Poverty, witchcraft blamed for fistula disease in Kwale

Lack of knowledge and poverty are some of the key factors hindering women in coastal regions from accessing early treatment for Fistula disease.

In Kwale county, fistula disease is linked to witchcraft and curses, denying women access to treatment. 

Kabuka Ngao, a public health nurse at the Samburu subcounty hospital in Kwale county, said some families believe that fistula is a disease which cannot be treated, hiding the patients in their houses.

Ngao who is also a reproductive health coordinator said with the support of Fistula foundation and Bomu Hospital, they have made milestones in changing the mindset of the community through their outreach programmes. 

Culture has also contributed to the loss of lives of women with fistula because a woman is not supposed to make a decision even when she is at a point of losing her life.

"We have really come from far in creating awareness and educating the community. In Duruma culture, a woman is not supposed to make a decision on her own," she said. 

"Everything is decided by a man even if a woman is at a point of losing her life, a man has to be there to give permission for any treatment or surgery to happen," she said.

Through a men focus group, an initiative they started to create awareness and educate the community, she said they have been able to empower men on the importance of allowing their partners access treatment.

"We started creating awareness among men and women who were the victims in different places where there was a challenge of getting the services. Through our community health providers, we do the group discussions for men to understand the importance of women getting health services," she said.

Their engagement with the communities has really helped in educating men and letting them know that it is not a woman’s fault to have the fistula health condition.

“The fistula disease was a big issue in our communities, women used to hide due to stigma but through our outreach programmes and the community engagements, we are changing the norm, men are now informed that it is not a must for them to make a decision for a woman to access treatment,” she said.

Some women, especially those from rural areas where accessing health services is a challenge, are in denial that fistula is a disease that can be treated.

Ngao said they see it as a miracle due to lack of knowledge about the disease as they believed that fistula cannot be cured. 

The success stories in the community have also helped those in denial accept their condition and come out for treatment. 

Financial instability also contributes to fear, however, Bomu hospital in partnership with fistula foundation have made it easy by providing free treatment, a move that has attracted more women to speak out about their condition. 

At the Samburu sub-county hospital, Ngao said there are more than 10 women who are beneficiaries of free the treatment.

"We are grateful for the support, we are still going in the villages to bring out these women. This is not a death sentence disease, it is a condition which if well treated, cannot recur,” she said. 

Safina Ramadhan, a fistula coordinator at Bomu hospital in Changamwe subcounty, Mombasa, said with the partnership they have with Fistula Foundation since 2015, they have been able to reach out to women in the six counties across the coastal region.

Ramadhan who links women with fistula disease across the six counties to Bomu hospital said they have a well equipped facility which is funded by Fistula Foundation to provide the free treatment.

So far, they have reached out to more than 500 women across the six counties.

She says many women are suffering from the disease but stay at home due to lack of information. 

"We have been able to reach out to them and educate them about  the disease through our outreach programmes. We have also encountered challenges from their partners who blame their women for having the disease and this is due to lack of education about the fistula. They end up denying them permission to go for treatment assuming it was their fault," she said.

Ramadhan said the awareness and community sensitisation programmes have really helped. "We had a vision of bringing these partners on board to help these women get treatment and allow them to make their own decisions either financially or decisions of seeking treatment."

She called upon men to support their partners and help in creating awareness about the disease, especially those who have walked the journey with fistula patients. 

"Men are the decision makers of the family therefore they need to support their partners and encourage them to go for treatment without having to seek permission from them, " she said.