Fistula is a devastating injury which is almost always sustained in childbirth, after an obstructed labour. This happens when the delivery of the baby stops often because the baby’s head is too big to pass through the mother’s pelvis. It is a tragic condition that leaves women leaking urine, feces or both. It can lead to chronic medical problems and cause social exclusion. Women are often abandoned by their husbands and sometimes by their own families because of their incontinence and unpleasant smell. They face depression and social isolation—either self-imposed or caused by their communities.
According to the Unite Nations Population Fund (UNFPA), around two million women are living with this affliction in the developing countries and around 50 to 100 thousand encounter this problem annually but only fifteen thousand of them get proper treatment and rehabilitation.
On the 11th June, 2019 the International Day of Fistula was marked at the Kudo Himbasha Hall in Mendefera under a theme “let’s work together to end fistula”. One of the areas Eritrea has achieved remarkable success in the health sector has been reducing child and mother mortality rates and things related with it such as fistula. A fistula rehabilitation center was opened on the premises of the Mendefera Referral Hospital to treat women with these kinds of problems.
Yirgalem Issak works as a head nurse at the Fistula Treatment Center based at the Mendefera Referral Hospital. She says “any hole between the birth canal and bladder or rectum, which causes pain and chronic infections, is called fistula. It causes incontinence, which often leads to women’s social isolation”.
It prevents women from getting together with their relatives and family members because of the bad smell. They become fed up with their lives. Some of them get divorced because of their incapability which creates further social problems for themselves and the family at large. “They have to work at home, cooking, cleaning and doing laundry as housewives but are not able to do any of that properly. This makes them feel incapable and useless in society”.
The main causes attributed to this problem are underage marriage and rape although they can be experienced by any mother who encounters prolonged labor. Especially when it happens to underage mothers, the effect could be severe because they are not prepared both physically and mentally to give birth. As a result it is often hard for them to tolerate it and cope with it.
Nurse Yirgalem says usually when the patients are first admitted to hospital they arrive chronically ill. They refrain from eating and drinking to avoid having to go to the waste room which often leads them to become underweight and severely malnourished. These problems, coupled with the grime, aggravate their injury. In some cases these problems cause disability in their legs that may be cured or become permanent for some of them. “The first thing we do when they first arrive here is that we help them get a balanced diet and check their hygiene. What is equally important is the intense psychological assistance we offer in order to rehabilitate them fast. The effects are much more than the physical pain. Therefore they must be brainwashed before they undergo medical surgeries,” says Nurse Yirgalem.
She remembers a woman with fistula who was severely malnourished, weighing only 25 kg when she was admitted to hospital. She couldn’t even stretch her legs. “When we gave her all the necessary treatments, she quickly recovered and her weight increased instantly to 56 kg,” she recounts. She is now fully recovered and pregnant for her second child. Most of the women who get rehabilitated at the center go to the hospital to give birth if they get pregnant again.
Treatment at the fistula center does not end with the surgeries and post-operative medical care. Other than the medical assistance, the center also provides vocational training such as weaving, literacy and hair braiding with the help of the National Union of Eritrean Women and the National Union of Eritrean Youth and Students in order to help them sustain their lives after their discharge. This has proved to be very helpful in the past and will continue with further motivation.
The National Fistula Rehabilitation Center was opened in 2007 in Mendefera Referral Hospital. Before the rehabilitation center was opened, patients were called through radio announcements every six months. The fistula operation started in 2004 in Massawa. Then it moved to Dekemhare in 2006 where it offered treatments for three rounds. The operations were led and conducted by committed health workers such as the renowned Dr. Habte and Dr. Morgan at this time. Currently, the center receives patients from all over the country. Some of the patients are treated permanently at the center while others come in every three months after the initial surgeries and medication. The center covers the cost of treatment, medication and transport for patients, and supports training for the hospital’s expert fistula surgeon.
The center has increased its capacity and is gaining experience. It is now recruiting new health professionals specializing in this area. The operation it offers is also improving from time to time. Nurse Yirgalem recommended that the campaign on the awareness of this disease should increase in order to prevent the social isolation the women face and help them get immediate and proper treatment.
Mrs. Rigat Yakob came to Mendefera from Tesseney to get treatment for her fistula. She encountered a prolonged labor in hospital at Tesseny and was referred to Barentu and then to the National Fistula Rehabilitation Center in Mendefera. She suffered terribly while giving birth to her third child.
“At the beginning, I was ashamed to tell anyone that I had fistula. Most of the time, I could not take part in social gatherings because I smelled bad. My life became very hard. I could not talk to anyone about my condition because of shame,” Mrs. Rigat recounted.
“It made my life completely unbearable.”
Fortunately, her family stood by her. “Especially my husband assisted me with everything available in his power. I am happy, healthy and hopeful again after the operation,” she said. “I am a capable member of society once more and can start over with my child, husband and family members and live a normal life,” she said.
Mrs. Asha Kerar, one of the patients who married underage, from Agum (sub-zone of Barentu) had given birth without a health attendant and as a result suffered terribly. This had left her with severe obstetric fistula. “Similar to other fistula survivors I have benefitted from counseling and the vocational training which will help me re-establish my life. I was divorced because of the problem that happened to me and my life was ruined, but now I can’t wait to go home to reunite with my family and restart my life. We are very thankful to the doctors who took care of us so well,” she said.
Nurse Yirgalem called upon every woman suffering from obstetric fistula to seek help without any concern and shame. “I also want to tell them to be careful not to go through childbirth without a skilled birth attendant to assist them during delivery,” she added.