Vesicovaginal fistula (VVF), commonly referred to as just ‘fistula’ is an abnormal hole extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault. It is as a result of long and obstructed labour and in most cases the babies don’t survive. MoH statistics indicate that there is an estimated 140,000 -200,000 women with this problem in Uganda, and only 13000 – 17000 women are able to receive medical attention.
Kizza is one of them. Just like the case with her last seven pregnancies she, walked into Nyenga hospital in Buikwe district to deliver her 8th baby. When she came out of theatre her bladder was leaking and she could not hold her urine. She thought it was normal and would stop on its own, but the condition got worse. In no time, it had become part of her. This was the beginning of a long walk of shame that she has had to endure for the last three years.
The 54 year old says her husband left her because she smelt. ‘I cannot describe the humiliation and scorn that I have endured. My husband left me and even my family members see me as a disgrace. I cannot go to public places and I don’t remember the last time I was at a family gathering. I pray that by the time I leave CoRSU I am completely well.’ Kizza narrates.
She is one of the 14 women who were mobilised in areas of Wakiso and Kalangala Island to receive reconstructive surgery during the week long camp held at CoRSU hospital, from 2nd – 5th February 2015.
According to Dr Judith Stenkamp, the brain behind the camp, Fistula is most common in first mothers but can also occur among women who have already had children. The most vulnerable people however are teenagers. “The head of the baby can be stuck too long in the pelvis, pushing against the bones and compressing the bladder; and the longer it takes also against the rectum, causing a rectal vaginal fistula, resulting into loss of stool,” Dr Stenkamp explains.
She notes that isolation, the stigma around the condition, ignorance, poverty and illiteracy also lead to many going untreated. Other causes of obstetric fistula are early marriages, sexual abuse, rape, trauma surgeries.
How is VVF treated?
Dr Stenkamp says VVF can only be treated through surgery. “When fistula is still small and fresh, it can be managed by catheterisation – a medical procedure used to drain and collect urine from the bladder.” She adds that it would be possible to detect VVF in its early stages if only women sought proper medical care and delivered in hospitals.
On top of receiving post-operative care, the patients currently at CoRSU received information about Fistula, its causes and how to prevent it. This was done to demystify some of the myths they had about the condition and hopefully boost their self-esteem. Dr Judith worked alongside Dr Andrew Browning, an Australian obstetrician and gynaecologist who has worked in Ethiopia and Tanzania as a senior fistula surgeon.
On why she organised the camp, the enthusiastic gynaecologist says “It is very rewarding nice work. I am happy the surgeries went well but all will be clear when we have removed catheters.”
This camp was sponsored by Fistula foundation, a non-profit organisation that raises awareness for prevention and treatment of obstetric fistula, whereas mobilisation was done by CoRSU CBR, Wakiso and Kalangala district officials and Terrewode, an organisation that mobilises and reintegrates patients with fistula after therapy.