Anne Akinyi, a patient suffering from obstetric fistula, awaits free corrective surgery at the fistula clinic at Kenyatta National Hospital in Nairobi, Kenya.
NAIROBI, KENYA – Anne Akinyi was 15 when she became pregnant.
She was living alone after her parents died and her elder sister got married and was attending primary school in Kisumu, a port town in southwestern Kenya.
When she went into labor, her elderly neighbor, who claimed to be a traditional midwife, came to attend to her. Akinyi recalls that the plump, dark-skinned woman, who used to wander her neighborhood with baskets of herbal medicine, told her to close her legs tightly every time she felt the labor pangs.
The pain disappeared within one hour, Akinyi says. Then, the elderly woman told her to go to sleep.
The next morning, Akinyi’s entire body was swollen, and her stomach had turned black. The old woman told her there was nothing to worry about, and she remained in the same state for three days.
On the fourth day, the woman gave her a concoction of traditional herbs meant to induce labor. They worked.
Akinyi pushed to force out twins. But by then, they had died.
The woman quickly fled when the dead infants were born, afraid she would be accused of the deaths, Akinyi says. The teenager had no idea what to do.
It was not long before Akinyi realized that she could not control the passing of her urine and stool. When she went to a local hospital a week later, she was diagnosed with obstetric fistula.
A fistula is an abnormal hole that forms between the bladder and the vagina or, as in Akinyi’s case, between the rectum and vagina as well. The most common cause of fistula is obstructed labor, say doctors at Kenyatta National Hospital, Kenya’s largest public hospital, in Nairobi, the capital.
Akinyi underwent several surgeries at a local hospital in Kisumu, but the condition persisted, she says. As is the case with many fistula patients, the condition cut her off from society.
“I could not go back to school, market or attend church because of the stench I carried around,” she says. “To trap the urine, I used old pieces of clothes, which I changed and washed often.”
Akinyi, now 23, lived with the condition for six years. She resigned herself to the fact that she would never have children or get married because of it.
But then she learned about an opportunity for free corrective surgery at Kenyatta National Hospital’s fistula clinic.
Akinyi was among the 113 women who underwent surgery in June and July 2013 during the clinic’s annual fistula camp, which aims to raise awareness about the condition. She was surprised at the number of women admitted with a condition like hers, she says.
“I thought I was alone,” she says. “I had never heard about the condition before, and I never told anyone that I had it.”
When she heard the hospital’s radio advertisement calling on women with the condition to go receive free treatment, she knew it was her best chance to get her health and life back, she says. She borrowed money from a neighbor and traveled the 350 kilometers (220 miles) to Nairobi.
Two weeks after the surgery, Akinyi was able to pass urine and stool normally, she says. Doctors told her she could have children in the future, though her past experience has dampened her desire to. After years of solitude, the chance to live a normal life again excites her most.
“I want to start my life over, go back to school, make new friends and attend church,” she says. “I really missed going to church.”
An increasing number of teenagers and women with obstetric fistula are seeking free corrective surgeries at the fistula clinic at Kenyatta National Hospital, the only major health care institution to offer this opportunity year-round. Beneficiaries say the awareness that other women suffer from the same condition and the correction of it are enabling them to reintegrate themselves into their communities and to regain their lives.
Surgeons attribute the increase in patients at the fistula clinic to a rise in incidence because of issues such as early pregnancy and delivery outside hospitals. Surgery sponsors cite awareness campaigns, such as the annual camp, that educate women about the condition and encourage them to overcome stigma so that they seek care. The fact that surgery at the clinic is free also makes it more accessible.
Eighteen percent of girls in Kenya become pregnant between ages 13 and 18, according to the Kenya Demographic and Health Survey 2008-09.
Teenage girls are at an especially high risk of developing fistula during childbirth because their bodies are not fully developed, says Dr. Weston Khisa, a fistula surgeon at Kenyatta National Hospital.
Each year, 3,000 new cases of fistula occur in Kenya, according to a 2011 report by Campaign to End Fistula, a global initiative by the United Nations Population Fund and various partners. But only about 7 percent are able to access care.
Khisa estimates the number of new cases to be 1,000 per year. As most patients do not receive treatment until years later, it is difficult to tell what percentage of women get fistula as teenagers, he says.
“Most of them get used to living with the condition and withdraw from the society,” he says.
Fistula hits teenage mothers the hardest, says Lucy Mwangi, director of Freedom From Fistula Foundation Kenya, one of the foundations that financially support the free fistula surgery program at Kenyatta National Hospital.
“The girls lose lots of opportunities,” she says. “They can’t go back to school. They can’t look for a job. They can’t get married and have other children. Their lives are totally disrupted.”
But now, a growing number of teenagers and women are obtaining free corrective surgery year-round at the fistula clinic at Kenyatta National Hospital, thanks to financial support from Freedom From Fistula Foundation and African Medical and Research Foundation.
Some private and public hospitals offer fistula services, but it is not free, Khisa says. A corrective surgery typically costs 60,000 Kenyan shillings ($700).
The fistula clinic at Kenyatta National Hospital performs 15 free surgeries per week. Every year for the last eight years, it has also held a fistula camp.
The goal of the one-week camp is to raise awareness about obstetric fistula, Khisa says. Doctors also perform about 100 surgeries during it.
The number of women seeking care at the camp increases every year, Khisa says. During the 2013 camp, staff screened 629 patients. Doctors performed 113 surgeries during the camp, and they have continued to schedule the remaining surgeries for every week since.
“We thought the numbers would go down, but we’ve noted they are still high,” Khisa says.
Khisa attributes the annual rise to an increase in the incidence of fistula. One reason is early pregnancy. Another is traditional birth attendants’ failure to refer patients to the hospital after diagnosing obstructed labor. The inaccessibility of medical facilities throughout the country and poorly equipped delivery theaters further the problem.
The cultural preference to deliver at home also contributes to the problem.
“Where culture is strongly against hospital deliveries, fistula is also common as traditional birth attendants take long before referring mothers to hospital,” Khisa says.
Mwangi says the reason why many women are now seeking treatment is because the Freedom From Fistula Foundation has been conducting awareness campaigns locally through vernacular radio stations, especially in advance of the fistula camp. Most women are too shy to seek help or advice because they consider it a private and embarrassing matter.
“In the last three years, we’ve gone all out explaining what fistula is in local languages and urged women who have the condition to come to the camp so they can be treated for free,” Mwangi says.
Sponsors and beneficiaries of the free surgery program also promote prevention.
Mwangi, who is a teacher by profession, says sexual education and a campaign for abstinence among teenagers could reduce the incidence of fistula because they are engaging in sex too early. For women, the foundation encourages visits to prenatal clinics and in-hospital deliveries.
Akinyi, who cites peer pressure as the reason she started having sex in her teens, says she is now careful about the choices she makes in life and choosy when making friends.
“Girls should be careful in whatever they do,” she says. “One mistake can cost them their lives.”
