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| Living in hell for 20-years with vaginal fistula |
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             The grey haired Mary Mugure smiles blissfully at us as two nurses at Kenyatta National Hospital (KNH) prepare her for theatre, where a condition that has seen her live in misery for the past 20 years will be rectified. Her problem was Vesical Vaginal Fistula (VVF) - a condition where a woman passes urine uncontrollably, making it difficult for her to enjoy normal social and economic life. In 90 per cent of the women, the problem is due to prolonged obstructed labour. Those who deliver babies with big heads; have undergone pelvic cancer treatment, or have births that present in an abnormal way, are also at a higher risk of developing vaginal fistula. Poor women, who cannot afford to deliver with the assistance of a skilled birth attendant, are the hardest hit. So when Mugure sought to have the problem corrected, doctors at the hospital then said they could not handle her case because they lacked a bed where she could recover after surgery. Tired for waiting this long, Mugure gave up, retreating into her home in Ruai, and vowing to die that way. After 20 years living with the problem, she three weeks ago came back to the same hospital after hearing of a free medical camp to operate women with a similar condition. “When I heard it over the radio, my husband encouraged me to come arguing that it was for free after all,” says Mugure. Dr Khisa Wakasiaka, a consultant gynaecologist and specialist fistula surgeon at Kenyatta National Hospital, understands Mugure’s resignation. He says the gynaecologists who were handling the cases in the late 1980s into the 1990s lacked specialized skills on fistula operations. “There is a woman who came to the hospital in 1995 when I was a post-graduate student. She is part of those we are operating on now.” Although a lot has happened since the two women sought assistance from KNH, the situation remains desperate. At the moment, the country is in crisis as it tries to handle the over 30,000 women who are waiting to have their fistula problem rectified. Those who manage to get to KNH, where close to120 new cases are reported annually, are lucky if they get treatment immediately. According to KNH, of the 400 patients with vaginal fistula problem who consulted the hospital in 2006, only 7.5 percent of them were operated on, leaving 370 on the waiting list for consideration the following year. The percentage increases to about 25 per cent only when there medical camps. The two vaginal fistula experts at the hospital are said to be overwhelmed by the numbers, forcing patients to wait for atleast six months before they get into the theatre. About 70 per cent of the fistula operations in the entire country are conducted at the hospital. “The other reason for this huge numbers is the inability of many patients to afford even the Sh 350 consultation fee required by the hospital,” explains Dr Khisa. Interventions at the district and provincial hospitals have not helped either as they too lack experts on fistula operations. Those doing it at these levels are gynaecologists, who are in most cases not specialized to handle such complex problems. “From March this year, 12 women have come with the problem. But the fistulas were complicated that I did not even attempt to correct them,” says Dr Yusuf Guled, the only gyneacology at the Garissa Provincial General Hospital, who is also expected to handle fistula cases from the expansive province. These women and other women not treated at the provincial level have to cover hundreds of kilometers to reach KNH or wait for outreach programmes conducted by AMREF. In fact, at the moment the two surgeons at KNH are training four gynaecologists from Kapeguria, Garissa, Kitale and Voi to help them reduce the huge backlog facing the country. Dr Yusuf is one of them. Most patients have in the past given up on treatment because of the Sh 15,000 to Sh 20,000 required for the surgery. In response to this, AMREF decided in 1999 to pay Sh 10,000, with the patient meeting the remaining Sh 5,000. This saw many women come forward for treatment. Still, some patients found the fee they were required to raise to be too much. Hence, in the past two years, the organization has been paying the entire Sh 15,000 for every patient with KNH waiving the rest of the expenses. A decision that has resulted in the number of cases attended to rising from 100 to 300 a year. The credit for this increase goes to the use of medical camps, a strategy doctors have adopted in the past couple of years to reduce the number of those in need of the surgery. Says Dr Khisa: “In 2006 we operated on over 300 women from various parts of the country because of the camps. While there is such great improvement, the situation in the whole country remains desperate.” The on-going camps, expected to reach more women, are part of a three-year project funded by DANIDA, Australian High Commission and Diplomatic Women Club in Kenya. It is these free medical camps that are coming to the rescue of women like Mugure who have to live with the stigma and isolation that comes with the condition. In what can be best described as a journey of courage, Mugure has managed to stay with the problem for 21 years, denying herself the trappings of social life. And the life story of this mother of eight is a heartrending one. Every single day, she has to use five napkins and three T-shirts to manage her leaking urine problem. The problem worsens when she has to attend public functions such as church congregations and women groups. At such moments, she goes around with a nylon paper bag with the napkins and T-shirts. On a typical Sunday, for instance, she is able to attend a four-hour church service by carrying at least seven pieces of clothing. After every two hours, she slips from the church, dashes to the toilet to on put on a new set of napkins to absorb the leaking urine. Night fall comes with more stress. “Even in my own house, there are times the urine is so much I have to wake up and spend the rest of my sleep sitting.” She says her urine leaking problem seems to reduce significantly while in a sitting position. “For the last 20 years, I have never spent a night outside my home. Even when my father died, I just went to bury him,” says Mugure. “To manage the stress, I sometimes smile at myself, vowing to fight on and lead a normal life. But it is not easy.” Relatives and friends have accused her for refusing to spend a night in the homes of bereaved relatives or friends or whenever it is necessary. “When they level these accusations against me, I just keep quiet because they do not know what I am going through.” Although it has been difficult, she has managed to confide in her children. “More than 10 years ago, I told my eldest children, and has done so to others as they became of age,” says Mugure. “They had wondered why I was washing napkins everyday when I did not have a baby. I had to explain to them.” After seeing what their mother went through, two of her daughters vowed not to give birth. It took a lot of convincing for them to deliver their first children. They have sworn not to get more. Her husband and the children remain “the biggest pillars in my life because of their support and understanding.” Mugure’s tribulations began in 1986, when she walked into Puwani maternity hospital expecting to give birth and then enjoy the bliss that comes with motherhood. Couple of days after delivering the baby, she started leaking urine. Doctors at the hospital referred her to KNH for specialized surgery. But after examination, a doctor at the hospital told her that they could not assist immediately because they did not have a bed where she could spend a couple of days after the surgery. “The doctor told me to go home and keep checking to see if one was available,” recalls Mugure. She was then put on the waiting list. But after waiting for six years without getting a bed, she gave up. “One day when I pleaded with the doctor, he told me they were giving priority to women in intense pain. Since my condition was not accompanied with pain, I could wait,” Mugure recounts what the doctor told her then. “I got angry and wondered why they were doing this to me. I left the hospital and vowed never to go back again.” By this time, her condition had worsened, forcing the family to rush her to Kiambu District hospital. Surgery was done, but the urine started leaking again after three weeks. She was rushed back to the hospital where a second surgery was done. Still, this did not bring any relief. A third visit to the hospital saw the doctor wheel her into the surgery room, and then out, without doing any operation. “I think the doctor was frustrated after the failure of the first two surgeries. I saw him reading some books in theatre before he decided not do the third one,” Mugure recalls some of the worst moments in her life. After this encounter, she was convinced that the medical fraternity did not know what to do with her. She gave-up on treatment, leaving her fate to God. But her 20-year painful wait turned into smiles two weeks ago when she was recruited to have specialized surgery free of charge. Mugure was one of the 60 women who benefited from the free operation done by AMREF in collaboration with KNH. Majority of the women who presented at the hospital had VVF problem as a result of obstructed labour. Some had been divorced, mistreated by family members and unable to lead normal lives. While at the hospital, the women used the opportunities to share their tribulations and the strategies to handle them. An AWC-Feature |
| Kenya Audio Visual Archives Conference |
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The African Woman and Child Feature Service, the Kenya Archival Study Group and the Ford Foundation office in Nairobi, Kenya will hold the Preservation, Conservation and Restoration of Audio Visual Media Conference. The conference will be held at the National Museums of Kenya in Nairobi, from December 3rd – 5th 2008. |
| AWC at the Highway Africa Awards |
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