The ravages of fistula

By Jane GodiaShe is only 13 years old but the deep worry lines on her forehead and ragged face add another 15. Cheptoo is at a great loss. She has nowhere to go and no one to turn to. Her woes began almost three years ago when she turned 10 and her father and community decided it was time she entered womanhood by undergoing female genital mutilation (FGM). Having seen her elder sisters, cousins and aunties go through the rite that is followed by feasting and celebrations, she had no problem with it. Her only worry was that she would be forced out of school. Already, suitors had approached her father for her hand in marriage. This she could tell by the number of beer bottles and traditional brews that were passing through the gate into their homestead.Soon after the ‘cut’, she was congratulated for being a full-grown woman even though she had only seen her menses twice. It did not take long before her father told her to prepare for the journey to her home. School was over and she was getting married.Soon, she was pregnant. Her labour was prolonged and difficult and with the traditional birth attendant unable to help, her baby died. But Cheptoo’s trauma did not end with the death of her child. Rather, the tragedy marked the beginning of her tribulations. Delayed birth and pressure on her urethra left her with a medical condition that affected the urinary bladder. "She now suffers from incontinence and stinks of urine throughout," says Rhoda Rotino, Executive Director of Pastoral Communities Empowerment Programmes. "Cheptoo has been chased away from her husband’s home because of her stench. Her family has also rejected her saying she no longer belongs to them since dowry was paid for her."Startling statisticsHer case is not unique. "Young girls between 10-15 years get married when their anatomies have not matured to bear children. This often causes complications during delivery especially for those who rely on TBAs.And the statistics are startling. Rotino says in Pokot, 90 per cent of circumcised girls aged 10-15 years drop out of school to get married.Like the Somalis, the Pokot cut the labia during FGM. "Unfortunately, the Pokot girls are not stitched the way Somali girls are. They are just asked to hold their thighs together when the labia is wet with blood until they heal," says Rotino.She says this makes the vagina too tight and upon marriage the man has to use extreme force to penetrate the bride. "When it comes to delivery, the girl has to be cut for the baby to come out. Although TBAs normally do this, they often cut the child in the process."Delayed birth and pressure on the urethra affects the urinary bladder. Although the problem is treatable, not many girls are aware that it can be treated hence live the rest of their lives facing stigma.The medical condition Cheptoo and others who give birth in their teens suffer from is Fistula. It is particularly common where forced and early marriages, as well as FGM are prevalent.Obstetric fistula is an injury of childbearing that has been relatively neglected, despite the devastating impact it has on the lives of girls and women. It is usually caused by several days of obstructed labour, without timely medical intervention. The consequences of fistula are life shattering: The baby usually dies, and the woman is left with chronic incontinence. Unattended obstructed labour can last for up to six or seven days, although the foetus usually dies after two or three days. During the prolonged labour, the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s pelvic bone. The lack of blood flow causes tissue to die, creating a hole between the mother’s vagina and bladder (known as a vesicovaginal fistula), or between the vagina and rectum (causing a rectovaginal fistula) or both. The result is a leaking of urine or faeces or both. Childbearing before the pelvis is fully developed, malnutrition, small stature and general poor health, contribute physiologically to obstructed labour. Rotino, whose organisation engages circumcisers to end this trade, says it is not easy. "We hold regular capacity building sessions with female circumcisers to tell them that if they can end FGM then the girls do not have to be married when they are barely into puberty," she explains.However, it’s not an easy task because the circumcisers view their job as a source of income and don’t see alternative ways of earning their daily bread.Seeking help Many girls have been sent away from their paternal and marital homes and most run to churches for help. "Some go to hospitals, not to seek treatment but to look for accommodation," says Rotino. "It’s only when they are there that their problem is discovered upon examination."There are others who seek accommodation from well-wishers.Rotino says that Moi Referral Hospital in Eldoret and Ortum Hospital in Kapenguria indicate that the Pokot and Marakwet from the North Rift have the highest fistula problem."Since the year started, 50 women have sought Fistula operations at Ortum Hospital," Rotino says. "These are girls who have given birth to their firstborns."The African Medical Research Foundation (Amref) has been at the forefront in helping those who have made it to hospitals."Fistula is a big problem for these girls because many are not able to have more children. Rotino’s organisation is trying to work with men but it’s not easy. "Most men don’t want to associate fistula with FGM and they think the woman is the problem so they chase her away."The organisation is also trying to build the capacity of female circumcisers by offering them alternative sources of livelihood such as buying them grain to sell or helping them start traditional artefacts making and trading projects. Rotino, who has been at the forefront of pushing for women’s sexual and reproductive health rights, says although their main focus is women, they need men to agree that women should articulate their rights.Until early and forced marriages are brought to an end by ending retrogressive cultural practices like FGM, many girls barely into puberty will continue suffering from ailments they least understand and live a dreadful life. —Jane Godia (jgodia@eastandard.net) is Deputy Managing Editor in Charge of Magazines.Additional information from Internet sources.

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