OBSTETRIC FISTULA

A CASE FOR IMPROVING MATERNAL HEALTH IN NORTHERN KENYA

he overpowering stench of stale adult urine or fecal matter on beddings and clothing, in a home, combined with the guilt and shame of the one who is the source of this odor and that of her family are not experiences one would want to associate with the arrival of a new baby and yet, the condition associated with this state is said to affect 50,000-100,000 women around the world, annually. I’m talking about obstetric fistula, a condition where a hole develops between the bladder, ureter, urethra, rectum and the vagina, resulting in uncontrollable passage of urine or feces from the vagina. It also results in associated infections like ulcerations, nerve damage in the legs and kidney disease.

Obstetric fistula is said to result from injury during surgery (i.e., it is caused by the surgeon), infection, tumors, endometriosis, trauma or obstructed labor. Fistulas are also said to be caused by pelvic surgery, reconstructive vaginal surgeries, cancer, radiation from cancer and chronic bowel conditions. Obstructed labor is said to be caused by various factors such as a narrow pelvis, obstruction in the vagina or even the size or position of the baby.

Surgeries that cause obstetric fistula include: surgery for obstetric complications such as cesarean section, repair of ruptured uterus, or hysterectomy for ruptured uterus, or even from objects being forgotten in the woman’s body by doctors. Obstetric fistula has also been linked to female genital mutilation, particularly the more extreme cuts such as those that remove the clitoris or those that remove the clitoris, labia minora and parts of the labia majora and the narrowing of the vagina by stitching.

The good news is that fistula can be corrected through surgery, followed by physical therapy, to help the women regain a full range of motion and to completely heal. Although, it is said that some who do undergo surgery may still struggle with incontinence to some degree.

According to a 2019 news story, fistula surgery costs US$750 at Kenya’s national teaching and referral hospital in Nairobi, and US$5,000/- at one of what is considered a top private hospital in the country. This is a cost that is prohibitive for many, particularly those who do not have medical insurance cover or cover that will accommodate surgery for fistula. Even in Kenya, the national insurer only recently announced plans to include fistular surgery in its packages. And this during a recent fistula surgery campaign, earlier in 2021. Such specialized surgeries are available in the capital city of Nairobi and a few towns outside of Nairobi. However, in towns such as Marsabit, located over 500 kilometers north of the capital, which DON’T have this option available the women suffering this indignity, it means that they have to find a way to travel to the capital or another town in order to have the surgery, find a safe place to recuperate, while going for follow-up visits and then travel back once healed –  That’s if they have the money or medical cover or even people who are willing to support them to end their struggle with this condition.

Many times, for women who find themselves wrestling with the condition of obstetric fistula in remote areas – or in low-income groupings in urban areas – the effects can be devastating. They find themselves ostracized, rejected by their husbands, family and friends and cut off from income-earning activities, as their inability to control their urine and/or stool means that they give off not only a bad smell, but also have constantly soiled clothing that can soil surfaces used by others. Unless they get support, such as the use of adult diapers or surgical interventions, they are unable to sit in public spaces or spend time with people for extended periods, let alone take public transport without being ejected or mocked and ridiculed.

The mental and emotional pressure, coupled with the economic and social pressure, can cause them to give up on themselves and even on life. Such was the case with the recent case of a young married girl from Marsabit County who, together with her infant child, was ejected from her marital home by her husband, who was unwilling to deal with the indignity and embarrassment that had befallen his youthful bride. Cast out of the home that had chosen her, she was, thankfully, taken in by a compassionate elderly lady, who, was also not very strong financially, but together, they were making a go of things. However, overwhelmed by her state, the young mother had made preparations to end things for herself and her child, but before she could do so, a kind-hearted local woman found her and enlisted the help of her daughter to ensure that she got corrective surgery for her condition. Unfortunately, due to her unfamiliarity and discomfort with the medical procedure, and possibly the lack of proper preparation and briefing of the inexperienced girl by medical staff, she still needs further surgery to complete the process, because she would pull out the invasive catheter, which must have been a source of great discomfort and even pain for her. The organization that sponsored the medical camp at which she was first treated declined to pay for a second operation, leaving her in a condition that is halfway resolved and their beneficence, incomplete. Her supporters are continuing to work to find ways in which to ensure the second surgery can be done.

For the millions of women who are forced to endure this humiliating condition and who may be unable to resolve it through surgery, unable to work and earn a living, unable to live with their families or interact with their communities, the cost of obstetric fistula, the stigma by their societies and neglect by governments, takes an unimaginable toll on them and their children… and as a consequence, their nation. The medical impact along with the socio-economic problems arising can contribute to poor and declining health and wellbeing in these women, that can lead to untimely death, not to speak of the effects of these deaths and conditions on the children and society as a whole. This is a vulnerability that exists in many communities and needs to be addressed – as a priority – by any government that claims to care for its citizens.

When it comes to prevention of fistula, suggestions range from good nutrition for growing girls in order to ensure that their frames develop proportionally; delaying the first pregnancy until the girl is fully mature; ensuring the woman is physically fit and has accurate, adequate nutrition, wellness checks during pregnancy and empowering those who support the birth process to know what to look for. One online source described the best prevention as using the same tools and steps that one would use to maintain a healthy pregnancy. It is also recommended that the pregnant woman watch her diet to ensure that her baby is the correct weight and size, thereby ensuring that obstruction during labor is not caused due to the size of the child.

Another online source, Apollo Spectra Hospital, says that fistula symptoms can be managed using natural means such as:

Ginger Tea: Its immune-boosting and mood-elevating properties are beneficial in fistula management. Ginger soothes the digestion and provides relief from pain, nausea and constipation.

Cloves: Cloves have anti-bacterial and antiviral agents; they boost the immune system and cleanse the colon naturally. They also prevent the occurrence of parasitic infections in the body. In this instance the site recommends that cloves be used as a drink.

Tea Tree Oil: This oil has antibacterial, antiviral, antiviral, antiseptic and anti-inflammatory properties and can be used as a natural ointment. It kills germs and promotes the growth of white blood cells.

Oregano Leaf Oil: drinking this oil is said to boost immunity and kill bacteria around the anus, reducing swelling and preventing bleeding particularly for anal fistula.

Turmeric Milk: turmeric has antibacterial and antiviral agents and it helps boost the immune system and is said, by the site, to be the best for management of fistula symptoms.

*Absorption of curcumin in turmeric is said to be facilitated by the addition of a little black pepper alongside. Please do your research to find how best to use these powerful natural remedies for relief from the effects of fistula. Remember that these remedies do not seal the hole, but help manage infections and pain.

Obstetric fistula affects women all around the world and it is a horrendous condition to have to deal with as a woman and for a family to face, particularly in countries where financial and other resources to manage the condition may be lacking or where governments have cast those in need aside, not dealing with the condition as urgent or critical. It is a tough situation for communities and families that don’t have the US$ 750 or US$5,000 per surgery to help their mothers and daughters. Much like the issue of menstrual health and the lack of affordable, safe, sanitary towels for women and girls who need these items monthly, fistulas are an indicator of the level of government care and interest in the condition of their communities’ well-being.

If the young girl I mentioned earlier had not been found on time, and had not been found by someone with a compassionate heart, both she and her baby would be dead by now; more casualties in a battle that needs more than lip service and photo opportunities to deal with. A battle that can so easily be won, as keeps being mentioned when one reads up on the subject, by providing the right care to these women and girls to ensure their health and safety before, during and after giving birth. Obstetric fistula should not be an issue that is relegated to the realm of the annual monthly campaign, no medical condition should. It should be an everyday priority for affected communities to constantly be searching out the correct solutions for.

So, I have presented to you the facts and information that I was able to unearth about obstetric fistula, but I have to be honest, even as I was doing the research around this condition, I felt like a lot was missing. I still do. And, as I often do with conditions that do not appear to me to have a cause that leaves me feeling satisfied that I have most of the answers, or where the information around them is – again to me – seeming to be either inadequate, vague or inadequately covered by those who claim to be concerned about resolving it, or where the doctors follow a protocol but seem to have nothing to offer as proof positive of the origin beyond a tentative ‘it could be’ or a fancy sounding name for the condition that is more general and descriptive about the condition than it is an answer. You know, things like Folliculitis, Autism, Eczema, Asthma, Cancer, Endometriosis or PCOS or Menstrual Health ‘problems’… Or where doctors get defensive and tell you that they are the experts – or shrink back just as defensively and say this is what they learnt and they’re just doing what they were told… I’m left with some nagging discomfort in the back of my mind about the true causes of obstetric fistula and the genuine ways in which they can be avoided and handled. I am dissatisfied with the numbers that I found online, which seem to be quite old and unchanging and based on the WHO narrative alone. I am bothered by the entire thing.

I’m left wondering about a condition that seems to be closely linked to surgical error, caesarean sections and hysterectomies and ruptured uteruses and items being ‘forgotten’ inside the woman’s body and even cancer and radiation therapy. Because, as you may know, the majority of caesarean sections being carried out today are more out of financial gain or benefit for the doctors and the hospitals that are doing them than out of genuine need. In fact, Jennifer Margulis, an American journalist and PhD in the US pointed out that during the ‘covid reset season’ (my latest name for this thing they foisted on the world) cases of caesarean sections and premature births actually reduced, leaving many doctors wondering what happened to the ‘preemies’ and her giggling to herself about how medical interference in the process of pregnancy has now been exposed for the fraud that it is. The same US, according to Margulis, has the highest maternal and infant mortality rates in the ‘industrialized’ world and gives free samples of formula to women who are planning to breastfeed, which we all know is best for baby and vaccinates its babies against an STD at birth. She also says that continuous monitoring during pregnancy does not improve outcomes but actually results in more caesarean sections because the medical system in the US – which many are copying around the world – is a for-profit system. She is the author of ‘Your Baby, Your Way’ which you might want to look into reading, as she dispels a lot of myths around pregnancy, childbirth and childrearing that you may be interested in. While you’re at it, do get me a copy!

You also may know that the birthing position that many are forced into in ‘modern’ hospitals is actually quite unnatural and even impedes the birthing process because it prevents the pelvic area from being able to attain a full and unhindered expansion. I remember that a woman once shared a photo of her birth experience where she was in a squatting position and the image of her back was shared having expanded freely in what was a revelatory moment for me. Traditionally women used birthing stools that allowed both gravity and the body’s contractions to work in harmony to provide greater ease during the birthing process.

You may know that epidurals and spinals, the pain medication given during childbirth, has side effects like itching, difficulty in urinating, back pain, headaches, fever (that can cause the baby to have seizures after birth), numbness from the waist down, blood pressure drops, does not always end up relieving the labor pain and the medication reaches the baby (unlike what many are told), it may compromise fetal heartrate and blood supply at birth due to lower blood pressure in the mom, it increases length of labor, reduces the chances of breastfeeding, increases the mother’s chances of having a cesarean section… and – doubles the mother’s risk of SEVERE VAGINAL TEARS.

Something else you may also know is that ‘modern’ diets which include a lot of added sugars, strange preservatives, colors, and chemicals, as well as fertilizers, herbicides and pesticides and GMOs actually trigger changes in the body that have a direct impact on fertility and even on immunity and overall body development. They are even known to cause cancers (which were mentioned above), diabetes and obesity, including fetal diabetes and obesity. Which leaves me believing that all of these things have contributed to a general weakening of the woman’s body which may have affected the strength of the bladder, ureter, urethral, vaginal and rectal passages to some extent. Especially since I know the One Who made us and that we were made fearfully and wonderfully and well able to go through pregnancy and childbirth very well. So, what happened to change all this and when did it really start?

Are all the changes that we have made in the name of progress, development, modernity and health actually the things that are now working against us and causing our girls and women so much hardship and humiliation? I believe so and I also believe that we need to retrace our paths to a simpler time, simpler way of life, simpler diet, simpler solutions, in order to recover our humanity and accurate divinely made anatomy, before it’s too late.

Your thoughts and insights are welcome.