AS an orphan and at age 14, Tendai Chimana (now 40), got into an early child marriage. This occurred after she had dropped out of school in Grade 7 and started working as a house help in Harare since she had relocated from her rural home in Birchenough Bridge, Manicaland.
By Michael Gwarisa
Some months into her marriage, she conceived and everything was normal. Trouble only came around the third trimester when her husband suggested that she goes and deliver the child in rural Bocha where her aunt resided.
It became a back and forth scenario, with her aunt arguing that she delivers in Harare where there are health facilities while the husband on the other hand maintained that she delivers in her aunt’s hands.
I got tired of the back and forth and decided to deliver in Bocha where my aunt stayed. One evening, i started experiencing birth pains. My aunt suggested we visit an old woman who was in the business of delivering babies at her home,” said Tendai.
“We got there and I was admitted in her homestead. I spent the entire night reeling from pain but the baby never came. I also spent the following day experiencing excruciating pain but still, there was no sign of the baby. Fortunately, that evening, my aunt’s son came from Harare and found us at the old woman’s homestead. He didn’t waste time and rushed me to Mutare Provincial Hospital where I was admitted in the emergency unit on arrival.”
The child however did not make it and was pronounced a still birth after the doctors failed to dictate any signs of life from the foetus. A caesarean section was conducted on her and the lifeless child removed from her womb. Unfortunately the baby had passed stool inside her mother’s womb.
“I fell sick afterwards. My tummy started swelling as if I was carrying another pregnancy. I was given medication to cleanse the system. I was admitted and spent two months in Hospital. That is when I started passing out urine uncontrollably. At first I thought it was a minor issue until the nurses advised me to see a Gynecologist.”
Her condition did not change, urine continuously oozed from her. She was referred to Parirenyatwa Hospital to see some specialist. They tried all they could to assist her but to no avail. She bought some medications the doctors said would work but still, it didn’t not work.
That is how Tendai learnt that her newly acquired condition was Obstetric Fistula. She was left with no option but to return to her rural home in Birchenough Bridge.
Obstetric fistula is an abnormal connection between the vagina and either the bladder (vesicovaginal fistula) or the rectum (rectovaginal fistula). The condition results mostly from ischemic trauma caused by prolonged and obstructed labour. The fistula (abnormal hole) leaves the woman uncontrollably leaking urine, faeces or both.
DESPERATION AND STIGMA
Out of desperation, Tendai says she moved from one prophet to another, from one religious and traditional healer to the other in search of a cure and permanent solution to her problem. All that did not work. Women with fistula have to live with incontinence and strong odor that accompanies the condition. It affects all aspects of the woman’s life including physical life, spiritual, emotional, social and economic life. It presents untold suffering to affected women.
“I lived with this condition for 12 years. The urine would flow uncontrollably. I became a laughing stock. There was no means of stopping the urine. I ended up buying some towels that I would use hold the urine from flowing. However, these towels would end up gathering a strong stench from the urine.
“People started isolating me. I stopped going to funeral gatherings, church or any fathering for that matter. Even at water points, people would keep their distance. I could see they would be talking about me. That experience was not good. Fortunately during that same period, I met a man who loved me as I was and supported me through the remaining part of the journey.”
The saying goes, hope comes when you are about to give up. As Tendai was about to get comfortable in her not so comfortable situation, a good Samaritan, a Village Health worker came to her rescue.
“In 2018, a certain Village Health worker from our village went to Changazi Clinic as per routine and she met some nurses who had come from Chinhoyi Hospital for a workshop. They were discussing about the Obstetric Fistula Repairs that were being conducted there and they were looking for women in need of such assistance.
“She sent for me and i went to her home where she told me about the fistula repairs at Chinhoyi. I took a bus and went to Chinhoyi. I was shocked at what I saw when I arrived at Chinhoyi Hospital. I saw a long queue of women who had come to get repairs for the same condition that had given me sleepless nights for 12 years. To imagine that I would at times curse God for putting me through this condition and yet I was not the only one experiencing it.”
After two days, I was booked into theater and the repair was conducted and it was successful. She was discharged and ever since, she has lived happily without worrying about her bladder emptying itself unprovoked.
OBSTETRIC FISTULA SITUATION IN ZIMBABWE:
It is estimated that over 2 Million women in Sub-Saharan Africa, Asia in the Arab region and Latin America are living with Obstetric Fistula and 50,000 to 100,000 new cases of Obstetric Fistula occur every year. Obstetric Fistula can be treated, however, its persistence is a sign of weaker healthcare systems. Healthcare systems in developing countries, Zimbabwe included, are still struggling with the condition whereas those in the first world that have mature healthcare systems eradicated Obstetric Fistula more than a century ago, it’s no longer a public health issue.
Underlying causes include persistent poverty, lack of access to health services, lack of adequate education, gender inequality, child marriages and adolescent pregnancies.
Dr Chipo Chimamise, the National Maternal Child Health Officer in the Ministry of Health and Child (MoHCC) however said despite the challenges in the healthcare sector, Zimbabwe has made significant strides in repairing Obstetric Fistula in women.
“The good thing is that treatment for Obstetric Fistula is now available but before 2015 in Zimbabwe, this was not the case. This treatment was a specialist intervention mostly found in tertiary and some private hospitals and yet we had so many people living with the condition. With assistance from our development and implementing partners and the outcry from our health facilities, the Ministry decided to make Obstetric Fistula a public health intervention.
“They started with Chinhoyi Provincial hospital in 2015. This intervention was delivered free of charge to the women who were affected. We had partners to fund the program fully. From transportation, surgery admissions and everything else. We started with one facility at Chinhoyi and that year alone we repaired 240 women. From there, Obstetric Fistula repair was conducted on a Quarterly bases,” said Dr Chimamise.
From August 2015 to date, more than 900 women have been repaired of Obstetric Fistula and the services have been scaled up to four other hospitals namely Mashoko Christian Hospital in Masvingo, Morgenster Hospital in Masvingo, Chidamoyo Christian Hospital and Mutambara Mission Hospital in Manicaland.
The surgeries would be conducted by hired foreign doctors who would work side by side with local Obstetricians. To date, a total 29 local Obstetricians benefited from the mentorship program to conduct these surgeries.
Meanwhile, Dr Marvin Venge, an Obstetric Specialist for MoHCC said Obstetric Fistula had negative social consequences on those with the condition.
“Obstetric care should be of good quality. In as much as Obstetric Fistula is a medical problem, it has social consequences. Because there is uncontrolled discharge of urine or feces, women experiencing fistula end up losing their jobs and livelihoods. Husbands divorce their wives because of the condition. The condition also causes depression and has a number of complex complications it causes,” said Dr Venge.
He added that there were other risk factors for fistula that are not obstetric or child brith related. These include Sexual Abuse of minors, rape, cancer, cancer patients receiving radio therapy and Tuberculosis (TB) of the Genital tract, accidents that happen during surgery among others.
Women from as young as 15 years to as old as 70 years have benefited from the free surgeries across Zimbabwe’s hospitals offering Obstetric Fistula repairs. Some of the women come with fresh fistula – duration of living with fistula for 3 months and some haven been repaired after living with fistula for more than 40 years. All repairs have high success rate for the fistula surgeries (87 – 95%.)
Usually, a total of 30 repairs are done per 2 weeks – with some procedures taking up to 4 hours. This always requires a dedicated team. About 45 women are repaired per quarter, targeting repair of at least 180 women each year. Total duration of hospital stay for a fistula repair ranges from 7 days for RVFs and up to 30 days for VVFs.