She watches us from the safety of the thin blanket she’s wrapped in. She is coiled in a foetal position. Her eyes are blank. One can see straight through to the back of her head. Her dark motionless face watches us dis-interestingly.
“Rose*! Rose!” the nurse calls her. Only her eyes shift towards the sound of the voice. She then adjusts her position by coiling tighter into her warm blanket.
“Can she talk?” I ask the nurse.
“She only responds to her name. Nothing more.”
I look at her surroundings. A folded wheelchair has been placed next to her bed. A half drunk cup of porridge long gone cold. A few clothes have been folded at the head of the bed supposedly to act as a pillow. She lies there, like a little child, folded in that position. There is a distinct smell around her. It is that of faeces.
This is Rose*. I would guess late twenties. Brought into the facility by good Samaritans more than 6 months ago. She suffers from fistula. A complication of a difficult child birth with resultant tears in the birth canal linking the bladder with the vagina or in this case, the rectum with the vagina.
Rose* has been admitted pending surgery to correct the fistula. She is one of the lucky ones to find a facility where this can be done for free. But there is s hitch. Her surgery cannot be done. You see, Rose* had a difficult childbirth five years ago in one of those villages deep in remote Kenya. Her baby died during the delivery. She also complicated by getting this fistula.
Rose* couldn’t deal with the loss of her baby. She became psychotic. Pueperal psychosis is what the medics call it. Deep in the village, her father did not know how to deal with her. A vibrant young girl now gone mad and leaking faeces. He did what he thought was the easier way out. He tied her legs in a flexed position. Legs together, knees bent completely and tied to the back of the thighs. Then locked her in a hut. For five years. By the time she was being rescued, her legs were permanently fixed in that foetal position. She had suffered bed sores so bad that her leg bones were exposed. And she still leaked feaces.
Rose* is currently awaiting review by another reconstructive surgeon to release her knees and hips now that her bed sores have healed. Then the fistula surgeons can attend to her.
She’s sobbing incoherently. A lesso wrapped around her tiny frame. I notice her hair. It is short. On her right hand she carries her urine bag. It is connected to her bladder through a catheter. She is seated on her bed. Dejected. Tears streaming down her young face.
I instinctively walk up to her. “What is wrong?” I ask.
She breaks down completely, “Ninaumwa. Nitafanyaje?” (I am in pain. What will I do?)
“Where is the pain?” I ask.
“Kichwa. Kichwa chaniuma!” (My head. I have a headache.)
She is speaking in a Coastal accent. She seems to be in her early twenties. Barely an adult. I beckon the nurse to come attend to her and excuse them.
The matron draws me aside. “We’ve had two days of counseling for her. She just found out that she will never be able to conceive again.”
You see, a month ago, Mariam*, a newly wed, was looking forward to her first child. Delays in seeking care resulted in a complicated labour and she ended up having a ruptured uterus. This being a medical emergency, the surgeons had to remove her uterus too. Unfortunately, her baby never made it either. She also developed a fistula with urine leaking through her vagina.
Mariam* had travelled 400 km to come and have surgery for the fistula. It was during the screening process that the news of her inability to ever carry another baby sunk in. She was still not stable enough to undergo surgery.
These two are just a tip of the horrors women go through when they suffer from fistula. Obstetric fistula is a severe maternal morbidity which can affect any woman or girl who suffers from prolonged or obstructed labour without timely access to an emergency Caesarean section. It is one of the most devastating consequences of neglected childbirth and a stark example of health inequity in the world. Although obstetric fistula has been eliminated in industrialized countries, it continues to afflict the most impoverished women and girls in the developing world, mainly those in rural and remote areas. Eliminating obstetric fistula required us to provide access to comprehensive emergency obstetric care, treat fistula cases, and address underlying medical, socioeconomic, cultural and human rights determinants.
To end obstetric fistula, we must ensure:
- Universal access to reproductive health services;
- Eliminate gender-based social and economic inequities;
- Prevent child marriage and early childbearing;
- Promote education and broader human rights, especially for girls;
- Foster community participation in finding solutions, including through the active involvement of men.
No more Roses. No more Mariams.
*Names have been changed to protect privacy of the two women.
*Image art by Alex Cherry