For the last 40 years, the presence of Beatrice Wambui at family functions has been rare. Not because she does not enjoy the company of her kin, but because she has been too ashamed, too embarrassed to mix with them, catch up with them and share a hearty laugh.
But things have not always been this way. Family gatherings were once events that Beatrice eagerly anticipated. So what changed?
Beatrice traces it back to four decades ago when she gave birth to her last born child, Tabitha. Just as she had done with her previous two deliveries, Beatrice, who hails from Gatundu South in Kiambu County, delivered at home assisted by a neighbour. Attending antenatal clinics or delivering in a hospital had never been a priority for the peasant farmer.
“At that time, delivering at home was common among women in my village, who would do so without complications so we did not really see the need to go to hospital. Whenever a woman would go into labour, she would call on her mother, sister, friend or neighbour to assist her,” Beatrice remembers.
But things did not go as expected. Her labour was not as quick as the previous two, and she remembers it going on for ‘about three or four days’. Eventually, she gave birth to a bouncing baby girl whom she named Tabitha. The painful labour and difficult birth was soon forgotten as she cuddled her only daughter in her arms. And as visitors poured into her house to congratulate her, they would bring with them pots of nutritious meals and beverages –deemed to enable her boost her breast milk supply and regain her strength. They included black eye peas (njahi), porridge and soup.
But as Beatrice consumed these meals, she soon noticed something was amiss.
“I realized that I was constantly wet, unable to hold my urine. I thought it was because I was taking too many fluids, so I slowed down on them. But even after doing so, I was still unable to control my bladder. I was behaving like a baby –urinating on myself –just like my newborn. This was very troubling,” she remembers.
Beatrice had been widowed during her pregnancy with Tabitha, and with three young children to look after, fending for the children was more important than her little ‘urine’ problem.
“It did not worry me so much because I knew that it would stop once my newborn was about a month old,” she says.
But the urine never stopped leaking, and 40 years passed before Beatrice eventually decided to seek medical treatment. That was last month, during the free fistula medical camp at the Kenyatta National Hospital in collaboration with the Flying Doctors Society of Africa and the Freedom from Fistula Foundation.
While delivering her last born child Tabitha, Beatrice had suffered an obstetric fistula, a devastating childbirth injury that develops due to prolonged and neglected labour which becomes obstructed. In obstructed labour, the baby’s head constantly pushes against the mother’s pelvic bone during contractions, preventing blood flow and killing tissues. If caesarean section is not immediately accessible, the destruction of vaginal tissue leads to creation of a hole (fistula) between the bladder and birth canal. Urine then leaks continuously through this hole, in a condition known as vesico-vaginal fistula.
When the same damage occurs between the rectum and the birth canal, faeces leak continuously from the rectum to the birth canal -a condition known as recto-vaginal fistula. Many times, the baby does not survive and for the mother, she is left with permanent incontinence -a fistula, which can only be repaired through surgery. Obstructed labour can also result in her death –where according to the World Health Organization (WHO), it accounts for up to six per cent of all maternal deaths.
In the 40 years of living with fistula, Beatrice had been forced to make some adjustments in her life.
“I had reduced my visits to friends and relatives in their houses because I knew they would offer me tea, which would cause me to produce more urine and soil their seats. I also stopped attending family functions since I would have to stay for long, eating, drinking and wetting myself. The foul smell would make things worse as people would keep their distance from me. I simply preferred to stay at home,” says Beatrice, who also stopped consuming fluids even in her house, taking them only when she was ‘extremely thirsty’. This was to reduce the amount of times she wet herself.
But as months turned into years with no sign of the incontinence ceasing, she thought of visiting a hospital for treatment. However, the logistics of getting to the hospital and loss of income for the hours she would spend away from her casual job discouraged her. Besides, the Sh 30,000 needed for the treatment at a public hospital was beyond her reach. She gave up and resigned to her fate.
It was therefore a relief when last month, a relative informed her of the free fistula medical camp at Kenyatta National Hospital. Her daughter accompanied the now 81 year-old grandmother to the hospital where she underwent the successful surgery.
“I am now happy that my shame is no more. Even though I am in my sunset years, I am eager to catch up on all the things I haven’t been able to do over the last 40 years. I want to visit relatives, attend as many family functions, such as weddings. I had never imagined that my life would go back to normal,” she said after the surgery.
But for her daughter Tabitha, the effects of the surgery were more immediate.
“Ever since I was a little girl, I have known my mother to be one who avoids taking liquids. It has always been a very rare sight to see her taking fluids. I cannot help but stare in disbelief as I watch her drown liquids without any reservations whatsoever,” a delighted Tabitha said.
Beatrice was one of the 208 women who underwent successful fistula repair surgeries at Kenyatta National Hospital last month. She was among 12 women from Kiambu County, which was one of the counties that recorded the highest number of patients. Other counties included, Nairobi, Makueni, Machakos, Murang’a and Meru.
“Many women who suffer from fistula are filled with profound fear and shame. They are heavily stigmatized by their communities and regarded as social outcasts. Many of them are not allowed to participate in church functions, weddings or chama activities -which are very important to women. Because of the foul smell, they find themselves isolated, with many unable to find gainful employment,” says Dr Stephen Mutiso, a gynaecologist and fistula repair surgeon who participated in the medical camp.
It is even worse for some women, who not only suffer a fistula, but also more serious injuries which render them unable to bear any more children. Living in an African culture where women are judged by their childbearing abilities, it is a devastating situation for them.
Even though fistula is a global problem, it mainly affects poor, young, malnourished, illiterate girls and women in developing countries, and especially in rural areas.
According to Dr Mutiso, these women are often in labour for days, assisted by unskilled family members or neighbours. These assistants are often don’t know how to handle complications that may arise during childbirth.
“Complications occur in about 15-20 per cent of deliveries, hence the need to deliver under a skilled birth attendant. Prolonged and obstructed labour is one such complication. Labour is said to be prolonged if it takes more than 24 hours. Majority of the patients with fistula often report to have laboured for three to five days at home under assistance of relatives or traditional birth attendants. In most of the cases (95 per cent), the babies are born dead,” says Dr Mutiso.
The fistula camp at Kenyatta National Hospital also recorded some iatrogenic fistula cases -meaning fistulas that were unintentionally caused by a healthcare provider. An example is during a caesarean section where the bladder is accidentally cut, causing a hole through which urine leaks. Women who suffered iatrogenic fistula, which resulted from abortions, caesarean sections and hysterectomies were successfully operated on during this camp, according to Dr. Khisa Wakasiaka, the lead surgeon.
But it is not all gloom for fistula is a highly preventable and treatable condition.
“Prevention of fistula is key, where women must be encouraged to access antenatal care in health centres. The importance of delivering under skilled birth attendants must be emphasized to them during these clinics, and all barriers that would hinder them from doing so addressed. Structures also need to be put in place to ensure that all women have access to emergency obstetric services if and when they need them, such as caesarean sections,” says Dr Mutiso.
Other strategies include, improved access to family planning, delaying the age of first pregnancy, elimination of harmful cultural practices such as early marriages and female genital mutilation, education about the birth process and involvement of men in maternal health issues.
“Investment should also be made in the health systems, such as the creation of more specialist fistula centres and training of specialized fistula surgeons,” he says.
Fast Facts
- It is estimated that more than two million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.
- In Kenya, there are an estimated 300,000 women living with fistula.
- According to UNFPA, an estimated 3,000 new fistulas develop yearly in Kenya.
- Fistula repair surgery at a public hospital in Kenya costs about Sh 30,000 – a heavily subsidized cost. In most private hospitals, it is more than five times that amount.
- There are less than 10 fistula repair surgeons in Kenya