My days were so full, it left my head spinning. I felt like a kid in a candy store and there was still so much I wanted to see and do during our time at the Moi Teaching and Referral Hospital (MTRH).The past several days had been fun and upbeat ; our weekend trip to the country, Veronicah’s very first shopping spree, and spending time with the HIV kids in the Sally Test Playroom. Of the many learning opportunities that abound at MTRH, there was one that was emblematic of the African woman’s degradation and heartbreak: Fistula. This was my chance to learn more about it.
I asked the PR Dept. to make a contact for me and 20 min. later Jared Momanyi was greeting me outside the door of the Fistula Centre, just a short walk from the hospital. He handed me a business card and explained that the foundation “One by One” raises money for these surgeries and almost 80% is thru individual donations. I glanced at the card and did a double-take; written on the card was 2622 NW Market St., Seattle, WA. He explained that 2 women, Heidi Breeze-Harris and Katya Matanovic, had heard about fistula on the Oprah show and wanted to do something to help, so they started this wonderful foundation and now support similar fistula repair efforts in Tanzania, Niger and Ethiopia.
Fistula: a narrow passage or duct formed by disease or injury; an abnormal opening between one hollow organ or cavity to another.
Fistulas can occur in many places in the body, but now I am referring to obstetrical fistula, which is quite prevalent in third world countries, and very, very rare in America. For the 3 million sub-Saharan African women with inadequate medical care, obstetric fistula is a life-changing situation. It is estimated there are between 50,000 to 100,000 new cases every year and pitifully few doctors willing or trained to treat it. It is the “by-product” of an uneducated culture firmly rooted in its traditions which are maintained thru relentless poverty. Young girls are married off early, often by 12 or 14, so as to assure their virginity for a suitable marriage partner. It is not unusual for them to be treated as second class citizens (domestic violence is not uncommon) and they are prized for their ability to procreate. Frequently they are taken to live in remote abysmal bush areas, far removed from medical facilities. With no prenatal care, it is not unusual for these young girls to be in labor for up to several days, resulting in death for over 50% of the newborns. The prolonged and unrelenting pressure of the infant’s head in the birth canal cuts off blood flow to the wall between the bladder and the vagina (or rectum, or both, in some cases), leading to tissue death. This tissue death leads to erosion with “holes” (fistulas) to the neighboring organs. Vesicovaginal fistula is an abnormal opening between the vagina and the bladder that allows the continuous and involuntary discharge of urine into the vagina, from where it flows freely out of the body. Rectovaginal fistula, occurring in 20% of the cases, is bowel incontinence thru the vagina. With subsequent childbirth, these fistulas often enlarge and get infected, and without treatment, this leads to weakness, cachexia and possible death.
The psychological toll almost defies description. Imagine being an adolescent girl who suddenly finds herself without bladder (or bowel) control. What an appalling situation! They often restrict liquids and food to decrease the leaking or seepage, resulting in marked malnourishment and kidney disease. They are shunned by their husbands who frequently leave them, and family members who view them as offensive. It is not unusual for them to be sequestered in small huts on the outskirts of their villages with limited personal contact. They are so poor that they use whatever rags they can find to absorb the soiling, then wash, reuse, wash, reuse.
Another cause of fistula in young women is secondary to infibulation, or ”female circumcision” (also called female genital mutilation: FGM) still practiced routinely by certain African Tribes. Even though it was finally banned by the Kenyan legislature in 2010 (barely 2 years ago!), the law is practically impossible to enforce. In this horrendously archaic and barbaric ritual, a pre-pubescent girl’s clitoris and most times, the labia as well are cut off (without anesthesia or sterile equipment, perhaps with just old knives or sharp rocks) and her vagina stitched tightly closed leaving a miniscule opening for urine and menstrual flow. She is then “unstitched” a short time later when a husband is found. Unfortunately, the damage is already done. These young girls suffer chronic pelvic infections which lead to anemia, dysmenorrhea, compromised fertility, life-long discomfort, and often times, fistula. It is not uncommon for them to be HIV positive.
Jared gave me a tour of the clinic, which had been an old condemned house. A small outside shed was the new kitchen where 3 young cheerful cooks prepared greens and rice for lunch.The original living room was now the patient waiting area, 2 bedrooms were made into exam rooms and the original kitchen with its kitchen sink became the scrub area and surgery suite. I was given permission to observe 4 women who were scheduled for surgery the following day and were receiving their pre-surgical exam. Two of them (one was very young, the other 67 years old) had been circumcised. The doctor spoke to the older woman in Swahili and learned that this was her first gynecological exam. He carefully explained that he would insert a catheter into her urethra and then fill the bladder with sterile saline solution colored with a blue dye (gentian violet). By observing thru a vaginal speculum, he could watch the stream of leakage and assess the size and location of the fistula. Almost immediately as he filled the bladder, the blue liquid flowed freely out thru her vagina and into the basin beneath her. She said she had been incontinent of urine since 1985 and only recently heard that this operation is available. It has a 90% success rate for simple cases and 60% in complicated ones. Three more patients were examined, one with a rectovaginal fistula. After the exams, the ladies went outside and chatted with the dozen or so other patients who were staying in the clinic wards, recuperating (seen in the photo outside the clinic).
We’ll see what tomorrow brings for them...hopefully, a new way of life, they have certainly suffered enough-
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| The Fistula Hospital in Eldoret |
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| The cooks are in the kitchen...fresh greens for lunch! |
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| Ladies lying down are post-surgical; those standing will have their operations tomorrow. |
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| Clean, tidy dorms where the ladies live for one month post-op. |
