Women af­flicted by fis­tula find hope at re­hab cen­tre in Tan­za­nia

A Dar fa­cil­ity is help­ing pa­tients lead nor­mal and full lives once more

The East African - - OUTLOOK - By LUCY TOMEKA Spe­cial Cor­re­spon­dent

Life for Sarah Sa­muel has been a se­ries of deaths — and still­births. She had her first baby at 16, but five months later, she lost it.

That would be the first of four ba­bies the young wo­man from Sum­bawanga in western Tan­za­nia would lose in as many years. She would lose an­other baby, through a still­birth, when she got mar­ried at 17. At age 18, she con­ceived, just as she did at age 19, and in both cases she had still­births.

On her fifth preg­nancy, she de­vel­oped ob­stet­ric fis­tula. Fis­tula is Latin for “hole.” The hole oc­curs be­tween the vag­ina and rec­tum (rec­to­vagi­nal fis­tula) or vag­ina and blad­der (vesi­co­v­agi­nal fis­tula), due to pro­longed, ob­structed labour, leav­ing a wo­man with lit­tle or no con­trol over her urine or fae­ces or both.

“I went into labour early. I was seven months preg­nant,” she said. “When I got to the hos­pi­tal, af­ter hours of labour, the doc­tor de­cided to op­er­ate on me.” This was an­other still­birth. This was too much for not just her hus­band — who aban­doned her — but also her mother and grand­mother, who be­lieved that she had been cursed.

She sought help from her lo­cal health­care cen­tre for her Cae­sarean wound.

“The wound had opened be­cause I was cough­ing so much and I had no­ticed flu­ids com­ing out,” said Sarah.

It is then that she met a doc­tor who broke the news to her: She was not cursed and the fluid was urine.

“He took me back to the theatre, opened my wound, then cleaned and closed it prop­erly,” she re­called.

The doc­tor then re­ferred her to a “hos­pi­tal” in Dar es Salaam — the Com­pre­hen­sive Com­mu­nity-based Re­ha­bil­i­ta­tion in Tan­za­nia (CCBRT). Not only does CCBRT lead in the treat­ment of fis­tula, it is also home to some of the best fis­tula sur­geons and spe­cial­ists in the coun­try.

Other cen­tres that of­fer ob­stet­ric fis­tula treat­ment in Tan­za­nia are Selian (Arusha), Bu­gando (Mwanza), KCMC (Moshi), Peramiho (Songea), Nkinga (Tab­ora) and Ka­banga (Kigoma).

“I am now here in the hope that I will be treated,” she said.

Sarah’s day at CCBRT be­gins with a gen­eral clean-up and break­fast. She then picks up her file from the nurse’s sta­tion and waits for the first round of the doc­tor’s visit.

“Af­ter the doc­tor’s visit, those who are sched­uled for surgery are taken away for surgery prep and the rest of us go about our day do­ing var­i­ous things. Some of us can’t read and write so CCBRT has been gen­er­ous enough to al­low some­one to teach us,” she said.

Some learn crafts such as knit­ting and cro­chet­ing while oth­ers do some hair­dress­ing, she added.

For hundreds of women liv­ing with ob­stet­ric fis­tula in re­mote parts of the coun­try, there is fi­nally a light at the end of this dark tun­nel.

On the In­ter­na­tional Day to End Ob­stet­ric Fis­tula marked on May 23, Tan­za­ni­ans con­verged at CCBRT. The day is set aside to help raise aware­ness about the hid­den in­jury that has caused so much dev­as­ta­tion and dis­tress for af­fected women.

For many of the women at CCBRT, hope for a bet­ter life has been re­stored. With the new skills they are learn­ing while await­ing treat­ment and dis­charge, many hope to take care of them­selves once they are back home. Sarah is look­ing for­ward to open­ing her own busi­ness. She is also glad to be learn­ing ba­sic read­ing and writ­ing which she be­lieves will be an as­set in the fu­ture she seeks.

Once women are dis­charged from the hos­pi­tal, they can lead nor­mal, full lives once again.

“They be­come am­bas­sadors, telling other women and men about fis­tula” said Dr Peter Ma­jinge. “They are free to have more chil­dren in the fu­ture through elective cae­sarean sec­tion to avoid stress­ing of the for­mer in­jured tis­sue.”

The ma­jor­ity of fis­tula pa­tients at CCBRT are women from re­mote ar­eas in the coun­try with lim­ited or no ac­cess to med­i­cal fa­cil­i­ties. Some of them are afraid to seek med­i­cal at­ten­tion be­cause of myths such as witch­craft or an­ces­tral pun­ish­ment.

“Fis­tula is treat­able” said Dr Ma­jinge, “How­ever, we face a lot of chal­lenges, the biggest one be­ing un­qual­i­fied sur­geons try­ing to re­pair a fis­tula and in­stead, caus­ing more dam­age to the wound.” So how does fis­tula oc­cur? Some women ex­pe­ri­ence ob­structed labour, which can last up to six or seven days. The labour pro­duces con­trac­tions that push the baby’s head against the mother’s pelvic bone.

The soft tis­sues be­tween the baby’s head and the pelvic bone are com­pressed and do not re­ceive ad­e­quate blood flow. This causes this del­i­cate tis­sue to die, and where it dies holes are created be­tween the labour­ing mother’s blad­der and vag­ina and/or be­tween the rec­tum and vag­ina. This is what pro­duces in­con­ti­nence in a fis­tula pa­tient

“Fis­tula is treated by means of surgery that re­pairs the hole(s),” said Dr Ma­jinge.

The World Health Or­gan­i­sa­tion rec­om­mends that an in­sti­tu­tion at­tain at least a 75 per cent suc­cess rate for fis­tula treat­ment. CCBRT has sus­tained a suc­cess rate of 83 per cent for the past three years. A suc­cess rate in this con­text does not re­fer only to suc­cess­ful surg­eries but to the num­ber of women who are dis­charged com­pletely dry and re­ha­bil­i­tated.

“Women with fis­tula tend to be dis­crim­i­nated against, stig­ma­tised and mis­treated... this is why we are proud of our suc­cess rate be­cause we are able to re­store the dig­nity of these women and they can go on with their life stronger,” he said.

CCBRT pro­vides fis­tula treat­ment free of charge. Pa­tients are pro­vided with trans­port money to and from the hos­pi­tal, ac­com­mo­da­tion, clothes and toi­letries, food and other ba­sic ne­ces­si­ties while they re­ceive treat­ment.

Fis­tula is treat­able; But un­qual­i­fied sur­geons who try to re­pair it in­stead cause more dam­age to the wound.” Dr Peter Ma­jinge, CCBRT

Pic­ture: File

Par­tic­i­pants at the In­ter­na­tional Day to End Ob­stet­ric Fis­tula on May 23 at the Com­pre­hen­sive Com­mu­ni­ty­based Re­ha­bil­i­ta­tion in Tan­za­nia .

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