Amref’s Surgical Outreach Programme- Fistula Campaign
It feels strange to be writing this blog after having returned home almost 2 months ago – just as the next set of PULSERs are getting ready to go out on their assignments! Nevertheless, I think it’s important to share my experiences with you all whilst it’s still fresh in my mind.
Living in the west, we are very fortunate to have access to all the essential commodities including easy access to the health care services. Now imagine what your life would be like if you were living on about a dollar a day and you needed medical attention and the nearest hospital/clinic was miles away through dirt roads. This is the reality for millions of Africans living in rural, often hard to reach places preventing them from receiving the medical care/treatment. It was exactly from this type of ‘unmet’ medical need that the clinical and surgical outreach programme was initiated by the founders of Amref Health Africa back in 1957. Today Clinical and Surgical Outreach programme continues to be the cornerstone of Amref’s mission to improve health in Africa.
Amref Health Africa’s clinical and surgical outreach programme covers a wide range of specialities including reconstructive surgeries for obstetric fistula and ophthalmological surgeries. I had the privilege of accompanying the Amref team on the fistula outreach programme in Siaya county and the ‘trachoma’ elimination programme in Kajiado county.
In this blog, I’ll share my experience of the fistula outreach programme ran by Amref Health Africa late February 2018 in partnership with CAIA-MNCM (Canada-Africa-Initiative to Address Maternal, Newborn and Child Mortality) project and couple of the moving stories of women impacted by this dreadful condition. These were just some of the ordinary women but with extraordinary courage and resilience. Whilst I did not directly change or impact the lives of these women, I hope through writing this blog, I have managed to increase the awareness of this condition amongst my fellow readers.
Amref Health Africa hired 3 nurses to interview and screen women of all ages for gynaecological conditions including obstetrics fistula – a condition usually resulting from prolonged and obstructed labor, leaving women incontinent of urine or faeces or both. I watched in awe as the nurses tirelessly screened the women one after the other, filled out the paperwork and scheduled the surgeries. I felt quite helpless through it all and questioned why we had these preventable conditions occurring in this day and age.
Those eligible for fistula repair would undergo surgery as part of Amref’s outreach programme and others such as those diagnosed with cancer would be supported and connected with appropriate cancer treatment clinic. Many of these women had travelled miles to attend the medical camp as their last hope to end a life of misery, to live normally and to be accepted by their families and communities. I noticed these women were treated with dignity and respect by the nursing staff and in return, I could see the gratitude and sense of relief on the women’s faces that at last, someone was going to help them.
Case one: a 25-year old woman, who never attended school, married early and fell pregnant in her early teens back in 2005. Unfortunately, during the pregnancy, the husband left her for another woman and tragically, she also lost the baby at childbirth which left her suffering from obstetric fistula. She had no support from her family as she’d lost both her parents by this time and was left in charge of 2 younger sisters who also abandoned her as soon as they could because she was ‘leaking badly of urine’ and they could not withstand the smell!
People laughed and ridiculed her. Her condition got so unbearable that she could no longer control her urine and she no longer visited people or allowed people to visit her at home which reeked of urine. Then she heard about medical camp organised to offer free screening. The community health worker in the village convinced her to attend the camp to have her condition checked. After confirmation of her condition, she underwent fistula repair surgery. Before the operation, she’s said “I’m fed up with life because everyone looks down on me due to my unending health problems and worse still, I can’t get married. If the operation is successful, I will be accepted back in society and I will be very grateful”.
I did not get a chance to find out but I pray to God that her operation was successful and that she was able to integrate back into society and start living again…….
Case two: Janet, a 32-year old woman from a nearby village attended the medical camp told us her story.
She’d suffered from her fistula condition after delivery complications during her first pregnancy at the age of 18 years. She’d undergone emergency caesarean section in a nearby county hospital but as in many of these cases, the baby did not survive. Despite being told by the medical staff that her ‘urine leakage’ would improve, her condition deteriorated with time.
She became uncomfortable around people, her self-esteem lowered and she became depressed as she had to wrap many layers of clothes around her private parts to absorb the urine. To add insult to injury, her husband also left her stating along the lines:
“the reason for leaving is that I can’t live with someone who cannot control her urine and unable to bear me children”. This just goes to show lack of knowledge about the condition and the need for education.
In Kenya, being married and able to have children is very important. Later, Janet re-married and moved-in with her new husband as his third wife. Her husband turned out to be abusive, not supportive of her condition and often raped her. We may well ask why she didn’t leave him – she had nowhere to go, no family support other than her mother and at least being married, she had a roof over her head and food in her belly. People around the village avoided her and no one was willing to employ her or give her house-hold chores because of the urine stench.
Then she became aware of the free fistula medical camp by Amref Health Africa and was encouraged by her mother to attend. At the medical camp she learnt that she was not alone – there were many other women suffering from similar condition. She underwent screening and the specialist noticed Janet had a bladder stone which needed to be removed before she could undergo fistula surgery.
Again, as with the first case, I was not able to witness the outcome of the fistula surgery but during the medical camp, Janet stated:
“ …I cannot put into words what you have done for me and other women having similar problems. I would recommend that anytime you hear that Amref has a medical camp, go and get yourself checked as this service is free and help those of us who do not have money for these procedures”.
Women undergoing screening…..
These are just couple of the women’s stories that I came across during my visit to Amref’s fistula medical camp in Siaya county. They’re the lucky ones – many women are not so lucky and in the long-term can end up with more serious chronic problems like kidney disease, ulcerations and so on.
It’s heart breaking to see women suffering from this chronic condition, stripped off their dignity and self-esteem, shunned by their families and friends. For some, the stigma associated with fistula keeps them from seeking help leading to isolation, physical and emotional issues and even resorting to suicide. In some communities, the condition maybe seen as witchcraft, a punishment or a curse for an assumed wrong doing by the woman rather than a medical problem.
It’s estimated that as many as 2 million women live with untreated obstetrics fistula in Asia and sub-Saharan Africa. The sad part is that it can be prevented by avoiding early pregnancy, stopping some of the harmful traditional practices and timely access to obstetrics care. Of course, these things are easier said than done in communities where early marriages are part of the culture and living in remote villages makes it harder to access timely obstetrics care a real challenge.
Whilst these challenges are likely to remain for the foreseeable future, NGOs like Amref Health Africa together with their partners are helping to improve the lives of such women by continuing with their mission to support and train communities/community health workers through their maternal and child health programmes…………..