New lease of life for obstetric fistula survivors
Lilian Kaivilu @liliankaivilu
When Maximila Akola gave birth to her last-born child in 1992, she had hoped to continue the list. It was her third born and nothing was alarming about her reproductive health.
“Although I had experienced a complication with my first born, I was still hopeful that all would be well,” she says.
But the mother of three would be diagnosed with obstetric fistula after delivery. “I delivered comfortably, but after a few days, I started leaking urine.
I went back to the Bungoma General Hospital where I delivered, but the condition was not fixed,” she tells People Daily.
For 27 years, Akola learnt to live with the condition while doing small businesses. She operated a grocery shop where she sold cereals. “I learnt to manage the situation so as to go on with my daily activities at home,” she says.
Although she is now healed after undergoing treatment in 2019, Akola, 58, says she experiences frequent backpains, especially when she does menial jobs.
She urges other women living with the condition to seek medical attention before the condition worsens.
Akola now exits the list of more than two million women in sub-Saharan Africa, Asia, the Arab region, Latin America and the Caribbean who are living with this condition. According to the World Health Organisation (WHO), about 50,000 to 100,000 new cases of obstetric fistula are reported every year.
In order to prevent the condition, WHO recommends cessation of harmful traditional practices such as Female Genital Mutilation (FGM), delaying of the age of first pregnancy and timely access to obstetric care.
Dr Hilary Mabeya is the lead surgeon at Gynocare Women’s and Fistula Hospital. He says women from poor homes, and especially those with limited access to hospital emergency services, are at a higher risk of obstetric fistula disease.
“Most of these women lack timely access to proper healthcare services. As a result, they experience prolonged labour,” he says.
According to Mabeya, a simple fistula repair can cost up to Sh80,000 while a complex one can cost up to Sh150,000. The latter, he says, is even more complex because only few gynecologists can repair it.
“The extreme one is when the bladder is completely injured and the patient requires urine diversion.
This involves creation of a new bladder using intestines or the appendix. This requires more days in the hospital and advanced techniques,” says Dr Mabeya.
The greatest achievement so far in the treatment of fistula in the country, he says, is awareness that fistula is treatable and availability of surgical centres in different parts of the country.
But Covid-19 poses a threat on such gains, with many mothers opting to give birth at home as a result of the night curfew restricting movements at night.
About 100 women have been delivered at the Gynocare Women’s and Fistula Hospital since March, this year. Out of these, about 15 per cent have experienced prolonged labour.
This, according to Mabeya, was due to fear by mothers to come to the facility at night.
Alice Masai, 50, is a mother of one. For 29 years, she lived in despair and couldn’t engage in most social activities due to her condition.
It all started at the age of 18 after undergoing a caesarian section. Masai had experienced prolonged labour and as a result suffered obstetric fistula.
She underwent repair at the Webuye Referral Hospital in 2019, after hearing of the fistula repair campaign via radio.
Although she worked as a grocer, she admits that many customers would shun her products.
“But I am happy because I can now freely interact with people,” she says.
In order to address cases of fistula in her county, Bungoma County First Lady Caroline Wangamati has held two obstetric fistula repair camps in 2018 and 2019 in partnership with Amref Health Africa. In 2018, 33 women underwent the repair while in 2019, 44 women were treated.
“Our highlight case was an 81-year-old woman who had lived with vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) for 23 years. She was successfully treated,” she says.
The fistula repair camps targeted four sub-counties of Tongaren, Sirisia, Bumula and Mt Elgon, with screening centres at Naitiri, Kapsokwony and Cheptais.
According to Wangamati, the targeting of these underserved areas was that the other parts of the county could access these services at the Webuye County Hospital.
An ardent champion of maternal health, Wangamati says her dream is to see women access healthcare services at the convenience of their homes.
“I don’t want a woman from Bungoma to travel miles to get a fistula repair. I want them to be treated at the comfort and convenience of their homes.
This has, and will continue to give them more confidence to access healthcare.”
She adds: “I hate seeing a human being in such indignity. I wanted to use my voice to give dignity to women living with fistula.”
This year’s camp that was scheduled for April, was halted due to the restriction of movements and gatherings in the wake of the coronavirus disease.
According to Bramwel Msambaki, the principal nursing hospital in charge at Webuye County Hospital, women with contracted pelvis are at a high risk of obstetric fistula.
“Such people may experience prolonged labour hence causing fistula. Also, a mother can have a normal pelvis, but be carrying a big baby.
If such a mother goes through normal delivery, then fistula could occur,” he adds.
At the hospital, Msambaki says the treatment for fistula is covered by the Linda Mama medical cover. He, however, says due to stigma, walk-in patients are not common.