Living the fistula nightmare

… As child marriages, poverty fuel devastating condition

By Patience Nyangove

AFTER being given away as a child bride at the tender age of 11, to a man who was old enough to be her father, but who had assisted her family during a drought-stricken period, *Selma (not her real name) fell pregnant two years later, but her baby girl was stillborn.
She had been in labour for four days.
But this was only the beginning of her nightmare 20 years ago, as she developed vesicovaginal fistula or VVF, which is an ab­normal fistulous tract extending between the bladder (vesico) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.
Selma became a human sewer, as the smell of urine and faeces turned into her 24-hour ‘deodorant’.
“At first I would tried to swipe the flies away from me, but as the days became weeks, the weeks became months and the months be­came years, I stopped trying. I let them be. I became a social outcast. No one wanted to be with me; not even my husband or my own family,” Selma told Confidente during an in­terview.
She said she had been given to her husband as an expression of gratitude, after he assisted her family during years of drought and had also given them cattle to till their fields.
Over the years, her medical condition had caused her to contemplate suicide many times.
“My only prayer was that the Lord should take me. It crossed my mind many times to take my own life, but I could never find the courage to do so. However, reconstructive surgery has given me a new lease on life,” she said.
Although Selma’s story may read like it is plucked from the script of an African Magic channel movie, it is what multitudes of wom­en – young and old – are forced to endure, be­cause of VVF.
The majority of these women end up with the condition, due to the harmful cultural practice of child marriages.
VVF is caused by prolonged, obstructed la­bour, and often leads to chronic medical prob­lems, depression, social isolation and deepen­ing poverty.
Without emergency intervention, obstruct­ed labour can last for days, resulting in death or severe disability. The obstruction can cut off blood supply to tissues in the woman’s pelvis. When the dead tissue falls away, the woman is left with a hole – a fistula, in medical terms – in the birth canal.
Tragically, there is a strong association be­tween fistula and stillbirth, with research indicating that approximately 90 percent of women who develop obstetric fistula end up delivering a stillborn baby.
Dr Penoshinge Shikonga, a medical practi­tioner at the Windhoek Central Hospital, says from January 2016 to date they have attended to 24 cases of women suffering from fistula.
The women are aged between 19 and 55 years.
Dr Shikonga says that in Namibia, fistula is more common in areas around Rundu, with some of the patients coming from Angola, as well as Opuwo in the Kunene region.
“In rural areas, especially patients via the Rundu referral hospital, come from Angola. We also see patients from Opuwo, because of early marriages,” he said.
Dr Shikonga also told Confidente that cur­rently there are two women awaiting recon­structive surgery for fistula, which costs N$30 a minute to perform
“The theatre is N$500 and the operation is about two hours. It costs N$30 per minute. VVF repair is mainly done at the Windhoek Central Hospital, but Oshakati also does some cases. It is a specialised procedure,” he said.
Dr Shikonga also explained how women with fistula are not only physically, but emo­tionally scarred, from their ordeal.
“Women with VVF are affected psychologi­cally; they feel isolated. They are not accepted in the community. Most of their marriages break up, because of this condition. There is also a financial loss. Women rather want to be isolated, because of the smell, and they always have to use sanitary pads, and other necessari­ly items, to keep them dry,” Dr Shikonga adds.
United Nations Population Fund (UNFPA) Namibia Monitoring and Evaluation Special­ist, Philomena Ochurus, describes obstetric fistula as one of the most serious and tragic childbirth injuries.
“Yet, fistula is almost entirely preventable. Its persistence is a sign of global inequality and an indication that health systems are fail­ing to protect the health and human rights of the poorest and most vulnerable women and girls,” she said.
“As the leader of the campaign to end fis­tula, the UNFPA provides strategic vision, technical guidance and support, medical supplies, training and funds for fistula pre­vention, treatment and social reintegration programmes.
“The UNFPA also strengthens reproductive healthcare and emergency obstetric services, to prevent fistula from occurring in the first place,” Ochurus said.
It appears that Namibia’s high rates of pov­erty, especially in remote rural communities, are also contributing to the surge in the num­ber of obstetric fistula cases. Ochurus said the medical condition has essentially been elim­inated in industrialised countries, through the availability of timely, high-quality medical treatment for prolonged and obstructed la­bour – the Caesarean section.
“Today, obstetric fistula occurs mostly among women and girls living in extreme poverty, especially those living far from med­ical services. Childbearing in adolescent girls before the pelvis is fully developed, as well as malnutrition, small stature, and generally poor health conditions, are among the phys­iological factors contributing to obstructed labour. However, any woman may experience obstructed labour, including older women, who have already had babies,” she added.
Ochurus said that if left untreated, obstet­ric fistula causes chronic incontinence and can lead to a range of other physical ailments, including frequent infections, kidney disease, painful sores and infertility. The physical inju­ries can also lead to social isolation and psy­chological harm.
Women and girls with fistula are often un­able to work, and many are abandoned by their husbands and families, and ostracised by their communities, driving them further into poverty.
“The continued occurrence of obstetric fistula is a human rights violation, reflecting the marginalisation of those affected and the failure of health systems to meet their needs. Their isolation means they often go unnoticed by policymakers, and little action is taken to address or prevent their condition. As a result, women and girls suffer needlessly, often for years, with no hope in sight,” Ochurus said.
Reconstructive surgery can usually repair a fistula. Unfortunately, the women and girls affected by this condition often do not know that treatment is possible, cannot afford it or cannot reach the facilities where it is available. There is also a shortage of highly trained and skilled surgeons to perform the surgery. Trag­ically, at the current rate, most women and girls currently living with fistula will die be­fore ever being treated, Ochurus added.