Enduring a harmful cut: when ‘no hope’ is Joyce’s only choice

Seated on a plastic chair in single-room  house at Mandu, Igoma ward, Nyamagana district in Mwanza region with her mother, Joyce Amos has not known happiness since 2012.

The 18-year-old, who battles fistula, has to contend with all manner of public ridicule. A person suffering from the condition has no control of the bowels.

“I do not know what happiness entails. I am not able to travel long distances and unfortunately whenever I sit near people, they move away claiming that they cannot stand my condition,” says Joyce.

According to Dr Thomas Nyakoba, an obstetrician at Bugando Medical Center, the most direct consequence of an obstetric fistula is the constant leaking of urine, faeces, and blood as a result of a hole that forms between the vagina and bladder or rectum.

This leaking has both physical and societal consequences. The acid in the urine, faeces, and blood causes severe burn wounds on the legs from the continuous dripping.

Nerve damage that can result from the leaking can cause women to struggle with walking and eventually lose mobility, says the medic.

The painful life as a teenager

Joyce, the resident of Machochwe village, Mugumu, Mara region, has been doing casual jobs like digging and fetching firewood for people in the village to earn a living. She was forcefully pulled out of school in July 2012.

At the age of 13, in 2012, Joyce was also forced to marry a man much older than her, whom, according to her, is illiterate and knows very little about her health and the living standard in general.

She narrates further about her misery, saying that in December 2012, she got mutilated in her genital area by force, a situation that she says affected her psychologically.

“My father organised for the circumcision since it had not been prohibited by then. they used a knife to cut me,” she recalls.

Joyce’s father deems her ‘useless’ in the society because of her disability. Joyce is crippled. And in most cases, she says she was a neglected child. The young lady, the third-born in a family of nine is crippled on her right leg.

Her current condition worsened after giving birth at Mugumu dispensary in Serengeti in December last year, but something else added to her misery—she gave birth to a baby girl who died a few hours later.

According to doctors, the child died because the mother’s bones were too narrow and the doctors avoided performing a caesarean surgery as her health situation did not allow.

Childlessness still haunts the Standard Five drop-out. A section of the Kuria community where she comes from, refer to her as a “cursed woman.”

For decades, the government and stakeholders have been working to eliminate Female Genital Mutilation (FGM) but the issue has continued to thrive in Tanzania, putting women’s health and lives at risk.

However, the number of girls reported to have undergone FGM in 2016 in Serengeti District has dropped by 60 per cent, according to the current FGM Elimination Project in Serengeti District, titled “Tokomeza Ukeketaji” funded by Amref Health Africa in partnership with UN- Women-UNTF.

Findings show that only 5,621 (39.8 per cent) girls were reported compared to 14,122 girls in 2014.

Data obtained from the program further shows that over 762 (13.5 per cent) out of 5621 girls who were interviewed, reported to openly denounce the FGM practices despite the parents and relatives’ commands.

At least 2,313 (41.1 per cent) out of 5, 621 girls who are reported to be cut, are mostly residing in the neighboring district (Tarime) or else in their households. Researchers say the cuts were done during midnight in which at least six girls died as a result of cuts in the district.

Did Joyce get through?

After experiencing a lot of health complications during circumcision back in 2012, she never attempted to tell anyone about the issue. She assumed it was a normal situation—and a ritual that would come to pass.

“Because I limp and had no courage to inquire about how it goes, I did not bother to ask but I had severe and prolonged pains in my private parts after circumcision,” she recalls.

When she was referred to Tarime District Hospital, health workers had to send her to Bugando Medical Center (BMC) at Mwanza for more health attention.

On her arrival at BMC early this year, she was diagnosed and admitted due to what doctors described as Infected Unrepaired Episiotomy. At that time, they said, she could not be treated because the wound had swollen.

“I was told to be back home until March 20th this year, when the wound have recovered. The wound had occurred due to rupture during delivery,” she narrates.

She tells Your Health that her genital areas had some swollen wounds from circumcision which had never recovered. She had to endure childbirth with the wounds.

Joyce waited at her relative’s home in Mwanza until March 20 where she went back Bugando for reconstructive surgery but she could not undergo the procedure because her clinical condition was not yet stable enough.

“I was given some drugs and directed to go back again in August this year for checkup, I still go through lots of pain with no alternative,” adds Joyce.

At BMC she was told that after a certain number of days, she would undergo a procedure where a tube would be introduced into her urinary pathway in order to reduce the frequency of going to the toilet.

Living with health complications

Walking from one point to another becomes hectic for her. She cannot do it easily. The better way for her is just to lay in her bed most of the time.

She avoids taking many fluids because doing so would mean that she visits the toilet most of the time.

But Dr Thomas Nyakoba warns about the consequence of Joyce’s decision to limit taking fluids.

He tells Your Health that in an attempt to avoid the dripping; women limit their intake of fluids which can ultimately lead to dehydration.

When that happens, she says, ulceration and infections can ensue, leading to kidney diseases and eventually death.

He further says, only a quarter of women who suffer a fistula in their first birth are able to have a living baby. This means it reduces their chances of conceiving a healthy baby.

Joyce’s regret

Joyce blames her situation on her father whom she says forced her into early marriage and circumcision rituals.

“My life is now like that of a toddler. I wrap myself with clothing because I cannot afford diapers and pampers all the time. I spread the beddings properly to avoid wetting,” she says.

Joyce’s friend and consolation for now is her biological mother, Agnes Chacha, 52. Joyce says her husband claims not to have the money to travel to Mwanza to meet her.

She is holding on to prayers so that later when she gets healed, she can speak strongly against early marriages and parents or guardians who take their children for traditional circumcision rituals.

She believes that the complications she is facing are a result of early marriage and Female Genital Mutilations (FGM).

Additional reporting by Syriacus Buguzi