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Obstetric fistula: Smell of painful motherhood

 Dr John Wachira performing fistula surgery on Ngurany Tumaina at Kajiado county referral hospital

It is one of those rare moments that a journalist’s camera is allowed inside a hospital theater. Ngurany Tumaina, a mother of five, lies sprawled on the surgical table. Dr John Wachira, a urologist, is hard at work. Stitch by stitch, he pieces together torn parts of Ngurany’s reproductive walls.

“These, here, are fistulas,” he motions to a team by his side at the Kajiado Referral hospital. “We have to repair all of them or she will continue leaking urine.”

As she lies on the surgical table, ‘crucified’ to keep her still as surgery proceeds, the look on her face speaks of worry and uncertainty of what lies ahead. If the surgery is successful then she will be happy. If not, she looks ahead to a ‘stinking’ future.

Prior to her surgery, Ngurany lived her life as a loner who avoided interactions whether in public or within her homestead. She feared sitting on anything because it would not be long before it became flooded with her urine.

“Urine flowed out of me without control and as you can imagine, that is very shameful for a married woman,” she says. Shameful because every time her seat went wet she’d receive fierce gazes that reeked of judgment just as much as she reeked of urine.

Ngurany began leaking urine 13 years ago after “a long labour performed by a traditional birth attendant” and as the second wife to an “old man who appeared least concerned about her condition”, she continued to bear her shame. This was until she learnt about a funded project paying for fistula surgeries.

To get help, Ngurany had to relocate from her husband back to her parent’s home so she could be close to a health facility and near family who would help her receive treatment.

At the same hospital, we meet Esther who is also waiting for surgery to repair her fistula and while she is willing to share her experiences with us, her husband is adamant that his wife’s story must not be highlighted.

“This is a very shameful thing. Please do not write about it. I am a teacher here and if it is known the shame will be too much,” he said giving us a clear picture of the burden these women are forced to bear.

For others like Kulaiyo Sandesa, 30, from Moyale, their experiences with fistula run deep. Kilaiyo has sworn to a life without a husband after her first marriage ended in a sea of leaking urine. However, unlike many fistula sufferers, her case was that of surgery gone awry after her doctor punctured her during a ceasarian section.

For ten years, she watched life go by from the fringes – secluded by a society that saw her as a bad omen rather than a woman in need of help.

Kulaiyo says: “The birth of my son was supposed to be a happy moment but it quickly turned into a disaster. My husband eventually chased me away. I was forced to go back to my parents and I had to give up my son for adoption.”

Dr Wachira, an officer with Amref Africa, has repaired hundreds of fistula patients and says fistula can be caused by cancer, botched surgery, and in very rare occasions, rape.

“However, the largest number happens through delivery of a baby. Obstructive labour that is stretched and lasts long, blocks blood supply to vital tissues that separate urinary, alimentary and reproductive tracts. This leads to death of the tissues which then slough off and leave holes that leak urine, faeces, or both,” he said.

When it is only urine leaking, doctors refer to the condition as vesico-vaginal fistula and when it is faeces the term is recto-vaginal fistula.

Dr Wachira says while he cannot pin a death incident directly linked to fistula, it is possible for the wounds to create routes for bacterial infection which can be fatal.

At Kapenguria County Referral Hospital in West Pokot, Pauline Chepochikok is flanked by her teary mother. “I feel bad that she is so young and has such a problem. She has birthed eight children already. I do not want her to have any more. I swear I will not let her go through one more pregnancy,” the distraught mother says.

At only 31, even by Pokot standards, Pauline seems to have earned herself something of a record. She tells us that she started leaking both urine and faeces after the birth of her third born.

“Yes, I stank and although my husband did not like the smell, it did not stop him demanding for intimacy saying he paid my dowry and it is his right to get what he wants when he wants,” she says.

Pauline’s mother says that her daughter’s fistula began with small leaks. “But with each subsequent baby it got worse. She leaked larger and larger quantities. It got very bad. That is why when this opportunity for free surgery arose we did everything possible to arrive here, regardless of distance,” she says.

The two hail from Nakwijit in North Pokot – hundreds of kilometers from the hospital.

Pauline, Esther, Kulaiyo and Ngurany, like many others, would still be suffering urine and stool leakage had it not been for a programme run by German pharmaceutical company, Bayer Health Care.

“These women bring forth life. It is sad that they have to suffer in the process. Birthing is a noble thing and no woman should have to pay the price that these women have paid,” says Helen Mwathi, officer in-charge of the project, which has seen hundreds of women “get their dignity back,” as she puts it.

She adds: “A woman who has her dignity equals a healthy family. Mothers, in many instances, are the pillars of families. When she is not fine the whole family is prone to trouble.”

Her sentiments are echoed by Esther Timpiyan, a community health worker in Isinet, Kajiado, who says women who suffer fistula in her community end up being ostracised and many lose their families.

“These women often stay away from the public. They continue to suffer in silence and often do not seek or have access to help,” she said.

Helen prays for a Kenya where her company’s philanthropy will not be needed. When the system will provide every woman with health to avert occurrence (of) or even treat fistulas.

For now such a system remains a dream that is far and distant. Despite working for the system, Catherine Mukenyang’, West Pokot county government health executive member admits that her people may have to endure the suffering.

“A single fistula operation may need a patient to have at least Sh20,000. Nearly all the patients who come to the referral hospital cannot afford it. We try to relieve the costs for very poor patients but it is not always enough,” she says.

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