Kenya makes strides in fistula treatment
As the world marks the International Day to End Obstetric Fistula tomorrow, we spoke to survivors who share their experience post recovery.
By Lilian Kaivilu
When Maximila Akola gave birth to her last-born child in 1992, she had hoped to continue the list. It was her third born and nothing was alarming about her reproductive health. “Although I had experienced a complication with my first born, I was still hopeful that all would be well,” she says.
But the mother of three would be diagnosed with obstetric fistula after delivery. “I delivered comfortably but after a few days I started leaking urine. I went back to the Bungoma General Hospital where I delivered but the condition was not fixed,” she says.
For 27 years, Akola learnt to live with the condition while doing small businesses. She operated a grocery shop where she sold cereals. “I learnt to manage the situation so as to go on with my daily activities at home.”
Although she is now healed after undergoing treatment last year, Akola, 58, says she experiences frequent backpains, especially when she does menial jobs. She urges other women living with the condition to seek medical attention before the condition worsens.
Akola now exits the list of more than two million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean who are living with this condition. According to the World Health Organization, about 50,000 to 100,000 new cases of obstetric fistula re reported every year. In order to prevent the condition, WHO recommends cessation of harmful traditional practices such as Female Genital Mutilation (FGM), delaying of the age of first pregnancy and timely access to obstetric care.
In order to address the stigma on fistula survivors, United Nations Population Fund (UNFPA) Kenya has trained a community of survivors known as Ambassadors of Hope, who sensitized and mobilized communities to identify those suffering from fistula.
According to the UNFPA Kenya Country Representative Dr Ademola Olajide, the agency has also supported socio-reintegration of those who have been successfully operated back into the community while supporting them with income generating activities. “UNFPA advocates for integration of treatment of the survivors within the routine surgical operations, rather than special patients either through camps or project supported initiatives,” said Ademola.
Ademola lauded the steps the country has made in treatment of fistula, particularly in the increased number of fistula surgeons and the facilities treating the condition. “There is an increased number of fistula surgeons from initial three over 10 years ago to the current 10 fistula surgeons. There are also more nurses and midwives as well as anaesthetists who provide supportive care during treatment,” he said.
Stigma, human resource gap in treating fistula and scanty data on fistula, Ademola says, is a challenge to achieving comprehensive results in fistula treatment. According to him, most surgical repairs are supported by external resources thus increasing the cost. “There is need to integrate fistula surgery in routine care and have surgery fully covered by the National Hospital Insurance Fund or Universal Health Coverage,” noted Ademola.
Dr Hilary Mabeya, the lead surgeon at Gynocare Women’s & Fistula Hospital, says women from poor homes, and especially those with limited access to hospital emergency services are at a higher risk of obstetric fistula disease. “Most of these women lack timely access to proper healthcare services. As a result, they experience prolonged labour,” he says.
According to Dr. Mabeya, a simple fistula repair can cost upto Sh80,000 while a complex one can cost upto Sh150,000. The latter, he says, is even more complex because few gynecologists can repair it. “The extreme one is cause when the bladder is completely injured and the patent requires urine diversion. This involves creation of a new bladder using intestines or the appendix. This requires more days in the hospital and advanced techniques,” says Dr. Mabeya.
The greatest achievement so far in the treatment of fistula in the country, he says, is awareness that fistula is treatable and availability of surgical centres in different parts of the country. But covid-19 poses a threat on such gains, with many mothers opting to give birth at home as a result of the night curfew restricting movements at night. At the Gynocare Women’s & Fistula Hospital, about 100 women deliver here since March. Out of these, about 15 percent have experienced prolonged labour. This, Dr. Mabeya says is due to fear by mothers to come to the facility at night.
Alice Masai, 50, is a mother of one. For 29 years, she lived in despair and could engage in most social activities due to her condition. It all started at the age of 18 after undergoing a caesarian section. Masai had experienced prolonged labour and as a result suffered obstetric fistula.
She underwent repair last year at Webuye referral hospital after hearing of the fistula repair campaign via radio. Although she worked as a grocer, she admits that many customers would shun her products. “But I am happy because I can now freely interact with people,” she says.
In order to address cases of fistula in her county, Caroline Wangamati, Bungoma County First Lady has held two obstetric fistula repair camps in 2018 and 2019 in partnership with Amref Health Africa. In 2018, 33 women underwent the repair while in 2019, 44 women were treated. “Our highlight case was an 81-year-old woman who had lived with vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) for 23 years. She was successfully treated,” she said.
The fistula repair camps targeted four sub counties of Tongaren, Sirisia, Bumula and Mt Elgon with screening centres at Naitiri, Kapsokwony and Cheptais. According to the First Lady, the targeting of these under-served areas was because the other parts of the county could access these services at the Webuye County Hospital.
An ardent champion of maternal health, Caroline says her dream is to see women access healthcare services at the convenience of their homes. “I don’t want a woman from Bungoma to travel miles to get a fistula repair. I want them to be treated at the comfort and convenience of their homes. This has, and will continue to give them more confidence to access healthcare.” She adds: “I hate seeing a human being in such indignity. I wanted to use my voice to give dignity to women living with fistula.” This year’s camp that was scheduled for April, however, was halted by the restriction of movements and gatherings in the wake of covid-19.
According to the principal nursing hospital in charge at Webuye county hospital, women with contracted pelvis are at a high risk of obstetric fistula. “Such people may experience prolonged labour hence causing fistula. Also, a mother can have a normal pelvis but be carrying a big baby. If such a mother goes through normal delivery, then fistula could occur,” he adds.
At the Webuye County Hospital, Msambaki says the treatment for fistula is covered by the Linda Mama medical cover. He, however, says due to stigma, walk-in patients are not common.