Condition of Women of

Balochistanand Fistula

Prof. Saadat Khan

Head of Urology Department

Sandeman Provincial Hospital Quetta

Map Showing Pakistan & Balochistan

The Province of Balochistan… Balochistan is located at the south-

eastern edge of the Iranian plateau.

It strategically bridges the Middle East and Southwest Asia to Central Asia and South Asia, and forms the closest oceanic frontage for the land-locked countries of Central Asia.

The Province Balochistan… Balochistan is the largest of the

provinces of Pakistan at 347,190 km² (134,051 mi²), which composes approximately 44% of the total land area of Pakistan

The population density is very low due to the mountainous terrain and scarcity of water.

The Province of Balochistan… Much of the province south of the Quetta

region is sparse desert terrain with pockets of towns mostly near rivers and streams.

As per the 1998 census inhabitants of Balochistan, were 5% of the Pakistani population.

Culture in Balochistan is primarily tribal, deeply patriarchal and conservative.

Women of Balochistan…

We live as slaves… (Taj Bibi)

Education is what is a dream for

most of us…. (Bibi Sabira)

Men decide when can we go to a

doctor…. (Marwari)

I was left stranded

and to die…

(Eidimah.. A

fistula surviver)

I don’t know what to do with myself

…. (Fatima…a fistula surviver)

We eat once our men are done with

eating… (Shahida…)

Oppression and Suppression

Women of Balochistan in a snapshot..

Harsh reality Balochistan has highest infant and maternal

mortality ratio (MMR).

Many women in rural areas are not allowed to even visit a doctor.

Majority of women give birth to child at their homes.

Doctors are considered outsiders and are thought of breaching the PARDA system.

Harsh Reality

In Balochistan province more then 90% deliveries (in rural areas) are conducted by traditional birth attendants at home.

This exposes women to a high risk for obstetric fistulae

Majority of our fistula patients are young in child bearing age, with 50% being below 30 years of age

Most common cause is the obstetrical trauma.

Harsh Reality…

In rural areas the only people who are allowed near women are either husbands or family members or TBAs who act as physicians and the one who assist the women in giving birth to child.

The concept that Doctors breach the privacy and PARDA system , is more prone in remote rural areas.

Harsh Reality… Majority of fistula cases are still

undiscovered and many women are living a life which they consider worse than being dead.

Fistula is more prone in the following districts ChaghiPanjgorLoralaiHarnaiAwaran

Causes of fistula in province… Lack of health facilities. Early Marriages

Teen pregnancies. Traditional Birth Attendants. Immaturely trained gynecologists. Misconceptions about doctors and

hospitals. Illiteracy and lack of information.

Causes of fistula in province… Women here are oppressed by not only

the family members but also by the culture or we can say they are oppressed by default.

Almost all of the women in rural areas get married around the age of 14 or 15 years.

Average marriage here in the province is when the girl reaches her puberty.

Causes of fistula in province… Traditional birth attendants or “Dais” as they

are commonly referred to, are the major cause of fistula.

They neither have proper tools nor have skills to conduct deliveries.

Women themselves are another cause as they don’t feel comfortable in going to or asking their husbands to take them to hospitals.

Causes of fistula in province … Many of the fistulae were developed because

of the less trained doctors.

Obstetric as well as iatrogenic fistulae patients were discovered whose deliveries were done by gynecologists.

A large number of doctors need to be under supervision of senior surgeons and gynecologists to gain more experience.

Causes of fistula in province…

Only when the patient is at the verge of dying, is brought to a doctor.

TBA’s also create a negative image of doctors as they consider doctors as threat to their business.

Causes of fistula in province… Majority of women here in province cant

even write their own names. Women since their birth are taught to follow

the instructions of the men of the house and later their husbands.

A place where women are not even properly nurtured cant access the basic health care.

Men decide when to take their women to hospitals or even to let a doctor visit them.

Causes of fistula in province… Women are not aware of their rights and

thus are forced to do what they don’t wish. Women in rural areas are treated as child

bearing machines. An average child count per woman is five. Average age for a girl getting married is

15 and a girl gets pregnant as soon as she gets married.

Causes of fistula in province… Women in other parts of the world at-least

can decide whether they wish to have a child or not but here they are under the command of their husbands.

Teens are fragile and when they get pregnant and give births to children at home under the supervision of TBA , the end result is devastating … FISTULA

Causes of fistula in province… Women once under the devastating condition “fistula”

don’t know that what caused this condition t o occur;They consider the leakage normal till they keep on leaking

even after months of delivery.Their husbands don’t know where to take them for

treatment.

Some get divorced and some are forced to live like outcastes.

Children, husband and even parents seldom go near such women.

Causes of fistula in province…

Many patients don’t even know whether it’s a curable disease or chronic.

As they are not allowed to seek medical attention therefore they don’t know that it’s a minor glitch in their body and can be repaired.

Doctors unaware of fistula??? Some of the doctors working in remote

areas don’t know where to refer the fistula patient.

They really don’t know why the woman is leaking.

Medicines ?? Yes they give the patients medicines and after months of treatment they declare their patients incurable.

How does the information reach the patient???

Before the year 2006 the only source of information, for women with fistula, were doctors or the lucky ones who got treated.

In 2006, UNFPA started a project on fistula and it has been the major source of information for the people.

Our team has already repaired a large number of fistulae.

Patients and Us… The number of patients is gradually and

exponentially increasing per year.

Even with the limited equipment and OT facilities we managed to bring smiles back to the faces of many women.

Many of the patients didn’t even know whether they will get cured or will have to spend their whole lives in misery and consider it as a part of life.

Patients and us…

God willingly we will continue to support the patients and will continue to bring smiles to oppressed women of Balochistan.

Plans…

Conducting seminars and disseminating the information about fistula and its cure.

Keeping coordination with regional center and PNFWH-UNFPA and supporting them in helping the patients get a new life.

Disseminating the information through meetings with other doctors.

Plans for rehabilitation of patients..

Unfortunately there is no facility for rehab of fistula patients in Baluchistan.Assisting the regional center in Developing a

counseling center for patient and her relatives.

Providing psychological treatment along with the fistula treatment.

Motivating patients and telling them that they are just like normal beings and the condition they are in, is not because of being cursed or punished.

Construction of Fistula ward…

PNFWH-UNFPA are providing support and are providing funds for construction of fistula ward at DHQ Quetta.

It will develop the Government sector to provide better care to fistula patients.

When the project ends, the patients, will still be getting free treatment.

Fistula Ward being constructed at Sandeman Provincial Hospital

Fistula Ward at Sandeman Provincial Hospital.

Message To educate the masses regarding the importance of

disease in relation to child birth.

To eradicate the fear of the patient and the family that the disease is not a curse and it is curable.

To conduct classes and workshops inorder to train the gynecologists and junior doctors .

Reduction in occurrence of fistulae is better than to increase the number of fistulae repair

Thank you for your time and attention…