Hope in the remote Bangladesh

Ayesha Begum gave birth to her baby at Hope Hospital. PHOTO: DR TAREQ SALAHUDDIN

Cox's Bazar Women and Children's Hospital — a project of Hope Foundation serves the people living in remotest area of Bangladesh. In some specialised services like fistula operation, they provide tertiary care at free of cost which is even rare in some district level hospitals.

The Cox's Bazar Women and Children's Hospital, which is more known as Hope Hospital started service mainly in maternal and child care. With the support of some donor organisation, it provides with quality care in fistula operation for the women who suffer with their problem in silence.

During a prolong obstructed labour, the baby's head is constantly pushing against the mother's pelvic bone causing tissue to die due to lack of blood flow to this area. All of that pushing creates a hole (a fistula) between the birth passage and an internal organ such as the bladder or rectum. A woman cannot hold her urine, and sometimes bowel content as well. This is a miserable condition whose consequence cannot be described literarily.

A woman with fistula is usually rejected by her husband because of her inability to bear more children and her foul smell. She is shunned by her community and forced to live an isolated existence. These women suffer profound psychological trauma resulting from their utter loss of status and dignity, in addition to suffering constantly from their physical internal injury.

Repair of a fistula is time consuming; in most cases the surgery needs to be performed repeatedly to heal a case completely. Moreover, it requires specialised training and skill which are not adequately available in Bangladesh.

The Hope Hospital started fistula repair with the support from Fistula Foundation which now has expanded their services in many folds in different dimensions. The hospital now has a full time available fistula surgeon Dr. Nrinmoy Biswas who got training from Addis Ababa in Ethiopia.

All the fistula operations are done in the hospital at free of cost. They repaired fistula of a woman who suffered for 37 years with the disease. But people hardly know about the services provided in this hospital.

Not only the operation is free, the hospital organises campaigns during the surgery and provides free transport, food, follow up of the identified cases.

While most of the cases require more than one surgery, the hospital authority maintains research protocol and proper follow up of the cases.

In spite of all these services, it is not very easy to get fistula cases. Because, fistula patients are abandoned from their families and the society; they are deprived of support and care.

To encourage patients coming to get the facilities, the hospital organises meeting with the successful cases. These recovered cases further spread in the community and serve as ambassador to encourage the patients hiding their problems.

Apart from providing maternal, child and primary health care, they also treat burn cases, cleft lip or palate and provide many other services.

In recent years, the hospital has expanded their safe motherhood project to safe motherhood project plus, including some more components in the new protocol. They have included free ultrasonogram in four antenatal care and two post natal care to encourage more women to come to hospital. During the antenatal care, they provide with free iron supplementation and folic acid to the women.

The hospital is also running some other good initiatives like training other doctors in fistula repair surgery. Dr. Nrinmoy who is trained form abroad is now training other physicians. Doctors and medical students from abroad also get hands on training from the hospital in different times.

Whereas fistula operation is such so complicated, time consuming and expensive, the hospital is providing an awesome service to the poor people in the remote area. Dr Iftikhar Mahmood, who is the founder of the Hope Foundation said, "We need to spread the message to more people so that they can get the services. It will be particularly helpful for the poor people who otherwise could not afford the service."

E-mail: tareq.salahuddin@thedailystar.net