​What kinds of symptoms do patients experience before receiving treatment?

Women with a vesicovaginal fistula experience urinary dysfunction. They may also experience infection and soreness. Women with a rectovaginal fistula experience excretory dysfunction. They may also experience recurrent vaginal or urinary tract infections, irritation, pain, and sexual difficulty.

​What is the impact on patients’ lives of living with these conditions?

This condition often leads to chronic medical problems, depression, social isolation, and deepening poverty. Fistula survivors are some of the most marginalized women in the world. They tend to live in extreme poverty in remote areas without the basic emergency care needed to treat an obstructed labor.

What cultural or regional factors affect the treatment of these conditions?

The 2011 Uganda Demographic Health Survey estimated that there are between 140,000 to 200,000 women living with a fistula in Uganda. Despite the large number of women with fistulas, social stigma often makes it difficult to identify them. Additionally, women who do not understand the causes of fistula or the possibility of repair may not seek treatment. Others may avoid health facilities altogether. Radio announcements, village health teams, and community leaders can help women come forward.

What does the treatment process look like?

After the patient arrives at the hospital, she will be admitted by the outpatient department. A clinical officer will review the patient’s file and refer her to a gynecologist for examination. The gynecologist will take the patient's history, examine the patient to determine the extent of the injury and damage, and order relevant tests. He or she will counsel the patient about the surgery and recovery. Surgery will be scheduled. On the day prior to surgery, the patient will be admitted to the hospital. Consent for surgery will be obtained. The patient will be taken to the theater at her scheduled time, and surgery will be performed. After surgery, the patient will be monitored every 30 minutes for four hours. She will stay in the hospital for approximately two weeks. She will receive counseling about the outcome of the surgery and what to expect from recovery.

What is the impact of this treatment on the patient’s life?

Undergoing a fistula repair surgery can completely change a woman’s life. She will rejoin her community and family and begin planning for her future.

What potential side effects or risks come with this treatment?

Sometimes, fistula surgeries are not successful. More complicated fistulas may require multiple attempts to repair. Other postoperative complications include hemorrhage, infection, anuria, wound breakdown, residual incontinence, hematometra, and urethral and vaginal strictures.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are approximately 18-20 medical facilities that can perform fistula surgery in Uganda. The nearest alternative to Bwindi Community Hospital is over a two-hour drive away on mountainous, dirt roads. Patients typically arrive at Bwindi Community Hospital by foot or motorcycle taxi.

What are the alternatives to this treatment?

There are no treatment alternatives.