SHC directs health department to prevent incidence of obstetric fistula

The Sindh High Court (SHC) has directed the provincial health department to take all remedial measures in order to prevent the widespread incidence of obstetric fistula, a severe pregnancy related injury that afflicts hundreds of women in the province every year.

The SHC issued the directives to the health department in its recent judgment on a petition calling for the utilisation of funds for a national programme to control maternal deaths. Petitioners had approached court on account of failure by the health department for taking remedial measures in order to prevent the widespread incidence of obstetric fistula.

The high court, on a previous hearing, had directed the health secretary and other stakeholders to formulate a policy for dealing with the subject and its implementation in the larger public interest. The SHC was informed that a meeting was convened with the objectives to start treatment of vesico-vaginal fistula (VVF) in another hospital of Sindh to lessen the burden from the treatment centre of Khohi Goth, Karachi.

A health department official informed the court that the Maternal and Newborn Child Health (MNCH) Programme of the department was allocated a sum of Rs11.76 million in PC-I which had been approved. According to the programme, 50 per cent of the allocated amount had been released and from the said amount VVF treatment (medical/surgical) centres were to be established at Liaquat University Hospital (LUH), Hyderabad/Jamshoro, Peoples Medical College Hospital, Nawabshah, Ghulam Muhammad Mahar Medical College Hospital, Sukkur and Chandka Medical College, Larkana. The Jinnah Postgraduate Medical Centre, Karachi was already dealing with the cases of VVF in its centres, the court was informed.

It had also been discussed in the meeting that all the centres were ready to deal with the VVF cases but they required some new equipment in operation theatres such as ureteric catheter, OT table and cystoscopy tools.

The health department assured the SHC that a list of doctors who were doing specialisation in fistula repair would be obtained from the college of Physicians and Surgeons Pakistan who would be engaged for the treatment of the complication.

An SHC’s division bench, headed by Justice Mohammad Ali Mazhar, observed that it seemed certain efforts had been made by the health department with serious concern to make proper arrangements to deal with the cases of VVF and funds in this regard had already been approved and released.

Regarding the appointments of gynaecologists and specialist doctors in various government-run hospitals against the vacant posts, the health department officials informed the SHC that the Sindh Public Service Commission had started interviews for appointments of specialist doctors, including gynaecologists, and immediately after the interviews and selection of the new doctors and gynaecologists, the health department shall depute reasonable strength in different hospitals so that VVF cases may be dealt properly within a reasonable time.

The high court observed that the petitioners’ counsel was satisfied with the efforts made by the health department pursuant to the orders passed by the court from time to time.

The SHC disposed of the petition with directions to the health department to implement all remedial measures as decided in their minutes of meeting and directed by the court within a period of three months and submit a compliance report through the advocate general Sindh. The court observed that in case the petitioners found out any deficiency, non-interest or non-implementation of directions of the court, an application could be moved in for the resurrection of the petition disposed of.

The petitioners, including Dr Shershah Syed, had said that around 5,000 women die during pregnancy in Sindh every year because of a lack of healthcare facilities in rural areas. They said there was a shortage of medical care facilities as well as trained staff to attend to the expecting mothers and handle deliveries.

According to the petitioners, the government had launched the MNCH Programme many years ago; however, the funds allocated for the programme were never utilised. More than 1,500 fistula patients hailed from the province where a majority of government hospitals did not provide fistula repair surgeries, they said, requesting the court to hold the government accountable for the lack of timely and adequate treatment and violation of women’s rights to life and dignity as per the constitution.

Obstetric fistula is a tear that develops between the birth canal and bladder or rectum usually during a prolonged labour or difficult delivery, and causes the uncontrolled leakage of urine or faeces or both. The petitioners asked that the authorities be told to ensure access to affordable treatment of obstetric fistula to all women in Sindh. They said the government should ensure that at least one qualified gynaecologist in every district was trained and equipped to provide fistula repair surgery.