Table of contentsSocio-economic challenges faced by fistula survivors after obstetric fistula surgerySocial challengesUnsuccessful repairEconomic challengesPost-repair interventionsSocioeconomic challenges faced by fistula survivors after obstetric fistula surgery A condition such as OF impacts the woman, the community and the family unit, and can have devastating effects. (Jarvis, 2017; Mselle et al., 2011). Only a few studies have examined the adverse social, economic, and psychological consequences of fistula; Nonetheless, these studies provide empirical evidence that treatment, counseling, social support, and rehabilitation can significantly improve the physical and mental health of affected women, and provide these women with a second chance to participate in family life. Thus, simple repair of a fistula is not a solution. the end of their challenges. The problems faced by women mainly fall into three categories: emotional and psychological trauma, social and economic difficulties, but this literature review will mainly focus on social and economic challenges. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”?Get the original essaySocial ChallengesErving Goffman (1963) defines stigma as “an attribute which deeply discredits.” His definition of stigma focuses on the public's attitude toward a person who possesses an attribute that does not meet society's expectations. The person possessing this attribute is "reduced in our minds from a whole and habitual person to a corrupt and demeaned person." From a public health perspective, stigma or discrimination is associated with worse health outcomes and is believed to be linked to reduced self-esteem and quality of life (Mselle, 2011). Among fistula patients, stigma manifests itself in a variety of ways, ranging from subtle to blatant discrimination. isolation, before and continues even after corrective surgery. It is even worse for those whose corrective surgery has failed. Obstetric survivors are labeled as having had an illness that left them imperfect and are therefore not fully accepted by their communities. Stigma is directed against women both by their families and by the community, which isolates them, subjects them to negative comments about their previous condition and, in some cases, does not allow them to participate in domestic, social and even economic (Khisa, 2016). . For example, in a study conducted by Khisa (2010), women reported that even if they were invited to social events like a wedding or community meeting, they were not allowed to help cook or serve the guests , even if they had healed. . Ultimately, survivors felt like the illness had left a permanent stigmatizing label. Even though they no longer leaked urine and stools, their outlook on the rest of the world had not changed. This treatment by the community or family members not only reduces the survivor to an inferior human being, hampering their chances of improving their life (Goffman (1963), but it also leaves them with a sense of diminished social worth. According to (Khisa, 2010; Mselle, 2011), after surgery, most survivors believe that their previous illness has reduced their chances of leading a normal social life Survivors are often embarrassed to enter into relationships with others.people, perhaps due to internalized stigma before surgery. For most, this is due to self-doubt that arises from the perception that if a person has had surgery, they are not normal. This kind of feeling often causes survivors to isolate themselves from other members of the community after surgery. As they avoid social events, their reintegration is very difficult because they have little or no activities to do with other members of the community. Failed repairs The biggest challenge for survivors of obstetric fistula is failed repairs. Even with a fistula closure success rate of 65-95%, there are cases where continence may not be achieved with successful fistula closure if the urethra is not functional or the continence mechanism has been compromised. destroyed. Up to a third of women experience persistent incontinence after surgery (Byamugisha, et al., 2015). Persistent urinary and/or fecal incontinence leads to continued social isolation and stigmatization of survivors as their situation has not changed. This leaves the survivor suffering as they did before the operation, making them feel cursed or blamed by the community and family members for not healing. (Khisa, 2010). Both parties expect that after the operation the woman will be cured, but as is the case when repair fails, it is usually the latter. Economic Challenges After Repair an OF, women are asked not to do heavy work. This threatens their ability to earn money, as work in rural areas, where most survivors live, requires manual labor. (Jarvis, et al., 2017). Most feel unable to re-engage in economic activities after reparations because they have been removed from the labor market for so long. In studies conducted in Ethiopia and Kenya on the challenges women face after fistula repair (Donnelly, et al., 2015; Khisa, 2010), women reported that they no longer had the strength or endurance necessary to carry out the work for which they were responsible. before the fistula. Many, especially those who were not married, lamented not being able to do more physically demanding work, which might deter potential employers from hiring them. This loss of income worsens the economic difficulties of survivors and threatens their already precarious livelihoods. Similarly, Women's Dignity and Engender Health (2008) and Ojanuga (1994) highlighted the economic challenges survivors faced after surgery. They examined the economic strain that obstetric fistula placed on a patient's family. They noted that income was lost through different mechanisms, starting with the direct cost of fistula care, time away from the farm, the survivor's inability to work due to stigma, health effects of fistula and the need for constant bathing or bathing. change clothes for those whose surgery has failed. All of these factors affected families because, as a result, one less person was working neither at home nor on the farm. This doubled the work of the rest of the family members, as they took on all the work that the survivor previously did, meaning they had to forgo income that the women might have previously contributed, reducing the family income. Due to widespread poverty, there is a strong and shared desire for women to become self-sufficient and improve their lives by contributing to household income. Even if theMen work to meet the main monetary expenses, women's work provides for the basic needs of the family. (Donnelly, 2015). Therefore, a woman's economic livelihood has implications not only for herself but also for her family's livelihood, as it is positively associated with well-being through increased expenditure on food at home and caring for their children. (Jarvis, et al., 2017) However, although women are highly motivated to increase their income by engaging in income-generating activities, they are severely limited by the lack of start-up capital or credit to create a business. business. Survivors felt that lack of economic autonomy was a potential barrier to full integration after surgery, as they found themselves dependent on their spouse and other family members. Being able to work and provide for your family is a source of pride and intrinsic self-esteem. When women were interviewed in two studies by Khisa (2010; 2016) in Kenya, most noted that when they returned home after surgery, they needed capital to buy food and provide for the needs of their children. The biggest worry when returning home for most was finding capital to take care of their children and family. Most said they did not expect their husbands to purchase care for every detail of their personal or family needs. It was therefore imperative that they find work or capital to start a business immediately after returning home. For each successful fistula operation, it is assumed that the patient will have a smooth reintegration into daily life; Unfortunately, these patients still face multiple challenges when they return home. Simply repairing a fistula is therefore not the end of their challenges. Understanding these challenges women face before and after fistula repair will help base the required intervention on clearly understood issues. Post-Repair Interventions (Engen, et al., 2016) defines rehabilitation interventions as planned, multidisciplinary measures or treatments designed to help users improve or maintain their level of functioning. Rehabilitation interventions are often complex and multidimensional and their effects can be influenced by individual processes and interactions between different elements of the interventions. (Whyte, et al., 2014). In the context of obstetric fistula, an intervention program must be able to address the physical, mental, social and economic harm that has been commonly inflicted on girls and women with obstetric fistula. (Mohammad, 2007). However, there is no clear definition of the term post-repair interventions as the term is defined in the program context. Thus, when talking about post-repair interventions in the context of obstetric fistula, two words: “rehabilitation” and “reintegration” are synonymous with the term post-repair intervention and are used interchangeably. Lombard (2015) defines rehabilitation and reintegration as any experience that contributes to improving the lives of women after obstetric fistula surgery, while Mselle (2012) defines reintegration as the process of helping women affected by obstetric fistula to return to the life they led before developing a fistula. . This includes how women adapt and reconnect to work, family,.