CHRONIQUE DU Dr Cheick Atab BADJI
Donner la vie en perdant la vie tout en restant en vie…, telle pourrait être résumée la vie cauchemardesque de ces braves femmes dites fistuleuses. La fistule obstétricale reste un bon baromètre de la fidélité sans faille du couple mais aussi le miroir de toute l’hypocrisie et de l’ingratitude de notre société. L’engagement de la gent maritale autour de cette épreuve noble de la vie de couple, la naissance, s’est avéré être que pour le meilleur et le pire des meilleurs. Point pour le pire. Encore moins pour le pire des pires ; ce qu’est justement la fistule obstétricale.
QUE CACHE LE BASSIN DE LA FEMME
Dans le bassin de la femme, trois organes vivent en bon voisinage, le sac réservoir des urines, appelé la VESSIE, derrière laquelle se présente le sac porteur du bébé en cas de grossesse et des règles qu’on appelle l’UTERUS et qui se prolonge en bas par le VAGIN, et enfin, tout à fait en arrière, vient le sac réservoir des matières fécales qu’on appelle le RECTUM. Ces trois colocataires du petit bassin ou pelvis sont indépendants les uns des autres et dépendent chacun d’un système diffèrent, appelé système urinaire pour la vessie, système génital pour le vagin et système digestif pour le rectum. Ils sont juste voisins mais « ne se fréquentent pas et ne commercent pas », chacun évacuant vers l’extérieur des produits ou déchets par sa propre voie et porte de sortie. La vessie évacue les urines par l’urètre, le vagin par la vulve et le rectum évacue les matières fécales par le canal anal.
QU’EST CE QU’EST LA FISTULE OBSTETRICALE:
Le terme « obstétrical » renvoie à la grossesse et à l’accouchement. Par conséquent la fistule obstétricale c’est la survenue accidentelle, des suites d’un accouchement difficile, d’un « trou de communication » entre deux de ces différents organes, soit entre la vessie et le vagin( on parle de fistule vésico-vaginale), soit entre le vagin et le rectum (on parle de fistule recto-vaginale).
MANIFESTATIONS DE LA FISTULE ET CONSEQUENCES SOCIALES
En cas de fistule vésico-vaginale ou de fistule recto-vaginale, la femme présente respectivement un écoulement d’urines ou de matières fécales par le vagin. Ainsi, de ses parties intimes s’échappe cette forte odeur ammoniacale ou fécale, qui affecte ses relations avec son entourage familial immédiat et social. Se pose également la problématique des devoirs religieux où urines et produits fécales sont souillures. Et la brave mère est vue comme source d’impuretés dans certaines sociétés, poussant ainsi le cynisme jusqu’au rejet systématique de tous ses services domestiques.
Le conjoint prend la poudre d’escampette dès les premières gouttes en criant à la sorcière et déserte le lit conjugal, si ce n’est pas tout simplement la jeune mère qui est évacuée manu militari chez les siens où le risque de marginalisation n’est guère moindre. Bref, il ne s’agit non pas d’une mort clinique mais d’une véritable scène de mise à mort sociale d’une héroïne de la naissance.
QU’EST CE QUI EN EST LA CAUSE ?
Comme son nom l’indique, la fistule obstétricale est causée par un accouchement par voie basse difficile. Il s’agit généralement d’accouchement forcé, lié soit à la petitesse du bassin de la femme soit au poids important du bébé entrainant une compression anormalement prolongée des organes de voisinage ci-dessus évoqués. Conséquence, il s’installe une fragilisation des tissus et apparition secondaire de « trou » anormal de communication avec déviation des produits et déchets vers le vagin.
Ainsi la fistule obstétricale est souvent la conséquence d’une absence d’assistance ou d’une mauvaise surveillance d’un accouchement dont la parturiente aurait dû bénéficier d’une césarienne. Déjà ici se pose tout le danger qu’encourent toutes ces femmes qui veulent accoucher par voie basse coute que coute au mépris des conseils de l’homme de l’art. C’est aussi souligner tout le manque de responsabilité lié à la diabolisation de la césarienne qui serait présentée comme un danger dans une approche de désinformation et de « peopolisation » d’une question aussi sérieuse. De vie ou de mort.
COMMENT VAINCRE LES FISTULES ?
La victoire sur les fistules, ce n’est pas de traiter toutes les fistules. C’est plutôt qu’il n’en ait plus jamais. Pour ce faire, il suffit de définir et mettre en œuvre de véritables politiques de santé reproductive qui ne vont simplement se focaliser surtout sur l’offre contraceptive mais davantage sur l’offre de soins de chirurgie obstétricale disponible à proximité des lointaines communautés. Chimérique, … si des régions entières ne disposent que d’un ou de deux gynécologues obstétriciens et que des femmes dans la douleur faillent faire des kilomètres avec des moyens de locomotion de fortune et contre plein d’intempéries pour accès aux soins adéquats. Le rêve est tout de même permis, mais d’ici là c’est plutôt le cauchemar d’une longue nuit noire de maternité pour ces femmes rurales qui ont eu le seul tort de se consacrer à leur devoir biologique : enfanter.
Dr Cheick Atab BADJI
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