The Sunday Mail
20-year-old Anesu Makova of Chitungwiza recently underwent obstetric fistula repair surgery
The smell of an uncontrollable and unending flow of waste became the norm for 20-year-old Anesu Makova of Seke, Chitungwiza.
The bright eyes and big smile that she once had were replaced by pain and loneliness.
In a not-so-common scenario, Anesu got pregnant at the age of 16 and experienced devastating labour.
In disbelief Anesu’s mother, Mrs Virginia Makova, took her to the nearest family planning office in Unit F, where the attending health official confirmed that she was, indeed, pregnant.
While giving birth at Chitungwiza Central Hospital in September 2012, Anesu endured fourth degree lacerations and soon after delivery, stool began coming out through her vagina.
Surprised at what was happening to her, Anesu sought answers.
“When it first happened, I thought it was associated with giving birth and thought it was going to end but the problem persisted,” she said.
“I tried to seek medical attention and was told that it was obstetric fistula and because of the high costs of corrective surgery, which my family couldn’t afford, I never got any help.”
Her aspirations to become a lawyer came to a dead-end as she had to stop going to school for two years because of her condition.
Obstetric fistula can have dire consequences.
“Living with obstetric fistula is painful and humiliating. It’s a condition that you aren’t able to share with just anyone, it became a secret between my friends and family,” explained Anesu.
“My life literally changed as I had to segregate myself and stopped going into public places for fear of being ridiculed. In some instances where I feel that I would want to attend functions, l would wear a sanitary pad.”
But hope is the last thing a human being loses.
For close to three years, Anesu endured obstetric fistula, until she heard about free corrective surgery conducted by Women and Health Alliance International.
Anesu’s corrective surgery was performed at the beginning of April by Ethiopian surgeon Dr Ambaye at Parirenyatwa Group of Hospitals in Harare.
“I am so relieved and grateful that my life is now back to normal. WAHA came to me as a Good Samaritan as I had lost hope on re-living my life,” she smiled.
Obstetric fistula occurs when a woman withstands days of obstructed labour, when a baby’s head is constantly pushing against her pelvic bone during contractions – preventing blood flow and causing tissue to die.
This creates a hole, or “fistula”, between a woman’s vagina and her bladder or rectum. Her baby is unlikely to survive. If the mother lives, she is unable to hold her urine, and in some cases, bowel content.
Symptoms include urinary or faecal incontinence and can lead to severe infections and lacerations of the vaginal tract. Some patients suffer from paralysis caused by nerve damage.
There is much social stigma due to the smell, perceptions of uncleanliness, and a mistaken assumption of suffering from veneral diseases.
WAHA national outreach co-ordinator Priscilla Mabhande said obstetric fistula was not a geographically defined condition in terms of occurrence, but rather one of poverty.
“The root causes of obstetric fistula are often poverty and the low status of women and girls. Poverty and malnutrition in children contributes to the condition of stunting where the skeleton, and therefore pelvis, do not fully mature. This stunted condition can contribute to obstructed labour and, therefore, fistula,” she said.
“Also, early marriage for girls as young as 13 or 15 years and becoming pregnant when their bodies aren’t ready or well-developed to go through with the birthing process.”
Although an estimated two million women in Asia and Africa live with untreated obstetric fistula, it is unlikely for these women to meet or hear of anyone else suffering from the same injuries, because of the lack of modern forms of communication and a reluctance to discuss the condition.
“In most cases, a woman with obstetric fistula does not know that a fistula is or that it is treatable with surgery. And if she does, she will be far away from any hospital and does not have money for – or access to transportation – let alone the average cost of US$500 for surgery and post-operative care,” added Ms Mabhande.
WAHA has been sponsoring a gynaecologist with special training in obstetric fistula repair to come to Zimbabwe. Some 45 procedures have been performed since the start of 2015.
Fistulas can be repaired with a delicate surgery, which has a fairly good success rate.
The majority of cases of obstetric fistula recorded in Zimbabwe are a result of women being in labour for two or more days. This is despite the fact that Government invested heavily in infrastructure and systems for pre, post and peri-natal care.
Health and Child Care Ministry director for family health Dr Bernard Madzima said they were working tirelessly to end obstetric fistula.
“The Ministry of Health and UNFPA are working on a campaign to end obstetric fistula in Zimbabwe by setting up fistula repair centres at designated hospitals. This will help to bring obstetric fistula repair services closer to the affected populations,” he said.
Government and UNFPA carried out a needs assessment survey in 2009, and Manicaland, Matebeleland North and Mashonaland West provinces were found to have particularly high prevalence of the condition.
“We have proposed that the first fistula repair centre be set up at Mutare Provincial Hospital. However, the equipment and supplies in the hospital wards and theatres would need to be updated,” said Dr Madzima. “It is the plan that the proposed fistula repair centre be modelled around the ones that have been established in East Africa, for instance Ethiopia which has best practices.”
According to the World Health Organisation, obstructed labour accounts for up to six percent of all maternal deaths.
Maternal mortality in Zimbabwe stands at 614 per 100 000 live births. Each year up to 100 000 women worldwide are affected by obstetric fistula.
Health experts propose that to prevent obstetric fistula, women need access to good medical care during labour. If necessary, they need emergency obstetric care as well as quick and safe caesarean sections for women in obstructed labour.
Pregnant women also need support from trained health care professionals throughout pregnancy and access to family planning.
Obstetric fistula still occurs in developed countries but is caused by other factors such as surgical error or Crohne’s disease rather than obstructed labour.
