By Maryanne Waweru-Wanyama
Lovina Okwara is a bubbly 17-year-old whose broad smile, infectious laughter and carefree attitude is evident of a young woman enjoying her life. However, this has not always been Lovina’s attitude. For the last four years, her life has been one of misery.
Lovina traces it all back to four years ago when she gave birth to her daughter. An occasion that was supposed to bring her untold joy and happiness turned out to be the beginning of her nightmare. She recalls the day.
“My mother helped me birth my baby in our small house. Maternity services were not free back then so going to hospital was not an option as I had no money,” Lovina says, adding that the baby’s father, also a young man, had no financial means either.
Lovina comes from Teso district, Western Kenya. She comes from a poor background and so do many of her neighbours. Many of the women deliver their babies at home with no skilled care — among the reasons being personal preference, ignorance and poverty. While some women and children die during childbirth, Lovina and her daughter are among the lucky who survived.
But it was not an easy survival.
“I laboured for about 48 hours and when my baby finally came, I was exhausted, physically damaged and in pain. My private parts had been ripped apart during the delivery,” she remembers.
A few hours later, Lovina noticed she was unable to control her flow of urine and faeces.
“When I sat, I felt wetness overcome me and when I looked down, I noticed I was urinating on myself. I also noticed that my underwear had stool. Worried, I asked my mother about it.”
Lovina’s mother reassured her that the leaking urine and faeces were nothing to worry about, that many other mothers experienced it too.
This situation would see Lovina, who dropped out of school in class seven, eat very little food and take few sips of liquids to avoid quickly filling up her bladder and bowels.
“I would starve myself yet I was breastfeeding. I also stopped laughing as this would make my urine gush out. Even though I am grateful for my daughter, it has been a harrowing experience for me ever since she was born,” she says.
When Lovina, a causal labourer in Nairobi, tried to seek treatment for her condition, she learnt it would cost her about Sh30,000, money she could not raise. So it therefore came as a pleasant surprise when in July this year, she came across information about a free fistula medical camp at Kenyatta National Hospital.
Lovina wasted no time in going to the hospital for screening and a few days later, underwent a successful fistula repair surgery. Today, she is a happy teenager who has since regained her cheer and laughter which had been taken away by the fistula she suffered for four years.
Photo: Lovina Okwara
Lovina’s fistula is likely to have been caused by the prolonged labour she went through. According to Dr Stephen Mutiso, a gynaecologist and fistula repair surgeon at Kenyatta National Hospital, obstetric fistula is a childbirth injury that develops due to prolonged and neglected labour which becomes obstructed.
“Obstructed labour causes destruction of vaginal tissue which leads to the development of a hole (fistula) between the bladder and birth canal. This causes urine to leak continuously through this hole. When the same damage occurs between the rectum and the birth canal, faeces leak continuously from the rectum to the birth canal,” he says.
Prolonged labour is that which goes on for more than 24 hours and according to the World Health Organization, obstructed labour accounts for up to six per cent of all maternal deaths. Dr Mutiso says that majority of the patients who present with fistula often have laboured for three to five days at home usually under the assistance of relatives or traditional birth attendants. In most of these cases, nine out of ten babies are born dead. Many of the women are from remote areas where the overall infrastructure is poor and they are unable to reach hospitals in good time.
In Mwingi district, Kitui County in Eastern province for example, women have to walk long distances in rough terrain to the nearest health centre. And when they get there, lack of personnel as well as lack of equipment and supplies is yet another challenge. A case example is Nyaani dispensary in Nuu location, where there is only one health worker, a community nurse who attends to all patients seeking services there. Nyaani dispensary serves a population of about 7,000 people.
Without a theatre or other basic equipment necessary for handling birth complications, the nurse has to call for an ambulance from Mwingi District Hospital which is 79km away. By the time the ambulance arrives and gets the pregnant woman to hospital, about four hours have elapsed. And this is when an ambulance is available. Many times it is not.
“A pregnant woman experiencing a birth complication and who is referred to the district hospital often has to use public transport. Public vehicles are hard to come by because of the poor state of the roads. Sourcing for transport and eventually getting to the hospital can even take a day,” says Damaris Wanjiru, the nurse in-charge at Nyaani dispensary.
Interestingly, while Damaris sees an average of 12 pregnant women a month attending antenatal clinics, she only delivers about three babies a month, with the rest delivering at home. Lack of transport is one of the major reasons the women cite for failing to make it to the dispensary when labour checks in.
Eastern province is one of the regions that bears the highest number of fistula cases. Other areas include Nyanza, Coast and Northern Kenya regions, as well as West Pokot. It is important to note that fistula can affect any woman regardless of her age, marital status, education level or income status. For as long as she experiences prolonged and obstructed labour and does not have access to emergency and quality obstetric intervention, then she can develop fistula.
In Kenya, there are an estimated 300,000 women living with fistula, with an occurrence of about 1,000 new fistulas each year, according to Dr Mutiso.
The consequences of fistula on the woman are dire. Stella Mburu, a nurse at Mbagathi District Hospital and who has been trained in fistula care, says that in most of the cases, the woman is emotionally pained following the loss of her baby. In addition, she has to deal with the continuous leaking of urine or faeces which make her smell foul. Most women from poor areas cannot afford fistula repair surgery and therefore use pieces of old cloth or mattresses to contain the leaking urine or faeces.
“They face rejection by their families and communities and because of the stigma, they soon stop going to public places such as the church or the market. They also stop attending social gatherings like weddings or chama. They also find it hard to find employment or engage in business. Some women experience domestic violence while some are disowned by their men who leave them to marry other women. Some women suffer depression as a result,” she says.
The good news is that fistula is treatable. Small fistulas can heal if a urinary bladder catheter is inserted for about four weeks immediately the fistula occurs. Surgery is the other option. However, the costs of surgery remain far beyond the reach of many women affected by fistula. In public hospitals, fistula repair surgery costs between Sh20,000 and Sh40,000 which is a subsidised fee. In private hospitals the price is much higher.
For women such as Lovina who cannot even afford the subsidised cost at government hospitals, they are lucky to benefit from organisations that sponsor their treatment through free fistula medical camps. Her surgery was made possible by the Freedom from Fistula Foundation, the Flying Doctors Society of Africa and Kenyatta National Hospital.
Fistula can be prevented by delaying the age of pregnancy and ensuring that all women have access to quality maternal care. The free maternity services in public health facilities are aimed at encouraging more women to deliver in hospitals under the supervision of skilled birth attendants to reduce negative maternal outcomes such as fistula.
Article courtesy: The Star