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Fighting Fistula: Finding healing after devastating birth injuries

 

 Migori County First Lady Dr Agnes Ayacko and Safaricom Foundation Chairman Joe Ogutu engage with a patient who received free fistula reconstructive surgery during the Migori Fistula Camp at Migori County Hospital. [James Omoro, Standard]

For many women in rural Kenya, fistula is a devastating condition that steals their dignity and isolates them from loved ones and their communities. Like leprosy, these women often become outcasts, stigmatised by the foul smell of urine and stool that they cannot control.

According to the World Health Organisation,  approximately 3,000 new  fistula cases are recorded annually in Kenya, but only 7.5 per cent of affected women have access to medical care.

Janet Kea, a mother from Chonyi, Kwale County, developed a fistula during her eighth pregnancy. Tragically, she lost her newborn due to prolonged labour at a local clinic before being referred to Mariakani District Hospital, where it was discovered that her cervix had closed, causing the baby to die from the pressure.

"I was taken for surgery, but the child was already dead," Janet recalls. "I stayed in the hospital for two days, and a pipe was inserted in me. It was removed after 12 days because I was coughing too much, but further treatment was delayed due to a doctors' strike."

After numerous unsuccessful medical appointments, Janet was eventually referred to Bomu Hospital, where she underwent corrective surgery. "After the surgery, I came out well. I thank God I'm here and well. If you have any fistula issues, come and get help at Bomu," she urges.

Despite the ridicule and discrimination from her community and relatives, Janet appreciates her husband's support during her ordeal. "He stood by me, prayed for me, even as people sidelined and laughed at me," she says.

Jane Nato, 42, from Kombani, Kwale County, has a different story. After suffering from a fistula during her first pregnancy, which turned out to be ectopic, her husband abandoned her. "I don't know if he will come back or if he has run away," she says from her hospital bed.

Initially, Jane thought fistula was a condition affecting only those in arid areas but soon realised it could happen to anyone. "Let us not fear fistula. It's a condition that can be treated. I tell all women to speak out whenever they have such an issue. You might be talking to the right person who will help you out," she advises.

After being diagnosed with an ectopic pregnancy at Diani Beach Hospital, Jane underwent surgery to remove the appendix. However, two days later, she began experiencing uncontrollable, watery discharge. Despite initially being told by a doctor that this was normal, the condition persisted, forcing her to wear adult diapers, which she couldn't afford.

 Janet Kea, at Bomu Hospital after undergoing corrective surgery to correct her fistula condition she suffered during prolonged labour. [Joakim Bwana, Standard]

Her situation became dire as her financial stability crumbled, and she borrowed money from loan apps to buy diapers. Jane's breakthrough came when a friend referred her to Bomu Hospital, where she was diagnosed with a fistula and underwent successful surgery on March 17, 2024.

"I am thankful to God and all Bomu staff. This condition gave me pressure and ulcers, and my child has delayed going back to school because all the money has been spent on treating me," she shares.

Dr Samuel Ngugi, a consultant obstetrician and gynaecologist at Aga Khan, highlights that fistula is prevalent in marginalised areas like Pokot County, where women cannot access assisted delivery and labour for long hours. Young teenage pregnancies also contribute to the high incidence of fistula, which often develops between the third and fifth day after delivery.

"Programmes like Linda Mama should be applauded and sustained," Dr Ngugi emphasises, advocating for increased healthcare personnel and low-cost interventions to manage and prevent fistula. "This is not a condition we should be proud to have in the community. It is not seen in the developed world."

Safina Mwalimu, Bomu Hospital's Fistula Outreach coordinator, notes that their efforts, supported by the Fistula Foundation, have reached over 500 women in the Coast region. These women receive medical treatment, start small businesses, and get empowered through support groups.

"Most women who suffer fistula gave birth at home due to late reporting to the hospital during labour pains because they lacked fare," Safina explains. "Due to stigma, they rarely come out and it takes trust to speak out."

Fistula affects not only the women but also their marriages and social lives. "It causes infections which are recurrent until treated," Safina adds, noting that the condition often leads to broken marriages, especially among young couples.

Through continued outreach and support, women like Janet and Jane can reclaim their lives and dignity, transforming their journey from suffering to hope.

Dr Swabra Swaleh, a gynaecologist at Mombasa Premium Hospitals, explains that the World Health Organisation recommends a cesarean section (CS) rate of around 30 per cent for middle-income countries, meaning one in three women should receive a CS during labour. However, in Kenya, this rate is much lower due to limited access to prompt CS deliveries, contributing to the high number of fistula cases.

"Most fistulas are found in rural areas because of staffing issues and the lack of prompt theatre services," says Dr Swaleh. "Facilities may be small, lacking gynaecologists, and staffed only with midwives, leading to prolonged labour and increased fistula cases."

Dr Swaleh emphasises the need for improved surgical skills among surgeons to avoid iatrogenic fistulas caused during surgery. She points out that more than 90 per cent of fistulas are caused by difficult deliveries, with obstructed labour being a significant contributor.

"The biggest cause of obstetric fistula is obstructed labour where the mother has been in labour for too long, and the baby's head becomes impacted," she explains. "Proper monitoring during labour and timely decisions for CS can prevent such complications."

According to Dr Swaleh, with so many technological development and education, no woman should be suffering from fistula. 

The doctor says treatment modalities are majorly surgical depending on the size of fistula and that not all fistulas will be repaired surgically but some can be observed and will close but most will be operated on surgically.

Read more on the fight against fistula here >> https://www.standardmedia.co.ke/branding-voice/article/2001496721/let-us-enhance-the-battle-against-obstetric-fistula-to-restore-health-dignity-and-hope-to-our-women (Sponsored Content)

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