- The basic vaginal fistula causes a woman to leak urine regularly.
- Women with pelvic cancer who have undergone radiotherapy as a medical remedy are susceptible to becoming fistula patients.
- In Mercy Mission Hospital Eldama Ravine, when such cases arise due to the delivery of big babies or obstructed labor, they are handled quickly.
According to the National Cancer Institute, a fistula is “an abnormal opening or passage between two organs or between an organ and the surface of the body.”
An injury, infection, or inflammation may cause the condition. It may also be created during surgery. Fistula is the disintegrating monster every pregnant woman dreads.
According to Dr. Kagendo Njoka, an obstetrician, fistula in obstetrics is basically looking at the communication between the bladder and the vagina, known as the basic vaginal fistula.
The basic vaginal fistula causes a woman to leak urine regularly.
Women with fistula also have stool in the vagina, meaning there is a miscommunication between their genital tract and the urinary tract or rectum.
The discharge is usually a chronic smell of urine and stool that passes without stopping, causing Urinary Tract Infections (UTIs).
Most of the cases start with pregnancy.
Pregnant adolescent girls are considered to have a high-risk pregnancy; most of their labor is untimely, unlike most mature women.
Doctors say that 15 hours of labor are a good range of time for women. Some women labor for days and become obstructed.
In most cases, an obstructed woman has very good contractions, but the head of the fetus cannot fit to come out through the vagina.
How it occurs
Fistula Foundation points out that during her prolonged labor, the woman’s contractions constantly push the baby’s head against her pelvis.
Soft tissues caught between the baby’s head and the mother’s pelvic bone become compressed, blocking the normal flow of blood.
Without sufficient blood supply, tissue sections soon die, leaving holes called “fistulae” between the mother’s vagina and her bladder or rectum.
These holes cause incontinence, making the woman leak urine and stool uncontrollably if untreated.
Women with pelvic cancer who have undergone radiotherapy as a medical remedy are susceptible to becoming fistula patients.
Most of their tissues are dry and have developed necrosis, lacking sufficient oxygen. The complication comes within a period of two years.
When a woman is sexually assaulted, she might also get fistula.
Why society should be alert
According to Dr. Njoka, “UNFPA has said that 2 to 3 million women have fistula in the world. World Health Organization data shows that in a year, we have nearly 50,000 to 130,000 cases of fistula. This is something that needs to be addressed.”
“So the problem this woman is going through is enormous. The baby might be born dead, then she realizes she’s leaking urine and stool.
She starts segregating herself, jeopardizing the marriage. Divorce ensues; the amount of emotional stress and psychological torture is high among these women.
Equally, fertility issues and how they return to their menstrual cycles is difficult because the periods might stop,” he adds.
Dr. Njoka says fistula affects the brain, causing a lack of periods. The woman’s sexual functionality is compromised because intercourse becomes painful.
Furthermore, the social issues that surround women, too, are overwhelming.
Some are built their own compounds to be away.
Dr. Njoka calls for support from spouses, families, and the community because fistula can be prevented and treated.
Cultural issues like Female Genital Mutilation (FGM) can cause fistula, and women who have undergone FGM are at risk of getting fistula during child delivery.
Though some communities believe this is a rite of passage, they do cause harm and risks to women.
The doctor says that the women in the community should take advantage of government-free delivery that has been put in place to reduce maternal-child mortality.
The Linda Mama insurance caters to all pregnant women in Kenya from clinic to delivery and even a month after delivery.
The National Health Insurance Fund (NHIF) is also an alternative to accessing health care services, and one has to ensure they are up to date with it if they want to use it as an option.
Home deliveries cause delays; every woman is advised to ensure they visit the hospital.
The clinics are set to help and prepare the spouse and the expectant mother, and the nine months is enough time to come up with savings and also a delivery plan.
The anti-natal clinics are a must-visit for pregnant women for check-ups and monitoring to ensure there are noticeable milestones.
If not, then the correct process is followed to rectify the issues.
Need for planning
The importance of planning is to ensure the family or woman considers her distance to the nearest hospital, its affordability and accessibility to find health care.
Planning helps the spouses to consider the time they will get to the hospital, whether those hospitals have qualified doctors to deliver the babies, have theatre services, a blood bank, and other essential services.
The absence of these things risks the woman.
Unfortunately, most women undergo the latter and are subjected to long labor.
Dr. Njoka says labor wards are where women are supposed to be monitored from by experts, but this rarely happens; most women come ready to deliver.
The specialist insists there is always a need for someone to make some timely decisions for these pregnant women.
This is where families and guardians and the community come in.
Though it is a tough situation to manage everyone’s life nowadays, Dr. Njoka says it is crucial to attend clinics and have facilities that are well equipped, a good referral system and patient education that would help in the reduction of fistula cases.
Seeking help if you have fistula
In the past, getting fistula surgery services was hard.
Currently, government developmental partners, in conjunction with gynecologists and obstetricians, have come together to ensure these services are there in county referral hospitals.
Trained staff in rural areas, AMREF and flying doctors are also present to offer timely treatment, making the services easily accessible.
Fistula mainly cannot heal without surgical corrections that take three months.
For fistulas of around 2 cm, the doctor will check and put a catheter to drip for about 21 days before another test can be done.
If it is still leaking, they are added another two weeks. If it does not heal, then a surgical correction will be taken, taking three months to heal.
The healing process needs psychological healing, need of rehabilitation in terms of counseling.
What you should know
Recovering women will not be the same again. Their bones may weaken, and they might not walk well.
The psychological healing is continuous and getting back to the community takes time.
One can give birth after being treated. One is allowed to abstain for three to six months.
If a fistula repair done was between the vagina and the bladder or the rectum and the vagina, it takes two years to conceive.
If the surgery was done between the vagina and the hole was too big in the bladder, it would take three years to conceive.
This also means this woman will not have to go into labor but is under elective C-section, in which she should visit the hospital before labor starts.
Concerning home deliveries, the health care model says that as long as the traditional attendants are trained, they can help in delivery.
Trained traditional birth attendants should be able to tell if a woman’s labor is normal or not and take professional steps to ensure the safety of both the mother and the baby.
However, Dr. Njoka advises women who have undergone C-sections before to ensure they go to clinics for safe delivery.
A few have a natural birth, but following up with the doctor is essential. Though some do go to the traditional birth attendants, it is risky.
The traditional birth attendants are usually known by most hospitals and always liaise with the facility to ensure the safe delivery of women in the villages when necessary.
Women who have pressure issues and some medical conditions too are advised to always keep in touch with doctors in credible health facilities for successful deliveries.
In Baringo County
In Baringo County, fistula is stigmatized and very few women come forward to be treated.
Most of the patients come from very humble backgrounds and need support. Fistula Foundation has been supporting several.
Despite Baringo County having gynecologists, most women seek help in Gynocare Eldoret and are assisted.
In Mercy Mission Hospital Eldama Ravine, when such cases arise due to the delivery of big babies or obstructed labor, they are handled quickly by referring the patient to Moi Teaching and Referral Hospital in Eldoret (MTRH).
The hospital does this with ease as it already has two standard-equipped ambulances in Baringo County. Most such cases in Mercy Mission Hospital fall under the 25% of women above 18 years.
“Due to our organization with the ANC Department and ensuring the pregnant women are checked, and clinics are attended, we rarely have such cases.
If we encounter such a case, we have links with organizations that directly treat and repair these patients. The appropriate centers include the MTRH Fistula Clinics,” says Dr. Cheboi of Mercy Mission Hospital, Eldama Ravine.
Sadly, some communities build side houses and compounds for their affected women and segregate them for life, seeing them as not women enough to deliver without any issues.
This happens in some communities that also segregate women who deliver through the C-Section, creating a monster of depression in them.
More efforts needed
May 23, 2023, marked the United Nations (UN) Fistula International Day, themed 20 years on—Progress but not enough! Act now to end fistula by 2030!
The UN international days are meant to sensitize the people and mobilize political will and resources to focus on addressing global problems and celebrate and reinforce human achievements towards attaining specific topical goals.
The UN has embraced these days as powerful advocacy tools.
UN Observes that by 2030, the problems of Obstetric Fistula should have ended.
YOU MAY ALSO READ: Why Mercy Mission Hospital is Baringo’s most-trusted healthcare facility
Delaying the age of giving birth, ending harmful traditional practices like FGM, offering timely access to obstetric care, and formulating ways of arresting the possible marriage of 13 million more children by 2030 are some approaches to achieving this vision.