Zambia: Women Suffer in Silence As Fistula Takes its Toll

By Lilian Museka

Lusaka, Zambia---We will call our patient Katundu* (for the purposes of patient confidentiality). She is 18 years and lies at the University Teaching Hospital UTH), Lusaka, Zambia recovering two days after undergoing fistula repair. She narrates her story to this reporter.

“When I started experiencing labour pains, I went to Kaphiri Health Centre but the labour was prolonged for two days. The nurses could not deal with my situation and therefore referred me to Kabwe General Hospital, where they took me straight for an operation. However, the baby had already died.

After two days of admission, I noticed urine just flowing uncontrollably. The nurses could not understand what was happening and tried to sort the problem for 11 days without any headway.

I was referred to UTH but since the operation wound was still fresh, I was given painkillers and told to go clean it till the next appointment.

On 7th April, I went back for check up and was given 14th May as the date to check whether the wound had healed to proceed for the repair. I was admitted on the said date and come June 8th, at 8.00, I was wheeled to the operating room and am glad am recovering.”

Patient 2, (Also we shall withhold her identity) was lucky because her baby survived. She had prolonged labour at the Kabwe General hospital and by the time they took her for an operation, the damage had been caused. She only realized she could not control her bladder after the operation. The child now one and a half years was weighing 3.4kgs at the time of delivery.

The mother of other two children only came to learn that the condition could be repaired after awareness by doctors from UTH.

“I was so traumatized and mostly lived in isolation but I thank God my husband has been very supportive and did not run away from me. I am now here at the UTH awaiting an operation to repair my condition,” She says.

Another one who has since been treated, narrated her ordeal:” I started leaking urine at 16 years [of age] after my first pregnancy ended in a miscarriage. My husband immediately left me and my family started shunning me. Since then, everyone in the village has been calling me many names because of my bad smell," Makayi said.

She was one of 31 women in Northwestern Province who underwent surgical correction of maternity fistula. After the procedure she said, "I am in pain just now, but if my problem can finish and I walk home without leaking or smelling urine once more, then this pain will be nothing to me."

A sad testimony came from one victim who said "Above all, what hurts me most is that my husband, who married me when I was 17 years old, had to divorce me soon after I developed this condition and he has now married a close friend of mine."

These are just a few of the many cases of women suffering from fistula. It is a condition where a hole between two body cavities is created that allows urine to pass through direct to the bladder without control.

Dr.Luckson Kasonka, Managing Director at UTH and a gynaecologist, in charge of fistula repair explains that the condition is mostly caused by a birth injury.

“It occurs when the sustained pressure of the baby’s head on the mother’s bladder damages the soft tissues, thereby creating a hole or what is called fistula,” he says.

He continues that if the size of the baby is too big to pass through the birth carnal, obstruction of labour occurs and this causes injury to the birth carnal. This leads to trauma and damage to the area, leading to bleeding after creating a hole, thereby allowing urine to pass through uncontrollably.

The World Health Organisation (WHO) estimates that globally, about 2 million women, mostly in Africa and Eastern Asia, suffer from this condition.

And the doctor says poverty, poor nutrition and high teenage pregnancies are major causes leading to this condition.

Young mothers whose bodies are not sufficiently formed to handle the rigours of childbirth, and women who cannot access qualified maternal health care, are particularly vulnerable to fistula, and to the disgrace, dejection and isolation that come with the demeaning condition.

“Women under the age of 20 are mostly affected as their physical development is usually not mature enough to accommodate pregnancies,” he says.

Another cause of the condition is women giving birth at home. The MD says about 56 percent of women in Zambia have home births, usually assisted by untrained relatives or traditional birth attendants.

“When prolonged labour occurs, they (attendants) do not know what to do but will always keep the patient. By the time the baby comes out, it has shrunk and already dead. Meanwhile they praise themselves of having achieved their mission of helping the woman deliver but forget that a baby has died and more so damage has been caused to the mother,” he adds.

The United Nations Population Fund (UNPF) has been spearheading a campaign since 2003 in the country to promote sound reproductive health using community groups to raise awareness about the condition.

Early child bearing comes about because of poverty and this leads to malnutrition since they cannot afford nutritious food.

Because of their low status in many communities, women often lack the power to choose when to start bearing children or whether to give birth. Older women who have delivered many children are as well at risk, says Dr. Kasonka.

Fistula is a hidden problem because it affects the most marginalized in the community mostly in the rural areas. Many never go for treatment as they live in isolation and stigma. Some are always shunned by family.

Dr. Kasonka says the condition can be treated by reconstructive surgery. The cost is however expensive but it is being offered for free at UTH.

“If you put a charge on it, no one will come out. We in fact have had to go to the villages to do sensitization and get victims because they are too traumatized to speak about it or even tell people about their condition. Some communities will even regard the victims as outcasts as it is considered to be witchcraft,” he says.

He says once a woman undergoes reconstructive surgery, she can resume to her full and productive lives. They can usually have more children but caesarean sections are always recommended to prevent a recurrence of fistula.