PHNOM PENH, Cambodia — “I am so happy to learn that I am completely cured,” said a jubilant Sah Sin, 58 years old, after visiting the Chenda polyclinic. After more than three decades of isolation and pain due to her chronic incontinence, she said she would be more confident to interact with her fellow villagers from now on.
Ms. Sin was at the clinic for a follow-up visit, after receiving surgery at the Children’s Surgical Centre to close an obstetric fistula she developed while delivering a stillborn child in the 1970s, when the country was in a civil war. At that time she was living in a camp run by the Khmer Rouge, where a traditional birth attendant delivered her child.
A few weeks after the delivery, she realized she was leaking urine uncontrollably. She thought she was the only person to have such a problem and did not know how to handle the situation. She was not able to consult an expert or get advice from anyone, and she had to adapt to living in pain and with shame for more than 30 years.
Tak Eap developed a vesico-vaginal fistula in the late 1990s, after delivering her first child. She was in obstructed labour for two days before her family sent her to the hospital. She lost consciousness while being transported from her village. The next day, she found herself in a hospital bed and realized her baby was stillborn. She did not remember well what she had gone through. A few weeks later, her husband left her quietly after he found out that she was losing urine in bed.
She started to isolate herself from the other villagers, as she got wet very often and could not manage to change her sarong most of the time.
“I had a very bad smell, so I avoided meeting people. I am so depressed from living with this condition,” Ms. Eap said, as she lay on a hospital bed waiting for her first operation after 13 years living with an obstetric fistula. The operation was performed with assistance from the Children’s Surgical Centre and UNFPA, the United Nations Population Fund.
Overcoming barriers
After years of civil war and post-war hardship, Cambodia is still rebuilding its social services infrastructure, which was completely destroyed. Many people are struggling for survival and have inadequate access to health information and services, especially in the rural areas where roads and transport remain a challenge.
Many women still do not have maternal health care due to limited resources, and surgery to repair obstetric fistula only recently became available for a few. Women in rural areas living with fistula have had to rely on services provided by traditional healers or untrained providers.
Gender inequality is still rampant. Born in a culture where men have a higher social status, women enjoy less access to higher education and public services, and fewer opportunities for employment or involvement in politics. Women are expected to perform housework, and to take care of children, sick persons and elderly parents. As a consequence, many women neglect their own health condition and endure various burdens.
Poor women, especially, have little knowledge about conditions such as fistula. Their families’ small income from farming mainly goes to everyday basic needs, making health services women a luxury and opportunity to seek for better including fistula treatment.
“Besides doing housework I have a very old and sick mother to take care of every day,” says Met Yorm, 50. A resident of Trapean Veng Khang Lech village, 60 kilometres south of Kampot provincial town, she has been suffering from urine loss through a fistula for 20 years since the delivery of her fourth child, who was stillborn.
“I underwent two fistula treatment surgeries before my third surgery at the Children's Surgical Centre in mid-2011,” said Sam Ean, who suffered for 28 years with a vesico-vaginal fistula. She and her family had despaired after the unsuccessful interventions to repair her condition, and were reluctant to seek further treatment.
Initially, after developing the fistula, she was so depressed by unpleasant words from her community that she locked herself in the house for months. Over the years, she sought help from local healers suggested by friends, relatives and neighbours but never had good results. The healers all told her she had a lifelong condition that could not be treated, leaving Mrs. Ean despondent. “I didn't know where to go for treatment,” she said.
Enjoying a New Life
Once Cambodian women suffering from fistula receive treatment, the results seem miraculous. After years or even decades of suffering silently and wishing for a cure, they feel as if they and their families have been given new lives – a feeling of hope and confidence reflected in their peaceful smiles.
UNFPA Cambodia has partnered with the Children’s Surgical Centre for the past several years to help many poor rural women get free professional treatment services in a safe facility, according to national standards.
“I am so delighted, I cannot express how happy I am now,” said Ms. Ean, while telling her neighbours about the treatment the surgical centre and UNFPA provided in 2011 in Phnom Penh.
To raise awareness about fistula, the centre’s Smile Train outreach team goes out to meet with vulnerable women in target provinces and give information. “We inform health workers and village chiefs about our upcoming trips, and when we arrive we find that women are waiting to talks with us,” said Sam Sitha, coordinator of the outreach programme.
Mass media, particularly radio, has proved to be another effective way to reach beneficiaries, especially those living in remote areas where infrastructure and communication are still a challenge.
“After I heard about it on the radio, I talked to my husband and daughter. Then, I was brought to the centre,” said Ms. Sin. Other survivors interviewed also identified radio as the way they found out about the treatment service.
Since starting as a pilot project in four north-eastern Cambodian provinces (Ratanakiri, Mondulkiri, Preah Vihear and Stung Treng) where infrastructure and social services for women and girls have yet to be improved, the Children’s Surgical Centre has provided free fistula treatment services to almost 30 women, ending their silent suffering.
- UNFPA Cambodia
