Thousands of mothers in poorer parts of the world suffer from obstetric fistula and this is a serious problem in Tanzania as well where too many of them give birth without any medical help. The numbers are overwhelming. According to World Health Organisation (WHO), each year between 50,000 to 100,000 women worldwide are affected by obstetric fistula, an abnormal opening between a woman’s genital tract and her urinary tract or rectum. The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.
When the labour becomes obstructed, prolonged pains and broken body is what they endure, exposing them to uncontrolled leakage of bodily wastes. These women are often held back by stigma by their families and societies; they suffer constant incontinence, social segregation and other health problems.
It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.
Because of that, a lot of initiatives have been made to ensure that women who have this condition get the right medical assistance and for many years we have heard a number of successful stories from them.
However most of these stories are unique that’s why each year, Your Health gets a chance to hear what these women have gone through and how their lives have changed after treatment.
Your Health had an opportunity to talk to three women who have gone through pain, stigma, treatment, and how they have put everything behind them to look forward to a brighter future. Here are their testimonials.
Two decades of lost dignity
For 20 years, Yusta Mbeya was shunned by her family and community before her dignity and happiness as a woman and human being were restored for good. 45-year-old Yusta who comes from Ludewa district in Iringa, is one among the many women who endured pain and stigma in silence following the tragedy of suffering from obstetric fistula.
“It’s now over”, Yusta tells Your Health with a tone of relief. She adds, “I can finally go home and start a new chapter in life just like other women out there without any worry of wetting myself.”
Explaining how it all started, Yusta says her problems began in 1992 when she was pregnant with her first child, who is unfortunately no more.
“I remember I was taken to a nearby dispensary when I began labour pain. After a thorough check-up by the doctor, I and my husband were advised to go to a hospital because of complications for better medical care,” she recalls.
The doctors at the dispensary refused to attend to Yusta because they did not have the facilities to take proper care for Yusta’s delivery. But Yusta’s husband refused to take her to the hospital.
“I was at the dispensary for two days enduring labour pain before the water broke in the evening. But I could only push the baby out the next day – unfortunately the baby got stuck in the birth canal,” Yusta shares.
Yusta’s husband was forced to take her to the hospital urgently and that he should arrange for a car immediately. Upon reaching the hospital, Yusta was taken aback by what was written on the referral forms. “The nurses wrote that I was careless and that I refused to push the baby out.” Yusta was shocked but couldn’t fight back at that point.
She was taken to the theatre for a caesarean section operation but the child had died because of the prolonged obstructed labour. Yusta developed complications but she was unattended to for 14 days at the hospital.
She was then admitted to another referral hospital where she was operated the second time to remove the infected part and continued to receive treatment for four more months. It was too late for her, she was already a victim of obstetric fistula.
“My husband refused to stay and care for me because he kept telling me that he could no longer live with a woman who stinks and that I was of no use to him. I was saddened by what he had told me and I let him go on with his life because I knew he was tired living with me,” she explains.
If that was not enough, soon after she got her second operation, Yusta developed more complications which after her father managed to raise some money for yet another operation. She was diagnosed with severe infection in her stomach.
In 1998, she was finally able to raise some money for a fistula surgery that was only half successful. Though she was able to control the urine, the problem didn’t go away completely
In 2012, Yusta moved to Morogoro to try and begin a new life. She started a petty business there but she was still suffering in silence. In March this year, Yusta’s life changed completely when she heard about obstetric fistula surgery and treatment at the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), Dar es Salaam. Her operation was done successfully. As Your Health spoke to Yusta, she was also finalising her discharge paper, ready to go home to start a new lease of life.
Married at the age of 12
30-year-old Tatu Kaite is a mother of five who got married at the age of twelve. Soon after giving birth to her first child, Tatu developed the problem of obstetric fistula.
“I was still very young when I first got pregnant. I remember I had a very tough labour experience, which led to this problem and because of poverty I couldn’t do anything about the condition except to live with it,” the resident of Sumbawanga tells Your Health. She conceived and gave birth to four more children while suffering from fistula.
However the last pregnancy almost took her life. “ I had severe headaches, cough and fever and even after giving birth a year ago, things got worse. I began wetting the bed a lot more than I used to that led me to be bed ridden,” she says. To make the matter worse, Tatu’s husband always humiliated her saying that she smelt awful and that she should flee the house with her urine and children.
Enduring pain, shame and isolation for 15 years and more, Tatu put herself back up and decided to try and get the operation done this year. She was treated successfully and Tatu now lives a happy life. “I can’t wait to go back to my children,” Tatu tells Your Health with hope and confidence.
Secluded herself from everything and everyone
Safreda Kaswahili, 35, mother of five children went through a tough experience with her last pregnancy and it all started in November last year when she was about to give birth to her last born.
Safreda who comes from Runazi village in Kagera shares with Your Health, “I went to the dispensary at midnight after I began feeling the labour pains. The doctor told me that I would deliver by noon, but the nurses had a different opinion. I was informed that the baby has failed to come down to its position.”
Safreda was moved to the district hospital where she delivered a baby girl through C-section operation after hours of enduring labour. She was discharged three days later but after a month had passed, one day in the middle of the night, Safreda woke up finding her bed wet. She assumed it was one of the side effects of the operation and that things would get normal. “The condition continued for few days and I decided to wait for one more month before going to the hospital for check-up. I was diagnosed with obstetric fistula,” she tells. Safreda was advised to come to Dar es Salaam after three months for treatment.
She was taken aback by the news and decided to live a life of isolation. “I was sad and confused because it is something that I never expected to happen. I went to church and asked the pastors to pray for me believing that the problem would go away but nothing really changed.
I told my children not to wash my clothes anymore and I even told my husband not to sleep in the same bedroom with me because of the smell.
It was not easy to live a life of waking up every day seeing yourself wet the bed. I used to lie there in stink and tears. Three months seemed like years to me,” Safreda shares.
In February this year, when Safreda came to CCBRT, she saw that she was not the only one with the problem.
Talking to the victims and survivors, Safreda sensed hope. In that hope, Safreda was positive about the operation and it went successful.
“I am so happy and I look forward to go back home and be a voice for many other women with a similar problem like mine. I want to guide them to get the treatment on time so as to restore their dignity back,” Safreda explains.
What the experts say
Dr Peter Majinge , a fistula surgeon at the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) says an obstetric fistula is a big problem where there are 3,000 new cases each year in Tanzania and only 1500 cases get treatment annually, leaving a majority not able to get the treatment .
“This is a big problem that has spread across the country living no region spared . Treatment for fistula is free, however, it’s unfortunate that majority of these women lack awareness. The best thing we can do is to ensure that infrastructures are available.
This includes having qualified health personnel - at least one fistula surgeon trained and placed in every regional hospital so they will be more likely to help people from their community.
Filling these gaps will bring us a long way towards ensuring that every woman with fistula has access to high quality treatment,” says Dr Majinge.
According to him, for three consecutive years they have successful managed to perform 600 operations, something which makes them above average based on rates set by World Health Organisation.
Clement Ndahani is a Fistula program manager at CCBRT and according to him some of the regions that they have been receiving a lot of patients include Mtwara, Rukwa, Morogoro, Kagera, Dodoma, Mbeya, Tanga, Kigoma, Iringa and Tabora.
He says their intention is to see that these services reach out to patients in their respective region by training more doctors and nurses who will assist them.