.  

Efforts to promote gender equality should expand to encompass policies that address the specific needs of women navigating menopause in the workplace. Recognizing and accommodating the challenges posed by menopause aligns with the broader goal of creating an inclusive and supportive work environment where women can thrive across various life stages, ultimately contributing to a more equitable society. Incorporating menopause considerations into existing gender equality policies can further enhance the overall well-being and empowerment of women in Uganda. 

Special Message to Women: let us celebrate not just our achievements but also acknowledge the unique journey many of us navigate through menopause. It’s a phase that may bring physical and emotional changes, impacting both personal and professional spheres. Remember, you are not alone on this journey. Embrace open communication, seek support, and prioritize self-care. Recognize your strength and resilience as you navigate these changes at the workplace. Advocate for your needs, and let’s work collectively to foster understanding, empathy, and positive change. You are valued, empowered, and deserving of a workplace where your well-being is prioritized.  

Examples of Workplace Neglect 

Temperature Control and Comfort: Many workplaces are not designed with consideration for temperature control, comfortable seating, or adequate lighting. This oversight exacerbates symptoms like hot flashes and fatigue. It is important that employers invest in creating a comfortable and supportive workplace environment. This includes adjustable temperature controls, ergonomic seating, and adequate lighting to accommodate women experiencing symptoms like hot flashes and fatigue. 

Flexible Work Arrangements: Some employers fail to provide flexible work hours or remote work options, making it challenging for women to accommodate varying energy levels and the need for extra rest during challenging times. Employers are encouraged to introduce flexible work hours or remote work options to allow women to manage their workloads effectively while dealing with fluctuating energy levels. 

Limited Education and Awareness about menopause: Many workplaces lack educational programs about menopause. This absence of understanding among colleagues and supervisors contributes to a lack of empathy and support for women experiencing these challenges. Workplaces may consider prioritizing implementing educational programs about menopause. This not only raises awareness but also fosters understanding among colleagues and supervisors, encouraging empathy and support. 

Limited Wellness Programs: Some workplaces lack comprehensive wellness initiatives addressing the physical and mental well-being of women going through menopause. This includes insufficient access to counseling, support groups, and fitness programs. Companies should incorporate comprehensive wellness initiatives addressing the physical and mental well-being of women experiencing menopause. This includes providing access to counseling, support groups, and fitness programs. 

Communication Barriers: In workplaces where open conversations about menopause are discouraged or not facilitated, women may feel isolated and unable to express their needs and concerns without fear of judgment. Encouraging open conversations about menopause is crucial. Creating a platform for women to express their needs and concerns without fear of judgment fosters a supportive and inclusive workplace culture. 

Creating a supportive environment for women experiencing menopause is not just an empathetic gesture; it is a workplace necessity. Advocacy for policy changes and the implementation of supportive measures is crucial to ensure that women can navigate this phase without compromising their professional growth. 

Together, let’s embrace women’s health and create a workplace where every woman feels valued, understood, and empowered to succeed.  

With solidarity,

Compiled by Nakalembe Judith Suzan, Community Empowerment Programme, CEHURD. 

 

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Healing Words: Expressing the Inexpressible Pain of Cancer Loss

By Sarah Akampurira

As we commemorate World Cancer Day 2024, my heart is burdened as I reflect on the loss of a dear one to cancer last year. I implore the government, private sector, and individuals to prioritize the creation of a supportive environment that ensures equitable access to treatment, information, and dignified care for all. The days of perceiving cancer as a distant concern are behind us; it now lives with us, impacting the very fabric of families and our social networks.

In recent times, cases of cancer have increasingly become common regardless of age, sex or any other demographics. In November 2015, Uganda rolled out free Human Papilloma Virus (PHV) vaccination for adolescent girls 10–14 years in its’ immunization schedule across all districts as a primary preventive measure for cervical cancer. Unfortunately, the uptake of HPV vaccination has been low across Uganda which may be due to limited knowledge and unverified information that spreads like wildfire on various media platforms causing fear and resentment among the users. As parents, let us embrace the HPV vaccination programme to ensure that our daughters aged 9 to 14 years are fully vaccinated before becoming sexually active to reduce their chances of getting Cervical cancer.

The 2024 World Cancer Day theme “Together, we challenge those in power” is a call to action for everyone stretching from Global leaders to double our efforts and deliberately work towards investment in cancer prevention and care to prevent early avoidable deaths due to loss of hope, and frustration related to cancer treatment. It is our responsibility to live healthy lives, exercise, eat right, and undergo routine medical check-ups to minimize the chances of cancer and once one is diagnosed, they should be facilitated to enroll in care for proper management.

The pain of seeing your loved one who has always been in charge of everything and everyone around her live in a situation of dependency for years, miss church sessions, work and always weak calls for support beyond the medical needs. When a parent is battling with cancer, family roles change, the other partner and children have to pick up those duties. The children start to act like adults and this becomes overwhelming at times balancing school, friends as well as taking on caregiver roles.

Witnessing a loved one, who has always been a pillar of strength, succumb to a prolonged state of dependency due to cancer is a distressing experience. Beyond the obvious medical requirements, there emerges a call for support that extends to the emotional and practical aspects of life. During the cancer battle, family dynamics undergo a profound shift, necessitating the redistribution of responsibilities among the partner and children. The children, forced into premature roles as caregivers, find themselves grappling with the challenge of juggling academic pursuits, social lives, and the weight of newfound responsibilities. The burden becomes overwhelming, highlighting the multifaceted impact of cancer on the intricate balance of family life. Psycho-social support remains a critical component in cancer care and management that should not only be limited to already identified clients but also the family members who in most cases shoulder the burden of care and support, live in a state of despair engulfed with fears of losing a loved one to the deadly cancer.

“Every single person has the ability to make a difference in the fight against cancer. Together, we challenge those in power to prioritise cancer management and neutralisation and ensure equitable access to cancer care for all.”

Under the leadership of the Ministry of Health- Uganda, deliberate efforts should be invested in creating awareness, through various channels not forgetting media platforms right from the local communities to facilitate behavior change. It’s no longer business as usual. Let us normalize talking about cancer in its entirety during health education talks like any other disease this helps to minimize the fears and also helps the patients to open up and embrace help from friends, health professionals, counselors, and family members even though it may not be easy.

The writer is a Programme Coordinator for Community Empowerment at the Center for Health, Human Rights and Development (CEHURD).

 

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Beyond Rhetoric: Let Us Address the Root Causes of Gender-Based Violence in Uganda

By Grace Awilli

In a parliamentary plenary session on November 23, 2022, the Minister of Gender, Labour, and Social Development passionately addressed the floor, commemorating the 16 days of activism against Gender-Based Violence (GBV). Despite the minister’s optimistic portrayal of government actions against GBV, the stark reality, as revealed by the National Survey on Violence Against Women (2021) and the Uganda Police Annual Crime Report for 2021, painted a distressing picture. An alarming 95% of respondents reported experiencing physical or sexual violence, and 16,242 cases of GBV were reported in the same year.

This fragility in GBV prevention and response efforts, showed an escalation in cases, particularly of teenage pregnancies and child marriages.

During parliamentary debates, Members of Parliament demonstrate fervent commitment by passionately voicing their concerns and the pressing need for the passage of pivotal bills, such as the Sexual Offences Bill, emphasizing their profound potential to address the pervasive issue of gender-based violence (GBV). The recognition of the bills’ significance in the fight against GBV reflects a collective acknowledgment of the legislative tools required to combat this societal challenge.

The importance of awareness creation regarding GBV emerges as a recurring theme, resonating with various stakeholders. Their collective emphasis underscores a shared understanding of the role education and advocacy play in fostering a culture of intolerance towards GBV. This recognition suggests a united front in promoting societal consciousness as an integral component of a comprehensive strategy to eradicate gender-based violence.

While the Ministry of Gender has championed laws such as the Domestic Violence Act and male engagement strategies, implementation remains a significant hurdle. The legal and policy framework aligns with international standards, but the non-implementation of these laws, policies, and strategies is the primary challenge. Government institutions tasked with GBV prevention lack resources, hindering their effectiveness.

The Child and Family Protection Unit of the Uganda Police Force, for instance, operates without a dedicated budget line, relying on district police leadership and partners for support. At the local government level, the under funding of the community services department, responsible for GBV data collection and non-state actor coordination, further impedes progress.

Critical to the resolution of the GBV challenge is a gender-sensitive justice system, essential for victim protection and holding abusers accountable. Unfortunately, Government institutions that are at the forefront of GBV prevention and response are constrained by limited resources and as a result, GBV prevention and response has substantially been left to Non-Governmental Organisations, which poses significant dangers.

It is crucial for the government to allocate adequate financial resources to ensure the effective implementation of existing legal and policy frameworks. As evidenced by the ownership and management of GBV shelters predominantly by civil society organizations, NGOs play a vital role in providing comprehensive care and support to victims.

Measures such as promotion of a gender-sensitive justice system, coupled with the passage of Witness Protection and Legal Aid laws, will protect vulnerable survivors during trials and ensure access to free legal support. The Parliament, in its legislative and appropriation function, can be the driving force behind these changes, ultimately improving GBV prevention and response in Uganda.

Concerted efforts to address the root causes of gender-based violence for a safer and more equitable society will go a long way in addressing GBV in our communities.

The writer is a lawyer at the Center for Health, Human Rights, and Development.

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A Silent Cry of the Majority

By Clifton Irahuka – Health Service Provider

In Uganda’s heart, where cultures intertwine,

A tale of resilience, against a patriarchal design.

Gender-based violence, a shadow so deep,

Infringing on rights, where women should sleep.

From child marriages at 34%, where innocence fades, 

To teenage pregnancies at 25%, where hope evades.

Female Genital Mutilation at 0.3%, a scar on the soul,

Robbing women of choice, taking away their control.

Physical violence at 56%, a silent, hidden cry,

Shattered dreams, where hope should lie.

Intimidation, threats, and fear’s embrace,

Silence imposed, leaving no trace.

Sexual violence at 27%, a violation so deep,

Leaving scars unseen, where secrets they keep.

Victims stigmatized, their voices unheard,

In a society where silence is preferred.

Yet amidst the darkness, a flicker of light,

Women united, their spirits ignite.

Fighting for justice, their voices so strong,

Demanding safety and choice, where they belong.

Sexual and reproductive health advocacy, a beacon, a guiding star,

Empowering women, reaching afar.

Access to knowledge, their choices to make,

Their bodies, their lives, for their own sake.

 

Education and research, a shield, a weapon so keen,

Dispelling the myths, the harmful traditions unseen.

Empowering girls, their voices to rise,

Challenging norms, beneath open skies.

 

Laws and policies, a framework to stand,

Protecting women, across the Pearl.

Enforcement and justice, a hand in hand,

Eradicating violence, taking a stand.

Community engagement, a bridge to unite,

Breaking the silence, shedding the light.

Changing values and attitudes, transforming the norm,

Creating a society where women are warm.

In Uganda’s journey, a path to unfold,

Where gender-based violence no longer holds.

SRH empowered, where women can thrive,

In a world where equality and equity truly survives.

 

The writer is a Midwife and Sexual and Reproductive Health and Rights Advocate.

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