One of the most heart breaking conditions that thousands of women in Tanzania face every year is suffering from fistula.
Obstetric fistula is a serious problem, especially affecting the marginalised and poor where too many women give birth without any medical assistance or do not reach to hospitals on time.
This causes an obstructed labour, where a woman endures long hours of painful labour.
Meet Jesca Ntalami, 28, whose baby did not survive but her body was literally broken during birth. Her uncontrollable leaking exposed her to being shunned by her own husband, family and community but she did not lose faith in getting the right treatment.
As she narrates her story to Your Health, the resident of Jaribu village in Rufiji district was living in deep hole of stigma for the past three years before she received treatment.
Jesca’s traumatic journey
“My pregnancy was full of challenges from day one up to the third trimester. I was not only anaemic but I couldn’t eat well, and at the same time, I was going through backaches which hindered me from farming,” begins Jesca.
When her labour pains began, she was all alone at home that evening and unfortunately it was pouring heavily.
She tried to reach her husband who was in Mwanza for business purposes, but availed no response. Her mother who lives in a neighbouring village was also out of reach.
As she was thinking on the way forward, her phone went out of charge, which paralysed her communication.
The rain took about four hours to stop till she could step out to seek for help. One of her neighbours assisted her to the hospital. But the journey wasn’t easy.
Jesca walked for an hour before getting hold of a bodaboda (local transport on two wheelers) to take her to the hospital.
Upon arriving to the hospital, the situation was worse. “There was only one attendant who was taking care of all the patients in the hospital including pregnant women in the labour room which had only two beds,” recalls Jesca.
Jesca, who was in terrible pain, was attended after an hour. “I was in labour for more than ten hours and when it was time to push the baby, I couldn’t do it as the baby was too big and hence was advised to go for a caesarean,” says Jesca.
Though the nurse did everything she could to save Jesca’s baby’s life, it was too late. Her baby did not survive and left her perineum teared. “I lost my child and developed fistula,” Jesca couldn’t hold the words.
Jesca couldn’t control both urine and faeces after developing the condition of fistula. Just like other women and girls who endure this condition, Jesca was no stranger to misfortune.
Two weeks later when her husband got back from Mwanza, he found Jesca with the condtion. “My husband only left me money to support my treatment and went back to Mwanza where he hasn’t called and visited till date,” Jesca says.
At the local hospital, Jesca was told that fistula is treatable but for that she would have to travel to Dar es Salaam.
With the support from her parents, it took about two months for them to raise the money for Jesca’s travels. They travelled to Dar es Salaam where her treatment began immediately.
The heart-breaking condition
The hole in the birth canal caused by prolonged labour, just like Jesca’s case, is preventable but yet it occurs in large numbers.
Dr James Chapa, a fistula surgeon at the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), where Jesca is currently receiving treatment, explains to Your Health the occurence of fistula.
He says that fistula is caused by unattended, prolonged and obstructed labour associated with delays in seeking and receiving appropriate and adequate birth care.
Statistics from CCBRT shows that, for every woman who dies, 20 or more are injured or disabled. One of the most serious injuries of childbearing is obstetric fistula. It is estimated that more than 2 million women and girls live with the condition globally.
Tanzania records 3000 new cases each year, but only 1500 cases are treated. This makes a total of 1500 unattended patients every year.
Responding to such an increase in the number of fistula cases among the marginalised women and girls, Dr Hashina Begum, the United Nations Population Fund (UNFPA) representative says that, UNFPA and its partners launched the global ‘Campaign to End Fistula’ in 2003 that aims at reducing the ongoing maternal death and injury.
The campaign works in more than 50 countries across Africa, Asia, Latin America and Arab region to prevent and treat fistula, to rehabilitate and empower fistula survivors.
Over the past 13 years, UNFPA has directly supported more than 85,000 surgical repairs for women and girls, while partner agencies have supported thousands more.
“Many women and girls who suffer from fistula are excluded from daily community life and often abandoned by their husbands and families, isolating them socially and emotionally, making it also difficult to maintain a source of income or support, thus deepening their poverty and magnifying their suffering,” she says.
Ending fistula is a high priority for UNFPA. Working with our partners in the Campaign to End Fistula, we have made progress towards eliminating fistula through prevention, treatment and social reintegration, she adds.
Dr Chapa says that, in East Africa, Rwanda records very few new cases in a year, that is 415 new cases. Kenya also has 3,000 new cases every year. Uganda has 1,900, while Burundi has between 1000 – 2000 cases.
Dr Chapa adds that in overcoming new cases of fistula, women should avoid early childhood marriages, they should go for family planning, they should deliver babies at a well-equipped health centre and a well-balanced diet should be made available during the growing stages of the girl child.
With Jesca’s case, she has successfully completed her first surgery and is currently waiting for the second one. “After my first surgery, I have already witnessed some improvements, for example, the frequency of uncontrolled urination has reduced to a greater extent,” Jesca says.
As Jesca looks forward to her second surgery, she already feels and looks confident.