Fistula surgeries giving suffering women their lives back

Mary Wambua is a happy woman. Watching her hang out and chat freely with her friends, it is hard to imagine that Mary, 48, has had a dark past. For many years, the mother of two from Makueni County suffered urinary incontinence, a condition that had eroded her dignity, almost turning her into a recluse. Until March this year when she underwent surgery to correct the condition. Now she is planning a wedding to celebrate a new chapter in her life.

‘‘You are invited to our wedding,” an elated Mary tells this reporter during the interview at her Kyamusoi village, flanked by her husband.

Beneath her radiance, though, lies the memory of a tough medical journey that she has had to endure since joining school. Her inability to hold urine made her the laughingstock and an object of ridicule in her school and community.

For years, Mary would avoid social places owing to the stench that caused her telling humiliation. If some people have experienced shame, Mary has waded in the depths of stigma.

But now with her successful operation, Mary can afford to go to church and other public places she has given a wide berth nearly all her life.

Her incontinence was a result of obstetrics fistula, an injury in a woman’s reproductive system often sustained during childbirth. It manifests in the form of a hole between the birth canal and either the bladder or rectum.

Although there are a few congenital cases, doctors say fistula is mainly caused by obstructed labour, especially when it is prolonged. The condition is characterised by urinal and faecal incontinence, where urine and stool leak from the body.

Mary’s parents had hoped that she would stop wetting her bed when she grew older. When the problem persisted, they got concerned. In the Machakos countryside, as in most rural areas, mysterious health conditions are associated with witchcraft. Mary’s condition, therefore, generated all manner of suspicions and talk.

• Not even a surgery at Kenyatta National Hospital could correct the problem. When her search for help came to a head, her parents consulted a witch doctor. It was now clear to them that their daughter was either battling a generational curse or she had been bewitched.

‘‘I was a teenager when the doctor performed several rituals on me,’’ she recalls of her frustrating experience. The intervention failed.

Now both medicine and sorcery had failed to cure her. Dejected, Mary fled to Nairobi to look for menial jobs. She would meet her future husband in 1998. While they dated, she perfected slyness, occasionally lying about the condition.

“She told me initially that she had a swelling in her belly that troubled her. As years went by, however, I discovered that there was a bigger problem than she was admitting,’’ Wambua narrates, saying his pleas to his wife to seek medical help came to nought.

After years of persuading her, she finally relented and underwent the surgery this year. “We are glad she is now firmly on the recovery path,’’ he adds, relief evident on his face.

Mary’s triumph over fistula is one of many inspiring stories across Makueni after the county government introduced fistula care services at the Mother and Child Hospital early this year.

The care is a joint initiative with Jhpiego, a non-governmental organisation affiliated with the John Hopkins University. Twenty-four women have been operated on at the facility, with 21 of them being cured of the condition, according to Dr Doris Mbithi, the lead obstetrician gynaecologist and fistula surgeon at the unit.

Among those treated at the hospital is Jane Mwele, 89, who had suffered faecal incontinence for 33 years. The mother of 10 says she endured embarrassment for decades, a situation compounded by misdiagnosis. On many occasions, doctors would prescribe treatment for intestinal worms with no result, heightening her frustration.

“At some point I thought I suffered from HIV/Aids I even challenged the doctors to let me know the truth instead of taking me in circles,” she recounts.

When the county government set up the facility, Mary and Jane were among the first patients to present their cases. Now Jane has become a champion of fistula care in the county. She meets other women to promote uptake of fistula care services.

Data shows that fistula affects mostly middle-aged women. Conscious of their condition, many recoil and avoid interactions, including using public transport, Dr Mbithi says.

Cultural beliefs in this and other parts of the country also hinder search for treatment, as Jane reveals to Healthy Nation. “Some of the women I interact with swear that they would rather suffer in silence than undress before a doctor. They are especially uncomfortable before male medics.’’

For some, having lived with leaking waste is all the shame they can take, she adds. ‘‘But I encourage them to seek medication than to live with the agony for the rest of their life.’’

Every year, about 3,000 women are diagnosed with fistula, according to data from the Ministry of Health. With only a handful of fistula surgeons available in the country, access to quality care is limited. It is in a quest to bridge this gap that Makueni County set up the fistula care unit, much to the relief of patients in the Lower Eastern region.

The programme started with training for 11 practitioners in fistula care. These range from anaesthetists to nutritionists, counsellors, physiotherapists and general nurses. It serves Kitui, Machakos and some coastal counties undeserved in specialised care.

To nip the problem in the bud, the county government has been promoting hospital deliveries, according to county Health Executive Paul Musila.

Besides treatment, the county has begun conducting awareness and outreach services in the population, targeting members of the community who may be suffering silently.

Dr Mbithi singles out cost as another impediment to access to fistula care, with most patients lacking medical covers. ‘‘The lack of the capacity to pay for this specialised healthcare services complicates the already sorry situation,” she says.

The success stories from Makueni County have attracted plaudits nationally, with no less than the head of the reproductive and maternal health division in the Ministry of Health Edward Serem lauding the county for the milestone.

Dr Serem, however, challenges counties to do more in fistula management to prevent and reduce its prevalence. He proposes the revamp of primary health care and referral systems as an intervention, noting: “The most sustainable way of addressing fistula is by preventing it from happening. Developing the capacity of doctors and retaining them in their specialties is critical.’’ he says.

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