Women with obstetric fistula are prone to depression and post-traumatic stress disorder, researchers found.
A study conducted over the course of two years by the Duke Global Health Institute in conjunction with the Kilimanjaro Christian Medical Center found the rates of mental disorder among women with obstetric fistula to be uncommonly high. The results led the researchers to establish a workshop in Moshi, Tanzania that used the findings of the study to initiate discussion about how to better care for women with obstetric fistula.
Obstetric fistula is a hole in the birth canal, which can arise after a woman gives birth without proper medical care. A woman who has a fistula experiences uncontrollable leaking of urine or feces and emits a persistent bad odor, said Sarah Wilson, a DGHI doctoral scholar and a leading contributor in the study and a leader in the development of the workshop in Tanzania.
“There’s a synergy between the physical and psychological symptoms,” said Kathleen Sikkema, professor of psychology and neuroscience, global health, and psychiatry and behavioral sciences, and a collaborator in the study and workshop.
In addition to the physical effects caused by the condition, women suffering from obstetric fistula are faced with social stigma due to the smell they emit, which leads to self-isolation. The psychological effects of the condition lead to PTSD and depression, added Melissa Watt, DGHI assistant professor and another leading contributor to the study.
“[These women] no longer felt like a person,” Wilson said. “There’s a significant amount of shame and anxiety.”
Watt noted that obstetric fistula is prevalent in low-income countries, particularly countries in sub-Saharan Africa and Southeast Asia.
Poor socioeconomic class also contributes to the prevalence of obstetric fistula, Wilson added.
Data for the study came from surveys conducted when sufferers from the condition were in the hospital for treatment.
“We think that women come to the hospital with a whole host of difficult stresses in their lives, which has led us to believe that the time they are in the hospital can be a real moment of opportunity because it addresses their mental health needs in order to effectively serve these women and address their overall health,” Watts said.
Participants in the workshop were receptive to the ideas it presented, Wilson said. The workshop identified ways to help women cope with obstetric fistula.
“We see these patients, and we know that they are coming in with mental health concerns, and that there is really a need for special health providers,” Wilson said. “The kind of intervention would be something that would not require any special degree…. It can be someone who just works with patients and has basic skills of active listening and empathy.”