Fistula woes: Stitching up torn lives in Teso

By Daniel Edyegu

FEW sorrows in life can rival the pain of a teenage girl stepping into the world of motherhood with two consecutive miscarriages.

When Lady Luck finally smiles to wipe off the sorrowful tears, with another healthy pregnancy that stretches the normal span of nine months, obstructed labour that culminates into a stillbirth is high on the list of fears a mother, who has undergone such painful miscarriages would wish stayed just that — fears.

 In addition, the long hours of labour pains and stillbirth culminate into obstetric fistula and Lucy Iwonyu, 40, from Kadungulu sub-county in Serere district, fits in the equation.

At only 15, Iwonyu was married off by her parents to Opila Ilebi in Ogera village, Bugondo sub-county in Serere district. Iwonyu twice conceived but miscarried. That was bearable — at least to the husband and in-laws as she was still considered fertile.

However, the third pregnancy that resulted in a stillbirth broke the gates of hell and spilled wild tongues of flame and glowing coals onto their marriage. The ill-fated birth severed Iwonyu’s relationship both with her husband and in-laws instantly.

“After two days of sharp labour pains, I was taken to Serere Health Centre IV and the midwives pulled out a dead baby from my womb. Shortly after, urine started leaking uncontrollably — she had suffered a fistula. The midwives told me it was normal and would stop with time. I was discharged from the health centre,” Iwonyu narrates at her hospital bed in Soroti Hospital, where she has undergone the third surgery to rectify the fistula.

Iwonyu is a living testimony of the gender-based violence minted against women, who suffer from fistula, by their spouses and in-laws.

Rather than recover from home as presumed by the health workers, Iwonyu’s condition deteriorated.

“Urine, mixed with feaces, started flowing nonstop from my private parts and soaked the clothes I wore. The stench was unbearable. Not even the frequent changing of clothes helped. I faced psychological torture that came with the leaking waste on one front and pressure from my husband and in-laws to leave the marital home, on another,” Iwonyu says.

At the peak of the marriage conflict, the in-laws forcefully bundled Iwonyu onto a bicycle and took her to her parents’ home. Her father-in-law told Iwonyu’s parents not to bother with refunding the bride price as stipulated by customary laws, but use the money to treat their daughter.

With the scanty grey hair spread all over the head and lines of wrinkles on the face, the stark reality that menopause has already set in and blown away all the hopes of getting a child are evident on her face.

What is obstetric fistula?

Obstetric fistula is a condition in which a hole develops between the bladder and vagina, or the rectum and the vagina as a result of prolonged labour.

The complication is common among young mothers with underdeveloped reproductive features, who give birth without medical help. Usually by the time medical help is sought, the child has died in the womb.

 It is estimated that in Uganda, 1,900 women suffer from fistula every year and another 120,000 are living with it. The ailment is treated through surgery to rectify the condition.

Alice Emasu, the executive director for The Association for Re-Orientation and Rehabilitation of Teso Women for Development (TERREWODE), a civil organisation spearheading the fight against fistula in Teso sub-region, says the violence against women suffering from fistula is mainly psychological and physical.

Emasu, a second runner-up in the 2011 Vision Group Women Achiever Awards in recognition of women in the country striving to enhance maternal health among mothers, explains that violence is bent on pushing unyielding women out of the marital home.

“About 95% of the women who suffer from fistula are divorced within six months of getting the complication. The women are rejected by their husbands, in-laws and siblings. So when we receive such a person, we help them access treatment and thereafter, guide her to either seek legal redress in case she needs to get part of the family property, or reconcile with the spouse after the surgical recovery. We also put the aspect of HIV/AIDS in consideration.”

“We are not against these husbands. The condition fistula subjects one (a man) to is unbearable. It’s not the best condition for any human to live in. However, husbands who divorce their spouses after getting fistula are ignorant of the fact that the condition is treatable,” Emasu says.

To step up awareness about the disease, TERREWODE has liaised with voluntary health teams throughout the districts in Teso to educate communities about the disease and the relevance of giving birth in the health units.

According to Florence Adongo, the Police officer in charge of family and child protection department in Soroti district, a total of three women with fistula reported to Police since the start of this year, accusing their spouses of violence after they suffered fistula.

“Though such cases are still few in Teso, this was completely unheard of in the past. Victims suffered silently. This implies that women with the complication are beginning to realise their rights in the marriage and resisting abuse. The message is gradually sinking,” Adongo asserts.

She says to the men who abandon their wives at the marital home, the Police often liaises with the in-laws to take care of the spouse.

Unlike in the past where women suffering from fistula stood at the mercy of external doctors, who occasionally flew into the country to conduct surgeries and fly out thereafter, the health ministry has stepped up effort to curtail the effect of the disease on women. 

At Soroti Hospital, management has gazzetted part of the maternity ward to treat fistula patients.

Betty Akwi, a midwife at the hospital, says because women who suffer the condition are few and far between, the hospital allocated part of the ward to serve fistula patients.

“We can even have only two patients in a month. After surgery, the patients are kept within for close monitoring for about two weeks. We advise them to keep clean to aid quick recovery. If married, we advise them to take six months before resuming penetrative sex,” Akwi says.

The rise in the number of women reporting abuse due to fistula, the allocation of a ward at Soroti Hospital point to a single fact — the campaign against fistula is gathering momentum destined to stamp out the condition in the country.