Saved from 25 years of fistula

After giving birth to a stillborn, Edna Siwila of Libalile Village, Traditional Authority Nyambi in Mangochi realised she had wet her bed. That was in 1988.

“For a moment, I thought there was another baby coming and my waters had broken. Then the smell told me something else—it was urine. I asked myself how, but didn’t have an immediate answer,” she recalls.

Although she did not know what it was, this was the beginning of her life of leaking urine throughout the day. Siwila learnt she had obstetric fistula, a condition that is caused by prolonged or obstructed labour due to lack of timely and adequate medical care, creating a hole in the birth canal.

It all started when she was in labour with her second child. The labour started at night and her relations took her to Mai Bula traditional birth attendant (TBA) within the village.

It was there that she delivered a stillborn after a prolonged labour. She was taken to the hospital, but they failed to treat her urine problem. Then, she fell pregnant again and had a normal birth, but the problem persisted.

“After I developed the problem, I was still married to my husband but he hardly spent time at home with me,” laments Siwila, adding it was vivid that she was losing him.

She says she would spend much of the day washing her wet beddings, changing her clothes and bathing several times.

“On average, I changed five times of folded two metre pieces of ‘Chitenje’ daily which I would use as a nappy. This was hard work as I couldn’t move properly or do household chores freely. I used to have a permanent rash,” Siwila explains.

When her husband left her for another woman, her relations suspected that she had been bewitched. Siwila then visited a traditional healer, and was told that her neighbours bewitched her because she was a successful farmer. But the herbs he provided did not help at all.

She often spent time alone because she would get uncomfortable when she wet her clothes in public.

“I stopped socialising with friends and relatives, even funerals were hard for me to attend,” says Suwila, who has lived with fistula for 25 years.

She is one of the many women in the country who experience social and physical challenges due to fistula.

Fistula camp

Thanks to United Nations Population Fund’s (UNFPA) yearly fistula camps, Siwila was one of the 74 women who had their fistula repaired at Queen Elizabeth Central Hospital (QECH) during the first International Fistula Day on May 23 this year.

QECH hospital director, Dr Andrew Gonani, says the hospital repairs about 100 fistula patients per year and when they have a camp, the number increases.

The hospital had a camp from May 6 to 24 2013.

Suwila could not hide her joy after undergoing a successful surgery.

“I have never had peace of mind like I have now. Sleeping and waking up on a dry bed? I’m thankful to God for what he has done for me,” she said.

Midwife and fistula nurse for QECH, Nomsa Sapao, says the facility has been having three-week fistula camps twice a year—in May and October for three years.

She says apart from prolonged labour and other maternity-related issues, obstetric fistula also develops from advanced cervical cancer, rape or defilement as well as sexually transmitted infections (STIs), although the main cause is prolonged and obstructed labour.

She says traditional leaders should encourage women to give birth by a skilled midwife at a health facility other than at TBAs.

The World Health Organisation (WHO) says each year, 50 000 to 100 000 women worldwide are affected by obstetric fistula.

“Women who experience obstetric fistula suffer constant incontinence, shame and social segregation, and health problems. It is estimated that more than two million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa,” says WHO.

However, the organisation says fistula is preventable as it can largely be avoided by delaying the age of first pregnancy and timely access to obstetric care.

Deputy Minister of Health, Halima Daudi said during the camp that although a United Nations 2012 report says Malawi maternal mortality rate is now projected at 460 for every 100 000 live births, 15 to 30 of the women who survive suffer from some form of child birth disability, the most severe of which is obstetric fistula.

“If the mother survives, it is usually at a price of a dead baby and an obstetric fistula, with social consequences,” she said, adding that in Malawi, fistula is common among women aged between 15 and 45.