Shattered joys: A mother’s 20-year battle with obstetric fistula

For many expectant mothers, the labour room signifies a gateway to bliss, heralded by the first cry of a newborn. But for Bassy (not her real name), that moment marked the beginning of a nightmare spanning two decades.

Twenty years ago, Bassy entered a prominent hospital in Accra to deliver her first child. She was full of hope, eager to embrace motherhood. However, complications during childbirth left her with obstetric fistula—a devastating condition that stole her dignity, livelihood, and marriage.

The ordeal began when Bassy attempted to deliver her 4.5kg baby naturally. Despite the baby’s size, she wasn’t advised to opt for a cesarean section, popularly known as (CS). During the prolonged and obstructed labour, she suffered a fourth-degree tear—a severe injury extending into the rectum.

“I was young and unaware of the risks,” Bassy lamented. “After delivery, they told me the tear was too severe to be sutured immediately and that I needed a specialist.”

Delayed medical intervention compounded her condition. By the time a doctor attended to her, the repair attempt failed. Over the years, multiple surgeries—each more hopeful than the last—ended in disappointment.

The cost of treatment drained Bassy’s finances. With each failed surgery, her hope dwindled, and the stigma of her condition isolated her from friends and family. “I couldn’t work or socialise because of the constant stench,” she revealed.

Her marriage also crumbled under the weight of mounting medical bills and unfulfilled promises of recovery. “My husband eventually gave up, and I was left to fend for myself,” she recounted.

Could it have been prevented? 

For her, the medical team that attended to her during her labour could have saved her from the condition if they had informed her about the size of the baby.

“Nobody told me that the baby was that big that I could not deliver because I was young,” she said, blaming the nurses for negligence.

“I spent the whole day in the hospital and they didn’t get a doctor till the next morning,” Bassy explained, adding that she delivered her baby around 12pm but had to wait for the next day before a medical doctor could attend to her and even with that, they could not fix the tear.  

According to her, after the first repairs broke down, she went home to gather some money for a new repairs. And after the second repairs, it broke down again. 

Considering the cost involved in each surgery, she had to stay home for some years to be able to gather another money in order to enable her to try the surgery at a different hospital. Unfortunately for her, that one too broke down. 

“I couldn’t get any doctor that could do it very well for me,” Bassy said, adding “after the repairs, you will find out that there are leakages all over.”

She said the condition “got her stuck” as she could not do much for herself, stressing “Where can you go with such stench? I was just hanging around, always looking for where to go next; and looking for money to do another repair.”

Desperate efforts 

She shared that she also visited Tema General Hospital, but was informed that the surgery could not be performed there. Consequently, she was referred to the Korle-Bu Teaching Hospital in Accra.

As Bassy recounted, during her time at Korle-Bu Teaching Hospital, the doctor assigned to perform her surgery suggested it be done at his private facility instead. Desperate for a solution, she agreed. Sadly, the fourth surgery also failed, leaving her condition unresolved.

Following the fourth surgery, Bassy began experiencing severe abdominal pain, prompting her to return to the private facility for another procedure. It was during this subsequent surgery that the doctors discovered a foreign object had been left in her abdomen during the earlier operation. This oversight left her unable to urinate or pass fecal matter. "I was in excruciating pain," she narrated.

Legal actions

When questioned about taking legal action against the health facility responsible for leaving something in her abdomen during surgery, Bassy said she did not.

"How could I pursue legal action? At that point, what evidence did I have? They could see what they had done; they knew exactly what was going on. All I could do was pray and hope to recover," she explained.

She revealed that it took nearly five years after the fourth incident before she could afford another surgery. After painstakingly saving enough money, she underwent a fifth procedure, hoping it would finally bring her relief. Unfortunately, her hopes were shattered when a negligent nurse compromised the results of the surgery.

According to her, after the fifth surgery was done, she went to the facility for her wounds to be dressed, unfortunately for her, the nurse who attended to her did not know that the suturing was done with a dissolvable stiches, hence opening the wounds by untying the suture. 

“She tore everything when she removed the stiches,” Bassy noted, adding “The nurse didn’t know. Even with the pain I was going through and shouting, she managed to remove everything.”

She recounted that following her harrowing experience with the nurse, she underwent three additional surgeries in an attempt to repair her fistula, but each one ended in failure. 

Her condition worsened significantly, leaving her in a more dire state than when she first sought treatment, as infections began to ravage her health. "I was in constant pain," she lamented.

Road to salvation 

Salvation came when someone told Bassy about the Fistula Repair Centre at the Mercy Women Catholic hospital at Mankessim in the Central Region. After years of suffering, she finally found relief.

“I don’t know how they did it, but Mankessim gave me my life back,” she said with gratitude, appreciating the facility and Dr. Gabriel Ganyaglo, a renowned Ghanaian fistula surgeon, for their expertise.

Angry over forced consent 

Although Bassy has regained her life, she still remains deeply resentful of how the nurses handled her delivery. She revealed that when the tear occurred, the nurses failed to inform her about it. Instead, they took her hand and forced her to thumbprint a form, which she later discovered was a consent document indicating that she had opted for a natural delivery.

“When it happened on the delivery bed, the nurses held my hand and forced a thumbprint on a form. Later, when I read the form, it suggested that I had been informed the baby was too big and should have been delivered via surgery instead of naturally,” she recounted.

She continued, “They didn’t consult me. They just grabbed my hand and thumb-printed the form themselves. I was lying there, lifeless, unable to resist after they had done so much to deliver the baby.” 

For Bassy, it was God who saved her baby from dying, saying “My son survived for a reason.”

Bassy recounted that when the tear occurred, the doctor on duty who assisted with her delivery informed her that his shift had ended and he could not perform the stitches. This left her unattended for over 24 hours until a new doctor arrived to perform the procedure, which ultimately failed.

“There was no doctor available to attend to me. I was left in the hospital for hours without care,” she lamented, adding “My whole life was turned upside down.”

For Bassy, the condition had “disrupted my work and my marriage.”

She revealed that when her son, now a university student, was preparing to begin his studies, her condition made it extremely difficult to secure the funds needed for his admission.

At her lowest point, overwhelmed by the weight of her struggles—no job, no marriage, and no relief from her condition—she contemplated ending her life. 

“You feel like a useless person just hanging around. You wonder, if nothing is working, why not end it? You see others moving forward with their lives, achieving things, while you remain stuck with your problem,” she shared.

Reflecting on her experience with fistula, she said, “Once you’re afflicted, your life feels completely limited. You find yourself in constant danger, feeling so defeated that nothing else around you seems to matter.”

Advocacy 

Bassy’s lonely road to successful recovery from fistula and its attendant shame had emboldened her to now speak for people who are going through the same challenges, encouraging them not to give up but to seek help. 

For her, “Education is crucial”, noting that “Many women endure this in silence, thinking it’s a curse or punishment.”

Bassy’s story is not unique. Women like Marian Tuffour, who suffered fistula after a cesarean section, and Rahina Yahya, whose community’s beliefs led her to endure a dangerous natural birth, highlight the widespread impact of this condition.

About fourteen years ago, Rahina endured a traditional delivery to avoid being stigmatised. In her community, women who seek hospital care for childbirth are often labeled as unfaithful to their husbands.

After her delivery complications, Rahina’s husband accused her of infidelity, claiming her condition was a divine punishment. This accusation led to her being ostracised from his home, forcing her to move in with her mother while caring for her newborn.

According to her, it was a U.S.-based NGO visiting her village in the Nanumba South District that eventually took her to Tamale for a surgery.

When she healed, her husband sought reconciliation, but she refused, choosing instead to live independently as a single mother. 

In Ghana, obstetric fistula remains a significant challenge. The World Health Organisation (WHO) estimates that over two million women globally live with the condition, with 50,000 to 100,000 new cases annually in developing countries.

Calls for Action

Health and gender advocates, including Ms. Josephine Oppong-Yeboah and Alhaji Kariama Awal of RISE-Ghana, stress the need for increased education, accessible healthcare, and community support to prevent and treat fistula.

Ms Oppong-Yeboah is of the view that women suffering fistula feel shy to seek medical intervention or report to health facilities, hence making it difficult to determine the actual prevalence rate in the country.

She noted that although much progress has been made to address fistula, interventions have often failed to reach those most in need.

She expressed the worry that in some communities, obstetric fistula is seen as a punishment for evil doers or as a result of a curse, a situation she noted, compels people to often seek help from spiritual healers instead of health facilities.

She also admonished health workers to respect the rights and dignity of those suffering from fistula and who seek medical attention in health facilities.

Ms Oppong-Yeboah said fistula is as a health condition could be prevented by improving the quality of maternal health care, education as well as empowering women and girls and their communities.

She explained that apart from prolonged and obstructed labour that mainly cause fistula, other factors such as rape and defilement can all cause fistula.

For his part, Alhaji Awal said deliveries at home mostly result in fistula, explaining that if the baby’s head is big and is unable to pass through the birth canal but the woman is forced to deliver, it could lead to fistula.

He explained that fistula can happen to any woman whether they had given birth before or not, adding that preventing fistula “depends on how you manage your labour and where you deliver.”

He explained that the condition is quite prevalent in the five regions of northern Ghana due to the deprived nature of the regions, coupled with lack of adequate access to maternal healthcare services.

“We need to do a lot of education on fistula. Many people are unaware about the condition and so they consider it as a spiritual thing,” Alhaji Awal noted. 

Both Ms Oppong-Yeboah and Alhaji Awal urged lawmakers to allocate resources for fistula repairs and fight the stigma surrounding the condition, arguing that “Stigmatisation worsens the plight of victims.”

They also called for the inclusion of the condition on the list of cases that the National Health Insurance Scheme (NHIS) covers. Their reason is that many of the victims could not afford the total cost of the treatment. 

There is hope 

The Ministry of Health, in collaboration with the Ministry of Gender, Children, and Social Protection, recently launched the 2024 Obstetric Fistula Programme. This initiative aims to address the condition through improved maternal healthcare and public awareness campaigns.

Sharing some insights, a renowned Ghanaian fistula surgeon and a member of the National Fistula Taskforce, Dr. Gabriel Ganyaglo, encouraged fistula patients not to endure their condition under the misconception that it is untreatable. 

He said fistula treatment in Ghana is nearly cost-free due to the contributions of the National Health Insurance Scheme (NHIS), the United Nations Population Fund (UNFPA), and other development partners.

That, Dr. Ganyaglo explained, the NHIS covers a significant portion of fistula treatment costs, including hospital admission and basic surgical items. 

“When a patient comes for fistula surgery outside the designated fistula treatment centers, their admission is covered by the NHIS,” he stated. 

While the NHIS does not cover the full cost of surgery, the Ghana Health Service (GHS) ensures that no fistula patient treated within its facilities bears the financial burden.

To ensure comprehensive care, Dr. Ganyaglo recommended that patients seek treatment at specialised fistula repair centers. These centers, funded by UNFPA and international development partners, offer entirely free treatment, covering surgery, hospital admission, and post-operative care.

Fistula Repair Centers in Ghana

Currently, Ghana has two dedicated fistula repair centers – Mercy Women’s Catholic Hospital in Mankessim, operated under the Christian Health Association of Ghana, and the Tamale Teaching Hospital (TTH), managed under the Ghana Health Service.

In these centers, he noted, treatment is fully subsidised, ensuring that patients do not incur any costs. Even for fistula surgeries performed outside these centers, funding from UNFPA is allocated to cover expenses, making treatment free across the board.

The Recovery Process / Statistics 

Dr. Ganyaglo in shedding light on the recovery process for fistula patients, explained that hospital stays after surgery typically last 14 to 21 days. However, he indicated, discharge does not signify the end of treatment and that full recovery can take up to three months, during which patients undergo a new phase of care, including rehabilitation and reintegration programmes.

Referring to a 2015 study, Dr. Ganyaglo revealed that approximately 1,300 new fistula cases are recorded annually in Ghana, with one to two cases occurring per 1,000 births. However, he noted, the absence of recent studies, makes it difficult to determine the current trends.

He said apart from birth injuries that result in fistula, other factors including surgical accidents, certain cancers, trauma, and sexual abuses could lead to fistula.

Dr. Ganyaglo dispelled myths linking fistula to spiritual causes or wrongdoing, pointing out that it is purely a medical issue arising from complicated labour.

To combat stigma and misinformation, the fistula surgeon urged the media to play a pivotal role in educating the public about fistula and its treatment. 

The good news, for him is that even the transportation that the patients spend going to the repair centres are paid back to them by the Ghana Health Service through their sponsors. 

For women like Bassy, Marian, and Rahina, these efforts symbolise hope for a future where no woman endures fistula in silence.

This reporting was completed with the support of the Centre for Journalism Innovation and Development (CJID) in partnership with the Institute for War and Peace Reporting.