When childbirth leads to lifelong tears
When she finally walks down the aisle on Saturday, June 8 to say “I do” to the love of her life, Sarah Omega will not only be making a major step in her life, but also celebrating a freedom and peace of mind that she almost lost a few years ago.
The ceremony will also usher her into a world she almost gave up on at the lowest point of the curve of her life, a trying time that shamed her so much that she decided she will never start a family, let alone have a man in her life.
“The very idea of having a boyfriend actually made me sick,” Sarah says, somehow managing to discuss that sad chapter of her life with a wide, reassuring grin. “The simple thought of it was revolting. How times have changed!”
That reassuring grin lights up a young woman seated next to her who looks disturbed, stressed and quite unsure of herself.
Even as we chat away, raising and lowering our voices to carry the message home, the girl seems spatially away, her gaze so empty it pierces the soul. Sarah reaches for her hand, strokes it and pauses for thought.
In the muteness of the moment, the two understand each other. They, after all, have walked down the vales of the same hell, soaked in the self-disgust and hatred that many find too hard to bear.
We are all at the Gynocare Fistula Centre in Eldoret, where Sarah has come to give moral support and inspiration to young Susan and two other women who are about to get into an operation theatre for corrective surgery, all hoping against hope that their “days of dishonour” will be washed away by the two-to-seven-hour operation they have so eagerly waited for.
Pregnancy complications
Sarah, a “survivor” of the condition medics call obstetric fistula, understands the emotions coursing through these women all too well. Caused mainly by pregnancy complications that leave the woman with injuries on the birth canal, the condition has become so prevalent that doctors say something has to be done to stem it, fast.
Prolonged labour and obstructed delivery—in most cases because the woman is unable to access medical care in time—puncture a hole between the birth canal and the excretory system, resulting in an abnormal connection.
“It is a poor (wo)man’s illness,” says Dr Hillary Mabeya, head of reproduction health at Moi University and one of the country’s few fistula surgeons. “Its victims are usually women and girls from poor, marginalised and illiterate communities.’’
Dr Mabeya says victims of the condition live in shame, ostracised and excluded by families and communities because the condition leads to an uncontrollable leakage of urine and, in extreme cases, even stool.
As a result, affected women live with a sense of shame and lack of self-confidence. Afraid to mix with other people, they keep to themselves as they attempt to hide the shame of stench caused by the uncontrolled leaking.
Research has, however, shown that while victims of the condition may feel unwanted, the societies in which they live actually regard them with sympathy. “However, because of the embarrassment that comes with the condition, most victims decide to isolate themselves,” says Dr Stephen Wanyee, a surgeon and assistant representative at the United Nations Population Fund (UNFPA).
When help is slow coming, some commit suicide. Sarah would have been part of that statistic had help delayed in its tracks. After living with the condition for 12 “harrowing” years, she says she felt life was not worth the daily stress and contemplated ending her life.
“Looking back, I am still not able to explain how I managed to go through that living hell. Every night I would wake up and plead with God to take away my life, but it never happened,” she told DN2 at the Moi Referral Hospital in Eldoret last Friday.
Her trauma was even more psychologically painful for her because, she says, the pregnancy that led to it all was as a result of “forced sex” by a clergyman when she was only 19. After three days of prolonged labour, she delivered a stillborn baby weighing 4.8kg at the Kakamega Provincial District Hospital through a ceasarian section.
Just as she was beginning to think the worst was over, and even before she recuperated from the CS surgery, doctors at the hospital told her she had developed fistula and would require more observation.
Two months later, they released her from the hospital without having carried out any corrective procedures on her, only explaining that the surgery she required was too expensive that her only hope lay in donors.
After years of struggling with the condition, Sarah went into depression and was admitted at the Moi Referral Hospital in Eldoret, where she met Dr Mabeya, the man who would eventually save her life.
“One of the doctors realised that I had a urine leakage problem and suspected it was the cause of my mental state. He referred me to Dr Mabeya... and the rest is history,” says Sarah, now an anti-fistula ambassador.
“Since that day in May 2007, I decided not to rush to start a family or even get a boyfriend. I swore to God that I would use my second chance in life to seek out women and girls with the condition and persuade them to come out of their shame cocoons, seek treatment and live decent lives.”
Sarah is now the manager of the local branch of One By One, a US-based non-governmental organisation which works with Gynocare to seek out women with fistula and help them access treatment.
Last December, the United Nations General Assembly designated Thursday, May 23 2013 as the first International Day to End Obstetric Fistula, and organisers plan to kick off comprehensive campaigns against the condition.
In Kenya, UNFPA will lead activities to mark the day in Eldoret town, home to two of the country’s eight fistula surgeons—Dr Mabeya and Dr Amon Chirchir, also of the Moi Referral Hospital.
Dr Wanyee says participants will mark the day by reflecting on progress made in the last 10 years and raising awareness by generating “new political and financial support to accelerate efforts of the campaign to end fistula”.
“There is a very urgent need to address this severely neglected health and human rights tragedy,” he says.
Part of the reason why the condition has not received favourable attention from the government, donor agencies and doctors is that it is not “lucrative enough”, says Dr Mabeya.
“Most patients are from very poor backgrounds and, in some cases, we even have to pay for their transport back home once they recover. You can only do this job as a service to humanity.”
Severe depression
The cost of the corrective surgery ranges between Sh50,000 and Sh70,000, excluding any further cost of psychiatric management of the women after surgery because some come in suffering from severe depression.
In Kenya, the condition is rampant in West Pokot, Kajiado, Samburu and South Nyanza. Girls from pastoral communities that still practise female circumcision and child marriages are particularly vulnerable to fistula since they conceive at an early age, way before their pelvis has fully matured, leading to obstructed delivery after prolonged labour.
Doctors say they have come across women in the 80s who have lived with the condition for more than 50 years. One of these is a woman from West Pokot who was recently cured after living in isolation for 57 years.
“She was abandoned and isolated,” says Dr Mabeya, “and although she does not have children, she is grateful that she will at least be able to lead a decent and normal life for the remaining years of her life. Giving such women back their happiness is what gives us the motivation to keep doing the work. When I bring a smile back to the girls who are forced to clean matatus or forced to pay more for soiling them, I could not ask for more.”
“This should not be happening in this day and age,” says Dr Chirchir, recalling that the last fistula care hospital in New York was closed down in the 1890s after the eradication of the condition, “long before researchers discovered penicillin”.
But it is happening in Kenya. In the 21st century. The shameful proof of it all is at the Gynocare Fistual Centre in Eldoret, where Susan, the young girl at the start of this story, is recovering after corrective surgery. Aged only 15, she developed the condition after a long obstructed labour that led to a CS that did not save the baby two months ago.
After further probing, she reveals that she is “married” to a 37-year-old man to whom she plans to go back after she fully recovers.
Source: Daily Nation