There are no statistics on the number of people suffering from fistula because many of them conceal their illness and shy away from the public, a Ministry of Health official has said.Dr Anicet Nzabonimpa, the coordinator of Family Planning and HIV Integration Programme in the ministry of Health, said the situation needs more efforts to reverse the trend.Obstetric fistula is a severe medical condition in which a hole develops either in the rectum and vagina or between the bladder and the private parts after prolonged labour or poorly attended delivery, causing uncontrolled passing out of urine or faeces.Speaking during the International Day to end Obstetric Fistula in Kigali, yesterday, Dr Nzabonimpa said most of the people suffering from the disease do not want to talk about it, while others assume it cannot be treated."Most of those suffering from Fistula are poor people in rural areas. It’s even hard for them to go for treatment because they can’t easily use public means of transport because of their condition. If the fistula health site isn’t within their reach, then they ignore the disease,” Dr Nzabonimpa said.He said some of the patients who cannot access a health facility from a ‘walkable’ distance usually just ignore the disease.The doctor, however, said fistula sites are being scaled up across the country so that more patients can have easy access. More medics are also being trained in fistula repair and care, he added.Patients’ challenges Flotine Munganyika, 30, has recovered from Fistula. Her breakthrough came in 2011 after undergoing an operation at Mugonero Hospital in Karongi District. It all started during delivery of her second child in 2005, a caesarian section that did not go well, leaving her with fistula.Her husband abandoned her two months after the delivery upon realising that Munganyika was suffering from Fistula.She was faced with stigma and isolation from people in her community, including her own relatives. Most of the fistula patients are discriminated in communities and cannot easily access treatment in rural areas, Munganyika said.Dr Tekle G. Egiziabher, an obstetrician and gynaecologist at Rwanda Military Hospital, said fistula is a big public health issue in the country and is mostly caused by prolonged obstructed labour and a small pelvis.Dr Egiziabher, who specialises in treating and repairing fistula, said most of the prevailing challenges they face include inadequate obstetric and emergency fistula care, few skilled attendants and no accessibility to proper antental care for some.Since 2007 to 2012, Dr Egiziabher said he has done fistula repairs on 250 patients at the military hospital.Cheikh Fall, from the UN Population Fund, said since 2003, UNFPA has been carrying out worldwide campaign to eradicate obstetric fistula. "In Rwanda, the UN will continue to support government’s efforts to fully integrate services that are permanent for on-going, continuous and holistic care of obstetric fistula cases until we end entirely this preventable and treatable condition. UNFPA strategy is mainly based on prevention, treatment and re- integration,” Fall said. Like maternal mortality, fistula is almost entirely preventable, yet every day nearly 800 women die from complications of pregnancy. For every woman who dies, 20 or more are injured or disabled, UNFPA says.The woman is left with chronic incontinence and, in most cases, her baby is stillborn. Unable to control her flow of urine or faeces, she is often abandoned shunned by community.