Guest blog: fistula in Kenya

Monday 09 June 2014

Jessica Fleminger will be volunteering with Orchid shortly, but is currently working at a fistula clinic in Kenya. Fistula is one of the many risks associated with FGC – obstructed labour can often result from the scar tissue left after cutting and women are more likely to give birth to a stillborn child than women who are uncut. Fistula can be repaired with a small operation, but this is often beyond the means of many. 

23rd May 2014 will be the second-ever United Nations International Day to End Obstetric Fistula, and here I am in Kenya spending a month volunteering at a fistula clinic. I am a 27 year old Londoner applying for Graduate Medicine this September and am currently in Eldoret, Kenya working with Dr Mabeya and his team at The Gynocare Centre.

Dr Mabeya started Gynocare in 2009 and most the girls and women who have been treated by the centre have had a fistula which occurred during an obstructed labour where emergency care is unavailable. The women will often struggle until the baby dies and during this agonising process, loss of circulation causes tissue to die and leaves large holes between the birth canal and the bladder or rectum, causing either urinary or faecal incontinence, and in many cases both. Most women suffering with obstetric fistulas are ostracised by their families and communities because of these difficulties, leaving them to live as outcasts. An estimated two million women in Africa are suffering with an obstetric fistula today. Although most cases of fistula have occurred through obstructed labour, women come to the clinic with fistulas caused but anything from sexual assault, congenital diseases or injuries from previous surgeries.

In my first week I sat in on eight surgeries, ranging from closures of small fistulas in the vagina to urinary diversions, a surgery of last resort for some patients, where the fistula is so severe that the surgeon disconnects the ureters from the bladder and attaches them to the colon. Alongside the surgeries I have also had the chance to speak to many of the patients here, all with their own stories. Judith (48) had had serious complications after a surgery to remove fibroids, which resulted in the loss of her left leg. After the surgery to remove her leg, a hole was torn in her bladder when the catheter was removed. She didn’t have enough money for surgery to fix the fistula (10,000 KSH, approximately £65) so went back to her village, expecting to spend the rest of her life with the condition, but luckily a friend saw an advert for Gynocare and sent her to the clinic where she was able to get the entire surgery for free.

With the help of Dr Mabeya’s wife, Carol, the centre has also developed a reintegration programme to ensure that the women are supported after surgery as they reenter society. The rejection and stigmatisation that they are usually subjected to is appalling and many struggle to cope psychologically even after the surgery. Through A Little 4 A Lot – a US charity – they are able to send some girls back to school and provide others with vocational training and English lessons.

Last Monday I travelled to Kakamega (Western Kenya), to spend a few days at the Kakamega General Provincial Hospital. It is there, at the Maternal and Child Health Centre, that local mothers are provided with antenatal care and education. Women are expected to attend at least four antenatal appointments but many do not and some don’t attend any. Sometimes this is because they struggle to get to the hospital (they don’t have transportation and can’t afford a bus, for example) but others are told by their family and community to rely on their local, traditional customs so choose to stay at home.

This is where the majority of fistula cases begin – women who cannot afford antenatal care and do not have an adequate understanding of the repercussions of giving birth so far away from a hospital, go into labour in their villages. If anything starts going wrong they can be days away from the nearest hospital with facilities for Caesarian sections or other emergency obstetric care. The roads are poor and public transport is almost non-existent. During my last day at the hospital a teenage girl was brought in who had been in labour for over 24 hours. Although she was finally able to deliver the baby vaginally (almost all obstructed labours require a Caesarian section), the baby had died during the process. She will return to her village, childless, and wait to see whether a fistula has developed.

I’m back in Eldoret now, and half way through my time here. Next week I will travel to another area of Western Kenya to work with one of the centre’s outreach officers – finding new patients and educating women on how to prevent the condition, before returning to Eldoret for my final week.