HARARE, Zimbabwe – “Every day for the past 19 years has been a social and emotional struggle for me – but today I am a new woman, with dignity,” said Tuwede Adam, 35. She was giving her testimony after benefiting from an obstetric fistula repair camp at Chinhoyi Provincial Hospital, in Mashonaland West Province.
Ms. Adam was one of 30 women who, having lived with the debilitating condition for many years, was given the opportunity to have life-changing repair surgery for free, thanks to UNFPA Zimbabwe, in partnership with the Ministry of Health and Child Care, and Women and Health Alliance International (WAHA).
With $100,000 committed to the Campaign to End Fistula under the H4+ initiative, the first of a series of repair camps ran from 19 August to 18 September 2015. The surgeons repaired 30 women from Mashonaland West and other parts of the country. The repairs included 25 veisco-vaginal repairs, one recto-vaginal repair and four combined CCF and RVF repairs.
Dr. Jean Yunga, a fistula surgeon with WAHA, led a team of local doctors supported by the Ministry of Health and Child Care, as well as theatre and ward staff from Chinhoyi Provincial Hospital. Social workers from WAHA provided patients with counselling and support before and after surgery.
‘I never thought I would feel this way again’
When Ms. Adam signed up for the obstetric fistula camp she had lost her sense of self-worth, having suffered from societal marginalization often associated with fistula. But after the surgery, she was able to leave the hospital with her head held high.
I have left all of that fear behind me; I am a grown woman again, and dignified. – Tuwede Adam, 35
For almost two decades Ms. Adam had lived with the condition. She became incontinent following an agonizing four-day-long labour that ended in a forceps delivery – and a stillborn baby. Compounding her grief from the loss of her child, she was ostracized in her community in Rusape due to the fistula that developed and subsequent incontinence. This is a fate commonly suffered by women with fistula.
Today, Ms. Adam looks forward to her future. She has returned to her community with a new-found confidence. “I feel fresh and clean, and there is no bad smell around me. I do not have to panic when among my peers for fear of wet clothes when I stand. I have left all of that fear behind me; I am a grown woman again, and dignified. Now I shall look for a job, and I know I will be okay!”
A denial of rights and dignity
Ms. Adam was one of the lucky ones. Her husband stuck by her despite her fistula. Many women and girls living with obstetric fistula are marginalized and neglected by their partners, families and communities due to the debilitating condition, which renders a woman completely incontinent.
It is estimated that two million women worldwide are living with the condition, with an estimated 50,000 to 100,000 new cases developing each year – yet it is almost entirely preventable and treatable. The persistence of obstetric fistula is a sign of serious inequalities and the denial of girls’ and women’s rights and dignity, according to Dr. Edwin Mpeta, UNFPA Zimbabwe Programme Specialist, Reproductive Health: “Many women with obstetric fistula in Zimbabwe are socially isolated and may be unaware that the condition can be repaired. Until now, and for a number of reasons including lack of capacity to deliver the service, there has not been a huge drive to address the problem.”
The partnership between the Ministry of Health and Child Care, UNFPA Zimbabwe, and WAHA has brought significant change, while ensuring sustainability by capacitating health personnel with the necessary skills to repair more women after the programme comes to an end.
My school friends all progressed to become wives and mothers, but my own life was one of isolation and sorrow. – Aisha, 18, fistula survivor
Repairing injustice
The injury includes many women like 18-year-old Aisha, who suffered from fistula for eight years following a sexual assault when she was only 10 years old. “I was raped by my uncle and no-one believed me. Just before my eleventh birthday I suffered a difficult and traumatizing labour at home.”
After three days of agonising labour, Aisha’s family finally took her to hospital but it was too late. Aisha delivered a stillborn child by Caesarean section and developed a fistula as a result of the protracted labour.
“I began to leak urine through my vagina. No-one wanted to be around me,” she said. Upon returning to her community, Aisha was ostracized. “My school friends all progressed to become wives and mothers, but my own life was one of isolation and sorrow.”
Reaching women through innovation
Things finally looked up for Aisha when she heard a radio announcement about the free obstetric fistula repair camp in Chinhoyi. The camp recruited patients through mass media advertising on local radio stations, flyers at local health facilities and using social media platforms, particularly WhatsApp. When she heard the advert, Aisha immediately phoned the hotline number. “I was so excited, I begun to pray that I would quickly get a date for surgery.”
Aisha’s prayers were soon answered. She received a call from Fortunate Mabhande, WAHA’s National Outreach Coordinator, informing her she had received a placement for free surgery at Chinhoyi Provincial Hospital.
As well as receiving repair surgery and counselling, patients are provided with money to assist with transport costs to attend the camp. Money is sent to the patients through EcoCash, an innovative mobile payment system that allows for cash transfers to those without bank accounts or those living in rural Zimbabwe, using one of the three major mobile network service providers in the country.
I am a woman, complete and dignified. My shame is gone! – Aisha, 18, fistula survivor
Aisha is now filled with self-confidence and hopes she will meet ‘Mr Right’ and start a family of her own. “Look at me today,” she said. “I am a woman, complete and dignified. My shame is gone!”
The campaign has been welcomed by the community, and has resolved the matter of social exclusion. “The campaign has brought women out in their numbers,” said Dr. Collett John Mawire, Medical Superintendent at Chinhoyi Provincial Hospital. After the success of the first camp, our aim is to make the initiative as sustainable as possible and create public awareness of the condition, especially that it can be repaired. If the number of women with obstetric fistula grows, and the partnership allows, the hospital may become a centre of choice for obstetric fistula repair in the country. ”
UNFPA is committed to working with the Ministry of Health and Child Care and partners to address the problem of fistula in Zimbabwe, said UNFPA Country Representative Dr. Cheikh Tidiane Cisse. “As UNFPA, we are committed to ensuring every woman lives a healthy reproductive life, in a state of physical, mental and social well-being at every stage of their lives.”
The Campaign to End Fistula is being implemented under the H4+ Programme funded by the Swedish International Development Cooperation Agency and Department of Foreign Affairs, Trade, and Development of Canada.
By Victoria Walshe
