Fistula, a dangerous disease causing misery among women

MANY women in Tanzania continue to suffer severely from fistula disease that is caused as a result of severe child birth complications. The majorities of these women prefers to remain silent and are unable to disclose their sufferings for fear of being stigmatized by close family members. For the last 15 years, Bhoke Chacha a resident of Kemange village in Tarime district, Mara region lived in loneliness after having been abandoned by her husband when she encountered with fistula and lacked special medical attention. She is 45 years old and has had been undergone for operation three times in order to prevent the situation but to no avail. Currently Bhoke is among few women who are receiving free medical treatment on fistula disease being offered by the Dar es Salaam based Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) disability hospital. Narrating her ordeal, she says that, she overcame with a fistula disease when she had given birth to a child who has died already. However, when she heard about the services at CCBRT hospital, she couldn't believe that her condition could be treated. She travelled all the way from Tarime and was treated.  “I saw how big my baby was and when I delivered, it tore me apart and when it came out, urine started to leak continuously” she said adding that, the urine kept on coming out whenever she laughed or sneeze. However, she is now happy with the gradual recovery after receiving good treatment offered at the hospital. Rebecca Amos (30) a mother of three children, recently lamented that she slept at night on wet beddings at her home village of Minigo which is located on the shores of Lake Victoria in Shirati location, Rorya district in Mara region.  She says during the day her family members and other people in the community made her a laughing stock as she was leaking urine and spreading a bad smell an aspect that she sometimes feels herself to have been stigmatized.  She stays alone rather in a solitude state and abandoned as well as being humiliated for no any cause by her entire family members and more seriously is when her husband left her in the house and decided to go and sleep with his second wife. This is the sad testimony of Rebecca Amos who recently spoke to the writer of this news when visited in a village two months ago. According to her, she has developed a hole, which professional doctors called it a fistula that had occurred after a difficult childbirth.  Fistula is a gap that develops between the bladder and the vagina, or between the bladder and the rectum, after obstructed labour or intense sexual violence. Women who survive such traumatic experiences will go on to continuously leak urine or stool unless the damage is repaired. During her pregnancy just like other women, Rebecca recalls, she used to walk the long distance from her home in remote rural area to the nearest health facility located at Shirati main shopping centre to attend a clinic and later on managed to give birth though with some difficulties. She felt some kind of abdominal pain that after a medical checkup results showed some signs of a developed fistula with internal organs that had been formed abnormally and surgically created in the body. After having come across the situation, clinical attendants gave her an advice to see the highly professionally trained doctors at a district hospital.

 

Doctors in operation to save the life of a fistula patient in a designated hospital.

"The health workers told me I should undergo for a medical checkup at a district hospital," she said. In a weak condition and on bad dilapidated roads she was transferred to Tarime district hospital the nearest and miraculously survived the struggle along with her baby as she felt the conveniences of potholes on the way. However, it was until after a check up that she realized she had obstetric fistula. When she began leaking bodily fluids, the health workers gave her pills to take, which did nothing to stop the leaking or repair the fistula. However, she later came into contact with a clinical officer trained in fistula and eventually underwent surgery. However, although she has ever heard of the free medical treatment services being offered by a Dar based CCBRT hospital, she often wonder how to get into contacts with the authorities of the hospital concerned in order to be included among the beneficiaries to receive such an assistance. Being financially squeezed, however, her mind is currently occupied by lots of thoughts including how she could travel all the way from Tarime to Dar es Salaam city at least to enjoy the free medical treatment services being offered by the hospital to its patients in the country including transport fare. CCBRT disability hospital as it is known by many is one of the largest hospitals in Africa and the leading in the country which is specialized in the treatment of fistula cases since 2002 and is continuing to expand everyday. For the last one year, the hospital has treated over 1,000 women with fistula cases through its program campaign dubbed, “MOYO” which is being teamed up together with the Ministry of Health and Social Welfare and financed by Vodafone aid foundation. A total of $ 10 million (Sh. 1.6 billion) has so far been contributed by Vodafone employees and partners to help facilitate the campaign with a view to help tackle new born deaths as well as major maternal health issues including obstetric fistula which needs strategic approach to get it eliminated by 2016.  In the meantime, Vodafone through its M-Pesa technology has eased referral system within CCBRT allowing the hospital to transfer transport costs to patients in rural Tanzania who cannot afford the treatment. Statistics made available by the hospital shows that, an average of 38 fistula surgeries are carried out every day at the hospital. According to CCBRT’s Chief Executive, Erwin Telemans, the Vodacom donations means his hospital can continue to provide fistula surgery, patient transport and rehabilitative services free of charge in the entire country. He says the hospital has their ambassadors scattered in various regions within the country who receives information about women with fistula and upon getting such reports, they send transportation money via M-Pesa technology in order to enable patients travel to Dar for specialized treatment. Currently CCBRT hospital is able to accommodate 70 patients per day as opposed to 9 patients it was able to accommodate in the past, and with the increased number, couple by increased skills and knowledge, the hospital has made a significant impact to the good progress achieved in the eradication of obstetric fistula in the country. According to Dr. Robert Malenga, an expert on fistulas disease at CCRRT hospital, fistulas are abnormal connections between different tissues or organs in the body and usually occur as a result of child births complications that causes injuries to women in areas around the genitals and anus (known as the perineum).  The four main types of fistulas are categorized as follows; there is enterocutaneous which is from the intestine to the skin resulting from the complication of surgery. It can be described as a passageway that progresses from the intestine to the surgery site and then to the skin. Entero-enteric or Enterocolic, this type involves the large or small intestine. Entero-vaginal is a fistula that goes to the vagina. Entero-vesicular is a type of a fistula which goes to the bladder. These fistulas may result in frequent urinary tract infections, or the passage of gas from the urethra during urination. Symptoms of fistulas can include pain, fever, tenderness, itching, and generally feeling poorly. The fistula may also drain pus or a foul-smelling discharge. These symptoms vary based on the severity and location of the fistula. Many women suffer fistula in solitude and shame, and the United Nations Population Fund (UNFPA) estimates that more than 2 million women live with it in the developing world, with more than 50,000 new cases each year.  Fistula is common in communities where women are married at a young age and give birth before their bodies are ready. Lack of financial resources and the persisting gender inequalities continues to ravage the societies in terms of social and cultural norms in sub-Saharan Africa.