"I was scared and did not understand what was going on", says 28 year-old Basgul, a Family Health Action Group member in Sangan, one of the most remote villages in Daikundi province.
Two years ago she developed an obstetric fistula during the delivery of a stillborn baby that lasted three days. After a repair surgery at Malalai Maternity Hospital in Kabul she picked up her life again and now she uses her experience to give lifesaving advice on maternal health to other women in her community.
During her pregnancy, Basgul did not receive any antenatal care. She delivered at home guided by her female family members as the custom prescribes in her village. The labor was obstructed and she struggled for three days to give birth. "It was my sister who eventually took the baby out", she recalls.
When Basgul regained consciousness after several days, she noticed her bed was completely wet. The prolonged labor had been very painful and she had developed a fistula in her bladder that made her incontinent. "I was very scared. I did not understand what was happening to me because I never heard of something like that before", explains Basgul.
The following months were difficult for her. "I got used to hiding. I didn't want to be seen by my family nor the neighbors who came to visit me. I was too embarrassed to be around anybody because I was continuously leaking urine. I smelled and my clothes were constantly soaked. I could not attend weddings or funerals. I felt like I had lost my social life," explains. When her mother discovered Basgul's condition, she took her to the only hospital in the capital of Miramor district.
One of the midwives at the health center told her about Malalai Hospital's Fistula Ward in Kabul, the only facility in the country where obstetric fistula can be treated thanks to the support of the United Nations Population Fund, UNFPA. Since she didn't have the money to travel to Kabul, the midwife lent it to her and scheduled a repair surgery for her in the following months. The operation was successful and Basgul recovered from fistula, something that she could have never dreamed of.
Recovering from this childbirth injury gave Basgul the strength to share her experience with other women, being eventually selected to be part of the Family Health Action Group in her village.
The Family Health Action Group is part of the Family Health Houses project supported by UNFPA, Canada and Italy in several provinces across Afghanistan to bring reproductive and maternal health care to the most remote communities in the country.
Family Health Houses
The Family Health Houses are community-based health structures serving 1,500-4,000 people and staffed by a trained community midwife recruited from the local population who provides reproductive, maternal, new-born, and child health services.
The Family Health Houses are intended as sustainable community-led initiatives, where candidates for community midwives are nominated and supported by residents, who also bear a third of the costs. The community midwives receive 26 months of training and are supported by male and female volunteer community health workers who provide health information and public awareness activities to their counterparts in the community; treat some basic illnesses; and refer patients and clients to Family Health Houses and high-level health facilities.
The community midwife works with the community and family decision makers to ensure that women receive preventive care services. Midwives are supported by women and men from the community, such as Basgul.
Being part of the Community Action Group gave Basgul the opportunity to join the Maternal Health Program organized by MOVE, a UNFPA counterpart in Daikundi province through funding from the Government of Canada.
Through this programme, she was trained to inform and support women about ante-natal care, postpartum care, newborn care, breastfeeding, family planning, hygiene and sanitation. She also pays home visits, informs her community during vaccination campaigns, and advises about the importance of delivering in a health facility.
"I learned how to stand in front of women, how to speak to them and, more importantly, I learned what exactly fistula is and why it happens. I am now able to explain the risks of delivering at home and why every woman should seek care during pregnancy so they won't experience what I did," explains Basgul.
Basgul is happy to be part of this project. She realizes that people listens to her and that her words make change happen. She personally followed and advised three pregnant women in the village of Asghar-Abad, and all of them delivered at Sangan's Family Health House. "I believe they decided to do so because of the knowledge I shared with them," says Basgul with a smile.
