Dr Homa Dost, women's health in Afghanistan

Fistula is a condition that shatters women’s lives, leaving them ashamed, suffering and often ostracised from their family and society. It sadly affects an estimated two million women in some 55 low resource countries of Sub-Saharan Africa and South Asia; with up to 100,000 additional women tragically developing a fistula every year in some of the world’s poorest and most disadvantaged communities.

This year, on International Day to End Obstetric Fistula, FIGO spoke with another of our FIGO Fellows to hear about women’s health in their country, and the importance of investment in addressing this devastating condition.

Dr. Homa Dost is a FIGO Fistula Fellow from Afghanistan. She graduated CURE International Hospital’s eighteen month OBGYN fellowship program in Kabul, following which, in 2013, she was chosen to undergo a further two years of training in obstetric fistula surgery in CURE International’s Obstetric Fistula program in Kabul.

Since this training Dr. Dost has undergone additional specialised  training in fistula surgery on the  FIGO Programme in the world-famous Hamlin Fistula Centre in Addis Ababa Ethiopia, using the FIGO training manual. In 2017 she took part in a second FIGO training period; again at Hamlin Fistula Ethiopia to not only enhance her skills and knowledge to Advanced Level, but also to upgrade her entire program in Kabul.

“I am so lucky to have had this training; I really feel that training made me strong.

Motherhood is more difficult in Afghanistan than in other parts of the world. We have to do something about this. Childbirth should be a joyful occasion but for these poor women it is a nightmare and horror, child birth at a young age, lack of access to health facilities, difficult road and transport, poverty and the lack of midwives are the main cause.

As a result, most women deliver at home where they have to suffer several days’ labor pain with nobody to assist or to help to relieve the pain. Sadly, finally they deliver a stillborn baby and experience the awful consequences of obstetric fistula which leads to incontinence of urine or faeces.

These injuries are preventable, lack of opportunity to undertake education is a key point. We need to train some midwives from the villages and then send back them to work in the communities, but it is not an easy job.

Women’s health and the education system can only be improved with the help of government, but it is not likely to happen in the near future because of severe war and security concerns in my country, although we are not losing hopes of trying to have it.

It is a pleasure for us to do this work on fistula, these women are young and beautiful, they a have right to be happy. When they are coming to the hospital they feel like they have lost everything in the world, except their faith and hope in us, this surgery offers them a second chance at life.

I want to thank FIGO for helping me reach my potential; you provide this opportunity for us to learn the skills of fistula surgery to help our poor and injured women that suffer from this problem, and also special thanks for my trainer Dr. Fekade and the Hamlin team. This training has helped me a lot; I really appreciate their help and this opportunity”.

Sadly, fistula is a neglected public health and human rights issue. For every woman who receives treatment for her fistula, at least 50 more go without because of a global shortage of trained, skilled fistula surgeons like Dr Dost. This means that there is a huge unmet need to treat and repair the backlog of women with obstetric fistula.

It’s time that obstetric fistula is brought back to the forefront of global conversation. Ask your leaders to invest in training the next generation of more fistula surgeons in low resource countries through collaborative partnerships.

It’s time to end Obstetric Fistula and to ensure that no woman is left behind.