Lilongwe, Malawi - Every day she walks into the Fistula repair centre at Bwaila Hospital in Lilongwe with delight and hope to restore women’s dignity through Obstetric Fistula repairing. It is the job she had chosen and made a decision more than 10 years ago having been inspired by another passionate surgeon.

“I felt sad to see fistula patients turned back because of the workload that one surgeon could handle was just too much; I then decided to join this profession to help restore women’s dignity” explains Dr. Enette Chipungu, the fistula repair surgeon at Bwaila Hospital Fistula centre in Lilongwe.

Dr Enette Chipungu aged 39, works for the Malawi Fistula Foundation programme at Bwaila Obstetric Fistula centre.  As a student at Malawi College of Medicine in 2002, she used to assist the only surgeon Dr Ryken, who was managing fistula cases back then. Over time, she developed passion for this profession and eventually she decided to specialize in Obstetrics and Gynaecology in 2007 at the University of Cape Town in South Africa.

Along in developing and sharpening her skills, she would go and learn from an experienced clinical officer, Alex Sembo who has done Obstetric Fistula repairs for many years in Malawi.
At one time, she was invited to a launch of the Obstetric fistula unit in 2012 as an ordinary guest; this is when her interest towards the subject started to develop further and she made a commitment to pursue her dream.

Her presence Bwaila Obstetric Fistula centre is a great relief in as far as providing routine Obstetric Fistula repairs is concerned. In the past fistula cases were only managed through camps and this posed a challenge as there were many cases to be repaired within a specified period.

From her recollection so far, she has repaired over 800 cases with 700 of them from Malawi and over 100 from other countries like Madagascar, Sierra Leone and Kenya.
Her job as a Fistula surgeon gives her immense joy as she is able to see the smile put on women’s faces after they are healed.

“It’s a life changing career and I am delighted with the work I do,” she explains.

The Bwaila Hospital Fistula centre in Lilongwe has a rehabilitation and empowerment component. Women that have been repaired are counselled on how they can re-integrate into the society.

It also involves teaching the repaired women skills in crafts-making among others so that when the patients go back home, they are empowered and motivated to support themselves. They are also provided with a small amount of business capital to run various small scale businesses.

UNFPA support to the centre

Dr. Chipungu explains that as a unit it is difficult to get some resources to procure even some of the medical supplies such as sutures- as the programme is mainly dependent on donor aid. “For instance the unit only has two repair fistula sets which were procured with support from UNFPA” she said.

UNFPA programme office responsible for Obstetric Fistula, Grace Hiwa acknowledges that the centre has brought so much relief in many women in Malawi. Through the support from UNFPA, Dr. Chipungu has been able to train other local medical doctors and clinicians in repairing Obstetric Fistula as well as improving her own expertise through linkages with other professionals outside Malawi.

“We have invested in her through trainings outside Malawi and also linking her with other consultant surgeons and we are happy she has been able to transfer such skills to other Malawian clinicians and doctors” said Grace Hiwa

Dr. Chipungu however, observes that it is sad to see the majority of cases coming to the centre are fresh fistula cases caused by prolonged labour and calls upon more efforts to be done on prevention.

Look to the Future

Dr Chipungu believes there is a lot of potential to eliminate Obstetric fistula in Malawi such that if more resources, both human and financial, to support obstetric fistula repair programmes, cases can significantly be minimized if not eliminated.

From 2011, Freedom from fistula Foundation and Amref joined UNFPA in to support the Government of Malawi on Obstetric fistula treatment in Lilongwe and Mangochi respectively. UNFPA also support the Bwaila Obstetric Fistula centre in Lilongwe with medical supplies and specialists to assist in the repairing of fistula cases.
Most clients are mobilized through media campaigns and community awareness where traditional leaders and fistula survivors act as advocates by taking the successful news to other patients.

Leticia Nangwale