Razia Bibi, 25, never heard the scream of her firstborn, announcing her arrival into the world. She never even got a chance to hold the little bundle of joy in her arms. The baby died even before taking her first breath. What was worse, the childbirth left Bibi to suffer from a debilitating disease called obstetric fistula.

Obstetric fistula is a medical condition where a passageway is formed between the mother’s birth canal and bladder or between the birth canal and rectum. The condition arises when due to prolonged, obstructed labour the baby’s head puts undue pressure on the lining of the woman’s birth canal, eventually ripping through the wall of the rectum or bladder, resulting in chronic urinary or faecal incontinence along with severe pain and infections.

More easily explained if your bowels, urinary and reproductive tracts are considered as a plumbing system, fistula is like bad plumbing as it connects the wrong things together causing problems.

It is unfortunate that thousands of women suffer unnecessarily because of a condition that is not only treatable but also preventable to a large extent

According to the United Nations Population Fund (UNFPA) survey, “There are around two million women living with fistula in the developing countries of Africa and Asia such as Nepal, India, Bangladesh and Pakistan.”

Dr Sher Shah Syed, a gynaecologist known for his work in obstetrics and maternal health, lamented, “Around 28,000 women die during childbirth in Pakistan every year due to poor maternal care facilities.”

Though fistula is a completely curable disease, there is little awareness about it. Syed said fistula has a low profile because it mainly affects the “poor, downtrodden women” living in urban slums and distant rural areas. “I never found any upper and middle-class woman suffering from fistula. Thus, it never gets due attention at any level,” he added.

A little-known condition in the developed world, there are many causes of fistula in the developing one.

Dr Sajjad Ahmed, Project Manager Fistula, Pakistan National Forum on Women’s Health (PNFWH) estimated that around “4,000 to 5,000 women” suffer from the condition in the country. Millions of women silently suffer from fistula, completely unaware that they can seek medical assistance and lead a normal life. Ahmed said, “We are unable to eradicate it due to ignorance, poverty and the stigma attached to the condition.”

Women with obstetric fistula often suffer social-psychological trauma besides physical pain. Due to constant leakage, they are often abandoned and shunned for being dirty and infertile thus unable to work and socialise.

The best treatment is truly case-dependent, there is no one-size-fits-all solution. Koohi Goth Fistula Hospital, in Karachi, is an island of hope for such women. The hospital offers free services including treatment, tests, surgery, and medication to poor patients, coming from all across the country. According to Dr Syed, “The same surgery costs around Rs50, 000 to Rs250, 000 in other private hospitals.”

The hospital is one of the 12 centres set up under the UNFPA since 2004-5. Its motto is ‘End fistula, restore women’s dignity’.

Ahmed said, “On an average 500 to 600 fistula patients are operated in the hospital annually, while it has the capacity to cater to as many as 2,000 women.” Besides fistula treatment and surgical training, the Koohi Goth hospital also provides gynaecological services, midwifery and nursing education. It is, however, the fistula ward that remains the hub of activity in the hospital. Every patient admitted here has her own tragic tale.

There are older women like Habiba (62) from Khairpur, Sindh and Walaat Bibi (55) from Kharan, Balochistan, who have been suffering from fistula for 30 and 20 years respectively.

“I used to live an unbearable life and couldn’t attend any social gathering even weddings and a funeral in the family due to my awful condition,” said Habiba.

Her first husband and children have died while the second husband divorced her. She has been in the hospital for six months with her sister. Her treatment, like Waalat Bibi, might take a year and require multiple surgeries due to age and time factors.

Most of these women need counselling in addition to treatment. The Koohi Goth Hospital also runs a rehabilitation centre. Its in-charge Shaman and her assistant Sajda work diligently to keep these women engaged in healthy activities.

Shaman said, “We run this centre to teach these women how to ‘cope with their situation and earn their living’. We help them to groom their talent in stitching, embroidery and craftwork. The objective is to restore their confidence, rebuild their lives and provide an empowering support network.”

The rehabilitation centre has a separate hall to display the work of fistula patients.

Besides midwives and nurses of the hospital such as Umm-e-Habiba and Nandni, are also trained to help and counsel both the patients and their attendants.

Women comprise more than half of Pakistan’s population, yet they receive pathetic medical and healthcare facilities, especially in the poor, distant areas of the country. According to the Demographic and Health Survey (2014), “about 276 women out of every 100,000 die during childbirth”.

As Syed lamented, “We live in a male-dominated negligent society where people “spend on and care about their cattle more than their women.”

In these circumstances, the Koohi Goth hospital seems an island of hope to many women. As Razia rightly pointed out, “As a blind person, I won everyone’s sympathy, but after I developed fistula, I was treated worse than animals. May God protect every woman from this curse!”

Published in Dawn, Sunday Magazine, December 20th, 2015