KENYA: In Visunu village, south of Webuye town in western Kenya’s Bungoma county, a bright Thursday morning unfolds. Diana Wafula is engrossed in dishwashing inside her hut after breakfast, while two of her grandchildren enjoy the warmth of the sun outside.
Aged 69 and a mother of fifteen, Wafula will soon head to her farm to weed the maize. This was a task she couldn’t perform for several months in 2021, as she had undergone corrective surgery to repair a fistula that developed during the birth of her youngest child in 1992. Recounting the experience, she explains, “It started as a boil, and I went to a traditional doctor who cut it with a razor blade. I didn’t know he had cut it badly, and it became weak, making it tear when I was giving birth.”
Wafula represents one of many women burdened with silent suffering, enduring stigma within their communities, and grappling with the harsh reality of being marginalized due to the foul smell of leaked urine and stool.
The U.S. National Cancer Institute describes a fistula as an abnormal opening or passage between two organs or between an organ and the body’s surface. Fistulas can be caused by injury, infection, inflammation, or may accidentally occur during surgical procedures.
The International Day to End Obstetric Fistula on May 23 provided information on a type of fistula that results from prolonged labour in women. The United Nations Population Fund (UNFPA) identifies obstetric fistula as one of the most severe and tragic childbirth injuries.
The UNFPA explains that an obstetric fistula is a hole between the birth canal and bladder and/or rectum, caused by prolonged, obstructed labour without access to timely, high-quality medical treatment. It leaves women and girls leaking urine, faeces, or both, and often leads to chronic medical problems, depression, social isolation, and deepening poverty.
Half a million women and girls in sub-Saharan Africa, Asia, the Arab States region, Latin America, and the Caribbean are estimated to be living with fistula, with new cases developing every year.
Wafula’s case is unique in that childbirth was not the primary cause of her fistula. Instead, it falls under the category of iatrogenic fistula, which refers to fistulas caused surgically during elective gynaecological operations like hysterectomy or through traumatic injury, such as dilatation and curettage, according to the International Federation of Gynaecology and Obstetrics (FIGO).
Regrettably, fistula is largely preventable, yet its persistence serves as a constant reminder of gross inequities, a symbol of global inequality, and an indication that health and social systems are failing to protect the health and human rights of the poorest and most vulnerable women and girls, as noted by the UNFPA.
Bungoma governor Ken Lusaka, during the inauguration of a camp aimed at providing free corrective surgery for women with fistula, acknowledged the ostracism and poverty faced by these women and girls in their communities, preventing them from engaging in meaningful labour.
He shared testimonies from women in the hospital wards, where they expressed the breakdown of their marriages and the unhappiness resulting from their inability to even attend church. However, Lusaka emphasized that their dignity had been restored through the camp’s efforts.
Bungoma County, despite making progress in reducing maternal mortality rates, faces a concerning statistic. With over 30% of gender-based violence (GBV) cases in the county, it surpasses the national average of 13%. GBV is also a contributing factor to fistula. Governor Lusaka expressed his discontent, stating, “This is a real shame. Honestly, Bungoma cannot be ranked like that. It is a shame for me to be your governor leading in gender-based violence. We must reverse this.”
John Kutna, the program manager for reproductive, maternal, and child health at Amref Health Africa, emphasized the impact of fistula on women’s and girls’ dignity within society.
He described it as a humiliating condition that diminishes their self-esteem, subjects them to societal hardships, and he expressed hope that supporting these women would bring smiles back to their faces.
The delay in accessing maternal services during labour is associated with obstetric fistula, as the condition commonly develops when women experience prolonged labor without immediate access to quality healthcare.
This delay stems from various factors linked to poverty. Dr. Weston Khisa, a consultant fistula surgeon, highlights the prevalence and severe consequences of obstetric fistula, noting that it leaves the patient with a life-altering injury.
He shares his experiences from various rural hospitals in Kenya, Tanzania, Malawi, South Sudan, the Democratic Republic of Congo, Sierra Leone, and Uganda, where he encountered numerous cases of fistula in women.
Kenya commemorated the International Day to End Obstetric Fistula in Bungoma County, where a consortium of humanitarian organizations joined forces to conduct a week-long camp, offering free corrective surgery to a total of 49 women.
The camp succeeded in restoring these women’s dignity through surgery, relieving them of years of living burdened by stench and isolation. Their joy was evident as they danced in the hospital wards, frequently laughing while conversing with each other from across their beds.
Before being discharged, the women received health talks from specialist fistula nurse Beatrice Oguttu. They were educated about the necessary exercises for a swift recovery and advised against engaging in strenuous and menial tasks.
The doctors recommended that at least 90% of women who have given birth vaginally undergo an elective caesarean section in subsequent pregnancies, suggesting a waiting period of at least two years after the surgery.
Dr. Khisa, the lead surgeon during the camp, acknowledges that there is hope for eradicating fistula. He explains, “If we look after our women, fistula can disappear, the way it has happened elsewhere in the world in developed countries. Much of what we see is a blockage of services to the woman, and it starts from low in the village where they deny them education, so they can get a job and decide for themselves when to get pregnant. Those are ills that lead to fistula formation.”