Joy as mothers and girls regain dignity after fistula operation at Ishaka Adventist Hospital
IAH MEDIA
A sixty-year-old Keneema Perusi (not real name) is among the 40 females that were operated on during a week-long Vesicovaginal Fistula (VVF) and Stage IV Uterine Prolapse operation medical camp that was held at Ishaka Adventist
Hospital on 10th-15th November 2024. The process saw over 60 women turn up for screening after they heard that the hospital was planning to provide the service for free, though only 40 were treated.
The twenty were screened, and it was found that the injury was not because of the tear they got during childbirth. They were screened and found that they were not legible for operation, according to Dr. Brian Musinguzi, the IAH Medical Director.
According to her narration, Ms. Keneema (one of the beneficiaries) had lived with the fistula condition for forty years, a period in which she lost a lot, including being rejected and abandoned by her husband and losing children. Thanks to a man who picked her up for another chance in marriage.
“I have lived with this condition for such a long time. In the process, though I was not stigmatized by the family and community members because they did not know, I lost my first marriage. I think the man found it hard to move on with me. Having waste come out in one opening was a terrible experience that he couldn’t bear with,” she said.
Keneema goes on to narrate that she tried going to different camps at different facilities to be operated on for more than three times in vain before hearing of another chance at Ishaka for another trial with hope of getting a lasting solution.
“This time I came and I was operated. Though total healing has not been guaranteed to me, I will be well. When we came here, we were received well, counseled, and operated on. We received the spiritual touch from the people here, and this made a big difference. I hope to be better,” she expressed.
Sponsored by Mr. Richard Noble, a friend of IAH from the USA., the camp was run by a team of urologists from Mbarara Regional Referral Hospital. During the camp, two girls and thirty-eight women were operated.
How the camp came about?
Over the last years, IAH has been receiving mothers at its gynecology department, reported as having been rejected by their families due to stench they have following delivery accidents.
These women are left suffering silently from vesicovaginal fistula (VVF) and stage IV uterine prolapse, conditions that have left them marginalized, ashamed, and ostracized by their communities. The stigma surrounding these conditions leads to segregation, being forced to live on the outskirts of society, and being kept away from family and friends.
“Most of these mothers cannot even afford to buy food that can even sustain them in the hospitals. It had become too hard for us to ignore their pleas for help to receive comprehensive treatment and rehabilitation,” says Dr. Musinguzi.
It is against this background that the hospital solicited support in the form of funds for surgical procedures and medical supplies, expertise and training for the medical staff, and offering rehabilitation and counseling services to restore the dignity of the women.
What beneficiaries went through before treatment
Mothers who talked to us said they experienced birth injuries can experience a range of physical and emotional consequences, including physical symptoms like incontinence, chronic pain, and sexual dysfunction; mental health issues like postpartum depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder; relationship problems like difficulty bonding with the baby and problems in the relationship with the partner; isolation like feeling disconnected and numb; and difficulty discussing the experience with family and friends.
Dr. Onesmus Byamukama, a urogynaecologist and leader of the team that worked on the mothers, intimated that the mothers lost their dignity and having them rehabilitated was long overdue.
“We believe that no woman should suffer these injuries during childbirth, and when they suffer these injuries, they lose their dignity and respect in the community, they lose hope, and this affects their entire life in their families and community. Our job is to give them dignity and hope by giving them the repair services according to the injuries that they suffer from,” he said.
Injuries also include when urine starts leaking, and this comes about after a hole has been created between the bladder and private parts, or sometimes they get a tear and they can no longer control stool or gas, and therefore this makes them become social embarrassments in meetings, church services, choirs, and women groups because they can no longer control it.
Sometimes the uterus comes out, and it kind of gives them discomfort, especially when they are going about their work. When the uterus comes out, it causes them to pass out stool.
This also makes it hard for the mothers to meet their sexual obligations because of the pain and bad smell from the stool, leading to marriage breakdown and men looking for other sexual partners, and this causes a lot of distress.
“I got pushed into a world so bad that I felt distressed and stressed. I was unable to feel like a real woman. I also got isolated from my family and couldn’t do anything productive apart from sitting at home,” Ms. Arinda (not real names) recalled.
Victims of fistula also lose their employment and end up being pushed into poverty.
According to the medics, the Ankole sub-region is not unique from other regions. The region posts high numbers of injuries after the Buganda region. In the recent records, the Ankole sub-region was number two in Uganda.
But what causes birth injuries?
One of the causes of birth injuries is mismanagement by healthcare professionals. These birth handlers sometimes make mistakes while delivering mothers. Some experts attribute this tothe training that some nurses and maternity staff acquire when studying.
“We are noticing that there is a trend that these injuries are caused by health workers when delivering the mothers. This is due to variations in training of midwives and doctors. We emphasize proper training of these people so that we can have a reduction in the cases.
Injuries were also attributed to the health-seeking behaviors of mothers, whereby some women arrived at health facilities when it was already late while others chose to deliver with the help of traditional birth attendants.
The affected mothers suffered silently because issues to do with sexuality are in the African setting and not made public or revealed. No one wants to talk about sex in public, and because of this, women tend not to come out and speak about the pain even with their immediate friends or relatives.
According to experts, traditional birth attendants are not well trained and skilled to do the work, and they end up causing devastating injuries to mothers.
Are these cases treatable?
During the camp, the mothers were told that these injuries can be treatable provided they have been identified once they have occurred and the right experts work on them at an early stage. Identification, recognition, and repair of birth injuries would result in women getting relieved and retaining their dignity.
Grateful that she had been operated on, another mother who had lost her sexual obligations due to the condition told this writer that she was excited that, having been treated, she was going to regain her marital freedom.
“I am very happy that God worked through the friend of the hospital to avail us of this opportunity. I have been repaired, and I have no worries any longer. I hope that in a short time, I will again perform my duties as I used to do,” she expressed.
“When all this has been managed, the women will regain the many things that they lost and also resume their sexual activities,” said Sr. Lillian Tusingwire, a nursing officer and senior midwife who attended to the mothers.
Reintegration of mothers back into communities.
According to the team that worked on the mothers, reintegration starts from the day announcements are done calling mothers for screening and treatment. When they get to hospitals for treatment, the mothers are offered counseling sessions to help them cope.
Reintegration of women who have suffered birth injuries is a very important aspect of treatment. The once rejected mothers are reintegrated and accepted back into their communities.
“We get to counsel them on what to do before they are sent back home. In some cases, we take these mothers home and talk to their families and close relatives about what we were able to do and what we expect their quality of life to be following treatment,” Dr. Byamukama noted.
Need for capital
Because of the fact that many of these mothers spent time without working, they revealed to the teams that they needed startup capital, which they didn’t have and the hospital was not going to support them. If they got some money, they would get help establishing their income-generating projects so that they could become more productive and live a normal life.
“From here, I don’t know where I am going to start from because I seem to have lost a lot. If I had some capital of about 500,000 Uganda shillings, I would have started a small business to help me support myself and my family,” said one of the mothers.
Dr. Kato Paul, a women’s doctor specializing in caring for women that have birth injuries, emphasizes the need for fistula survivors to have a second chance in life by being supported to completely overcome.
“In treating these women, we operate them and address the physical problems, and these women can become cured of the challenge. However, these women have psychosocial problems that sometimes prevail and cause them to need a lot of support from all who reach them. Support can include a warm welcome back into their homes and involvement in leadership within the community and others,” he said.
While Sr. Tusingwire appreciates that the government of Uganda has done a good job of putting facilities at different levels, some women opt to give birth at home or at the homes of traditional birth attendants. She therefore calls for more sensitization of mothers, explaining that “sensitization needs to be boosted so that we can hit the required standard by engaging in talks that encourage these women to give birth from health facilities.”
Together with the health workers, mothers maintained that surgical healing is just the first step in recovery and they needed economic empowerment, which is the ultimate path to a renewed life and brighter future for the survivors.
END