As an update for those who may not have heard: I am working in SW Uganda now as a programs advisor with an organization called Medical Teams International (MTI). My job has many facets and involves working with many programs. As I get to know and work with each one, I’ll be sharing stories and experiences about them all, but the first one I want to highlight is the obstetric fistula program.
The World Health Organization estimates up to 2 million women in sub-Saharan Africa and Southeast Asia suffer from obstetric fistulas. Humanitarian groups who work with these women estimate that number to be far higher. Uganda is ranked third in the world for the highest number of fistula cases, with an estimated 140,000 to 200,000 women affected, and 1,900 new cases occurring annually. Obstetric fistulas are usually caused by difficult births. Many women in sub-Saharan Africa give birth in the bush or in their banana plantations – without a midwife or any other medical assistance. If there is prolonged pushing or if the baby is in the wrong position, tearing can occur and no one is present to stitch it up afterwards. Girls who get pregnant in their teens (either because of early marriage, rape or lack of birth control) are at high risk for this as often their bodies are not yet ready to allow passage of a baby through the birth canal. And finally, gender based violence at any age can also cause tearing and tissue damage leading to fistula formation. Either way the damage goes far beyond mere physical as the girls or women are then ostracized from their families and communities. The fistula can affect any or all parts of the genitourinary tract from vagina to anus. The resulting tears cause the women to leak urine and/or feces uncontrollably. The smell becomes a source of shame and embarrassment, and their inability to properly function as wives and mothers further devalues them in the eyes of their communities. Forced to fend for themselves and live in isolation in the bush, many die of starvation or infection, others live as half animals in the jungle, hiding during the day and coming out to forage and steal food or supplies at night.
Thankfully, surgery to repair these fistulas is fairly simple and can restore these women to full physical health, even allowing them to give birth again. Finding these ostracized women and then convincing them to have the surgery, however, is not as simple.
Medical Teams International, partnering with the Ugandan government to provide health service to refugees, began a fistula clinic at the end of 2015, and performed its first successful surgery in April of 2016. Since then, 59 women have had the surgery with only 3 not successfully healing. Their goal is to expand services and efforts to reach more women as awareness of the enormity of the problem continues to grow.
One challenge is the long recovery period. Women must stay at the clinic for up to 3 weeks following the surgery and then cannot resume normal activities of daily living for another 3 months. Families, and particularly husbands, overjoyed at getting their wives back are often not content to wait the 3 months. One of the first women to have the surgery was ruptured almost immediately upon returning home by her overeager husband who was not willing to be patient. Fortunately he has become one of the program’s champions and voluntarily talks to groups of men educating them to not make his mistake, and to wait the allotted time.
Convincing the women to come to the clinic can take weeks and even months of visits by MTI staff to gain their trust after years of being reviled and humiliated. One woman living in a lean-to she built with banana leaves resorted to alcohol to numb her isolation and loneliness. She hid from the MTI team who came to visit her for 3 weeks before finally agreeing to talk from behind the tree where she was hiding as long as no one came any closer. They brought her sugar, salt and flour, luxury items she hadn’t had access to in years. Finally she accepted the gifts and agreed to meet with the doctor who would perform the surgery. But when they came to get her on the appointed date, they found her too drunk to travel. They had to come 3 more times before she finally agreed again and only when they promised that she could sit by herself in the back of the Land Cruiser. Most of these women have been forced off public transportation and publicly humiliated because of their smell, so she could only feel safe if she knew she would be alone and sitting far from the rest of the team. Her surgery was successful and afterwards she moved in with her mother. When the MTI vehicle drove to her new location she saw the vehicle coming while it was still far away. As they drove up, the staff saw a woman they didn’t recognize dancing beneath an avocado tree. It took them a few minutes to realize it was her. She was clean, her hair was no longer in tangled dreads, and she had gained enough weight that her bones no longer protruded. She was dancing with joy and tears streamed down her face as she welcomed them by showing off what she could now do. After talking to her for a while one of the team noticed there were no alcohol bottles or wrappers lying in the yard. She asked the woman if she still drank. The woman snorted in disdain and then shrugged, “I don’t need it anymore.”
The women all receive individual counseling but are also required to take part in monthly group meetings with other women who have received the surgery. For many, finding out they are not alone is the first real step in healing. The group sessions are an opportunity for them to share experiences openly with others who understand perfectly. One of their favorite topics is talking about their husbands. One woman confides she didn’t tell her husband he had to wait 3 months: “I told him he had to wait at least a year.” The others roar in laughter. One woman who hasn’t said a word suddenly stands up and says, “You know what I can do now? Watch.” And she takes off running. Her 8-year son, who has only recently been reunited with her, catches up to her, grabs her hand, and they run together laughing in circles around the group sitting under a tree. Other women jump up and start running too and suddenly everyone is up either running or dancing, laughing and crying.
Sometimes they share more personal stories. One woman recalls growing up in the Congo where war was part of her earliest memories. Different tribes or political parties have always fought over land rights, and violence, to ensure terror, is part of the warfare. When she was 10 her village was attacked. She was outside hanging laundry when people started screaming. She watched as her 6-year old brother was struck down by a machete. Then she was surrounded by men and brought before her parents who were being held down by others. Boys can grow up to be soldiers so are instantly killed. Girls aren’t so lucky. At least a dozen men took turns raping her in front of her parents. Others ransacked their home. Her 4-year old sister was found hiding in their house and tortured. She died from internal bleeding and injuries later that night after the marauders left. When they fled across the border into Uganda their family of 6 was down to 3: her parents and herself. Another brother was never seen again and to this day she has hopes he escaped. After fleeing to Uganda, her father left one day and never came home. Her mother who was also raped that day contracted HIV and died a year later. With no family to take her in, this woman had been living alone since age 11. Because she smelled and always had dirty clothes, no one wanted her living with them. Now for the first time, roughly in her 20s, not only is she healthy, she finally has friends. Now MTI is struggling to come up with the space needed to expand the program. Because the women require such a long convalescent time, they can only do a few surgeries at a time because there aren’t enough beds to accommodate the women for 3 weeks. The surgeon who has been trained to do the surgeries also needs better training. He learned at a 3-day seminar with a larger group of surgeons from other parts of the country and had no hands-on time with the instructors. Finding funding to get better training for him, train new surgeons, and build a 10-bed ward just for fistula patients are some of the challenges with which we are faced. But the local staff who work with this program remain committed and passionate as they admit their lives have all been touched and forever changed by the amazing women so far this program has been able to help.
Pray for these women, the doctors and the Medical Teams International organization and me. You may donate to this cause as this site - https://www.classy.org/campaign/karen-alford/c113452