Today I met Celestina, Nkwimba, Speciosa, and many other incredibly brave women who have found their way to the fistula ward at Bugando Medical Centre in Tanzania. Their stories are different but revolve around the same theme: prolonged and obstructed labor, often in a village in absence of a trained birth attendant. When no baby is delivered after many long hours—or more likely days—and there is no money for bus fare to take them to the nearest health center or hospital where a cesarean section is available, they are left with a hole in the birth canal causing chronic incontinence and are often ostracized by their communities.
These women have endured what women in the developed world will never have to endure. Many of us outside the public health circle do not know this condition. Why should these women have things any differently? Here are their stories—certainly sad but also hopeful, as they are some of the lucky few that have made it to a surgical center and have great potential to leave Bugando with their dignity restored.
Celestina is from Kigoma region along Lake Tanganika, many hundreds of kilometers (about 300 miles) from Bugando. She was in labor for three days at home with her eighth child. She did not have the bus fare to make it to the district hospital in time. When she finally arrived, her baby was stillborn and she had developed a fistula. During a routine outreach visit that the Bugando Medical Centre surgeons do in hospitals around the country, Celestina learned of the fistula repair services available at Bugando. (There were too many people on the waiting list in Kigoma for Celestina to be treated there.)
She had her fistula surgery two weeks ago and is healing nicely. When she is discharged from the hospital, she will be given bus fare for her trip home. Only when she arrived at Bugando did she realize that she was not alone in suffering from this condition. She will spread the good news that treatment is available at Bugando to others in her village who may have fistulas.
In March, Nkwimba went into labor with her eighth child in her village in Shinyanga District. She was also at home and had no bus fare to the hospital, which was too far on bad roads. Nkwimba suffered significant injury in childbirth, including paralysis of her right leg due to prolonged obstructed labor, severe back pain, and two fistulas, vesico-vaginal (VVF) and rectal-vaginal (RVF). She has been at the hospital since May when her husband was able to afford to bring her to the VVF ward. Her leg feels much better now, and the RVF has been repaired. She is still waiting for her VVF surgery, which could be several more weeks, given the ever-expanding waiting list. It is amazing that she can still smile given what she has been through.
Speciosa is from a small island in Lake Victoria. She is one of the older ladies in the VVF ward at 39 years old. Speciosa developed a fistula 10 years ago when giving birth to her first child, which was stillborn. Since developing a fistula, she has been divorced from her husband and has no children. She is waiting for her third surgery; the first two – performed over the last five years – have not been successful. For many women, one surgery repairs the fistula. Speciosa remains hopeful. She has taken on a maternal role among the pre- and post-surgery patients in the VVF ward.
More than two million women worldwide suffer from fistula and have similar stories to Celestina, Nkwimba, and Speciosa. Eighty percent of these women are in Africa. Direct Relief can do a significant amount for them and for the incredible surgeons who have dedicated their life to helping these women who are the poorest of the poor. There are not many doctors who want to do VVF repair as it is a time-consuming procedure and more urgent cases take precedence (i.e. cesarean sections, which, of course, are critical to preventing the fistulas in the first place). Fistula repair is clearly part of maternal and child health that is at the core of what we do. Fistula does not directly cause maternal mortality—very often prolonged and obstructed labor results in the death of the child—but it is the worst kind of injury and morbidity in childbirth I can think of.
I realize what I’ve written sounds rather sad, but really it was a hopeful day as these women have access to treatment that will truly change their lives. The women were happy to tell me their stories and were laughing and smiling, and particularly enjoyed looking at their digital portraits.
Women must have access to cesarean section and good emergency obstetric care if the incidence of maternal and infant mortality and morbidity, including fistula, is to be reduced. Small steps are being taken by our partner facilities in Tanzania and throughout Africa to make this a reality. In select regions, Direct Relief is helping to facilitate the installation of operating theater suites that have enabled more women to get the care they need.
Until fistulas are eradicated in Tanzania—as they have been in the developing world—with the advancement of good emergency obstetric care, BugandoMedicalCenter’s VVF program and its outreach treatment services give women a reason to smile.