It is a beautiful thing for a woman to conceive. The realization that there is a life growing inside the womb brings a lot of joy. The feeling of becoming a mother is overwhelmingly gratifying. The more the days go by the more alive an expectant mother becomes.
For most women, giving births is a blessing. However, when something bad happens before or after giving birth, it looks like a curse. One of the most devastating diseases women lack the courage to handle is obstetric fistula.
Cherry Msangi was so terrified when she was first told that she suffers from obstetric fistula some four years ago. “It was in 2013. I locked myself up in the house for almost three months. I was very sad and frightened. I didn’t understand why a precious thing like giving birth could lead to such a horrible situation,” said Cherry when giving her testimony at a recent event.
“After undergoing operation, I saw urine excreting without my will to stop it. A quick thought came to mind; I thought maybe I have been bewitched. I didn’t tell anyone because I was ashamed of such an embarrassing situation. Worse enough, I didn’t know that it was obstetric fistula until when I saw it on TV,” narrated Cherry.
According to her, if it hadn’t been for the aired TV programme discussion centred on obstetric fistula, she could have still been suffering from the disease. “The symptoms explained on the programme were akin to what I was experiencing. I held my breath. I then decided to share it with my husband who didn’t share the same views as mine. The whole situation was like a curse,” said Cherry.
After a long discussion, Cherry and her husband decided to do some research in order to find out exactly what the problem was. They then visited Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) in Dar es Salaam to seek medical treatment. After a short period of time the situation became normal.
Suffering in silence
While Cherry was lucky not only to have received treatment but also to have known what the problem was, thousands of women and girls in Tanzania suffer from obstetric fistula without knowing what to do. Available statistics show that more than 21,000 women and girls in the country suffer from obstetric fistula with about 1,500 to 3,000 new cases every year.
Although Cherry was among women who suffered from obstetric fistula, she is now happy that she fully recovered from the disease. She was lucky to get early treatment. While undergoing treatment at CCBRT, she was among women who were selected to join “Mabinti Centre” project, an entrepreneurial training for women with obstetric fistula. “I was happy to get the second chance in my life. Joining the training programme for a year was a fresh restart, something that totally revived me,” she said.
“The experience I got from Mabinti Centre project was useful. I was given a tailoring machine after a year of training. If I kept my suffering a secret, I could have missed such an opportunity. I urge women who suffer from Fistula to come out and defeat the disease, it is treatable,” she said.
Mabinti centre project is part of CCBRT’s holistic model of care for women recovering from obstetric fistula. The project’s unique vocational training and holistic care programme has unlocked the confidence, potential and economic independence of 100 women previously treated for obstetric fistula at CCBRT.
Speaking during the celebration to mark 10 years of Mabinti’s growth as a social business, Ummy Mwalimu, the Minister for Health, Community Development, Gender, Seniors and Children, commended the project for transforming lives of some 100 girls, recognizing efforts done by Mama Katia Geurts, in particular, in supporting the initiative.
The minister acknowledged that myriad challenges are still facing the country in its endeavour to provide quality maternal and child healthcare services to the population. “We are determined to have dispensaries in every village and health centres in every ward at the village level. However, we have not reached the target yet,” she said when addressing the occasion.
Although obstetric fistula may not be as widely recognized as other maternal health issues, the Fistula Foundation estimates that over two million women and girls in developing countries suffer from this condition today. The World Health Organization has labelled it as “the single most dramatic aftermath of neglected childbirth.”
For medical experts, obstetric fistula is a devastating condition often resulting from obstructed labour that can cause infections, incontinence, and even paralysis. According to them, such a condition largely afflicts poor, rural, and illiterate women mostly in developing countries who lack resources and access to emergency care and surgery. The sufferers often face an additional burden of social stigma.
“Indeed, we still have a large number of women who are suffering from obstetric fistula. Some women stay at home until the last minutes of labour pain,” she noted. Most health centres in rural areas cannot perform operation or provide caesarean services to expectant mothers. Such delivery delays pregnant women experience during the rushing from one health centre to another could, according to the minister, be the cause obstetric fistula.
“Also there are a large number of women who do not attend clinic as advised by the specialist. Our human resource in the health sector is also a big challenge. The country still has shortage of about 49 per cent in human resource in the sector despite efforts to expand recruitment of health professionals,” noted the minister.
According to her, about 21,000 women are suffering from obstetric fistula and others are yet to be reached. “Obstetric fistula is still a challenge in the country as every year; between 1,500 to 3,000 new cases are reported. Out of the number, less than 1,400 women are treated annually. The only way to reach these women is to improve access to health services and improve health facilities across the country,” she noted, adding that the government is planning to spend some Sh160bn to upgrade 150 health facilities countrywide by June 2018.
She said some $36m the government has so far received from the World Bank, plus other funds that came from Canada and other health stakeholders have already been channelled to some regions to start construction of maternal surgery theatres and upgrade some health facilities.
The minister used the celebrations to challenge health stakeholders to join forces with CCBRT to reach out to over 20,000 women with obstetric fistula, most of them in remote rural areas. “Let us reach those 21,000 women in villages who have obstetric fistula. Let us reduce the number. It is possible to cut down the new cases from the current 3,000,” urged the minister, commending Cherry’s husband for supporting his wife as most of African men abandon their wives who suffer from the disease.
Urging good customer care
She also challenged health professionals to provide the best customer care to patients so that they can feel comfortable in attending clinics and build trust on the service provided.
“About 90 per cent of pregnant women who attend clinics in our health centres visit the clinics once instead of four times a year. Why are these women not coming back after their first attendance?” Ummy queried, saying: “May be it is because of poor customer care in our health facilities”.
With close cooperation with health stakeholders, the minister was confident that the country can at least achieve to increase the number of visits to at least 80 per cent. “We should be able to make them attend clinics four times a year. Currently, only 50 per cent of pregnant women attend clinics. The number should at least reach 80 per cent,” she noted.
For his part, the CCBRT CEO Erwin Telemans said the project helps to reduce stigma and barriers existing to patients with obstetric fistula. “As we celebrate 10th anniversary of Mabinti Centre, the project has imparted new life to those who had suffered from obstetric fistula, giving them more confidence, dignity and new life,” he said.
“They visit obstetric fistula patients at CCBRT hospital, help in prepare wards and share experience with patients, giving them hope that there is a life after obstetric fistula is cured,” he said.
“Today they are here to celebrate the day and display their legal business as some are former trainees who now have shops. They hail from Kigamboni and Kisarawe, in the outskirts of Dar es Salaam. A year ago some of these women were wearing blue gowns in the hospital but today they own shops,” he added.
Leokadia Namhani was only 17 years old when she had obstetric fistula in 2013. By then she was a Form Two student at Kisorya Secondary School. The 22-years-old Leokadia said she was in labour pain for three days. Her parents told her to wait a bit longer for the baby as going to hospital early would make her tired of waiting for the baby to come out.
“After seeing that there was no sign for me to deliver, they took me to a nearby dispensary where I stayed for two more days without any help from the nurses or doctors. I didn’t know why. My parents decided to take me to another hospital in Bunda where it was later found that the child had already died. They operated on me to take remove the stillborn baby,” she recalled.
“After the operation my health condition deteriorated every day. I was seriously sick. I leaked urine everywhere I sat. I only stayed indoors. I reeked and even my relatives stigmatized me,” she said.
Leokadia didn’t know what to do, thanks to a little boy who brought home a leaflet with him, without knowing, the leaflet contained information about obstetric fistula. “After reading it I knew that the disease is curable. They took me to Sekou Toure Hospital in Mwanza. However, the treatment did not do any good. It was lucky that I met an old woman who took me to CCBRT hospital where I was operated for the third time. It only took me two weeks to get relief and recover. The entrepreneurial training offered by Mabinti Centre brought a new lease of life to me,” she added.