She smiles and clears her voice to talk to me. Her facial expression exudes happiness and a sense of relief. And why wouldn’t she be happy? For a year now, it has been bliss because the fistula she suffered from for eight years was finally treated.
Caritas Musanabera, a 31-year-old resident of Gashara in Nyaruguru District, lived in shame for eight years. She was diagnosed with fistula in 2009. Fistula is a condition that affects hundreds of thousands of women, sadly 90 per cent of them in Africa.
An obstetric fistula is a childbirth complication due to obstructed labour when the tissues between a woman’s vagina and her bladder or rectum are damaged from the continuous pressure from the baby’s head stuck in the birth canal. The dead tissue falls off resulting in a hole through which the woman continuously leaks urine or faeces or sometimes both.
From 2009 to 2016, Musanabera was rejected in society and, she says, people only got close to her after she got better.
The problem started when she had her first child. She went into labour at home, alone, with no one to take her to the hospital, which was far away.
“I went into labour for two days, during that time, I was alone at home as my husband was away working to take care of us,” she says.
By the time he returned, Musanabera was in a bad condition and could barely sit or stand because of the pain she was in. Her husband managed to take her to Munini Health Centre for delivery.
Worse still to come
Like every woman, Musanabera hoped to deliver safely and have a healthy baby. Unfortunately, that was not the case. She was not able to deliver normally and had to be operated because sadly, it was a stillbirth.
“The doctor removed the baby. It was unbearable losing my baby after going through all that pain. I lost all hope and I had nothing to do but go back home without a baby,” she recalls.
Her misfortune continued. As days went by, she started experiencing a loose bladder and she could barely control her urine. To her, she thought it was normal for a woman who had delivered to experience what she was going through.
The situation got worse day by day and she had to use pads to prevent the flowing of fluid and urine.
After consulting different people, she realised that the condition was not actually normal but that she suffered from fistula, which if not treated, she could have for the rest of her life.
“We lacked the kind of money needed for a procedure like this, and so I suffered with the condition for eight years. I had to depend on my husband for everything as I feared to move around and make other people uncomfortable with the stench that came with the leaking.
“It’s hard for someone who doesn’t have fistula to understand the situation. So I would just sit in my house and keep on changing clothing and pampers like as if I was a baby,” she narrates.
She says that most of the people in the community avoided her and didn’t want to be associated with her. This was mostly because of the bad smell, regardless of how many times she changed clothing.
“For all those years, I lived in shame and rejection. I even lost the will to live and wished that one day I would sleep and never wake up,” she says.
She says that although her husband never abandoned her, there was no peace in their marriage, and that every time he saw her wearing a diaper, he would walk away and only go back to the room to sleep.
“I don’t blame him because I was also sick of the life I was living. Somebody else in his shoes would have left, I can’t imagine it is easy to stomach the fact that your partner smells bad all day every day,” she says.
Hope at last
With all hope gone, a saviour came her way.
In 2016, while at home, she got a surprise visit from a health worker from the Ministry of Health.
“I will call him an angel sent from heaven because after he told me that my condition could be cured, tears of joy run down my face. Even though I didn’t know how that would happen, I believed every word he said,” she recalls.
In August 2016, Musanabera was operated at Ruhengeri Hospital, and was completely healed.
“I am so thankful to God for saving me from the misery I was in for eightyears. It’s one year since I was cured. Now I have gained confidence and can socialise with people as well as work with them without worrying about anything,” she says happily.
She is also grateful to her husband who chose to be by her side all that time.
“I still can’t believe that he endured all of that,” she says.
A problem solved
Athananse Karemera, a health worker in Nyagisozi sector in Nyaruguru District, found out that a good number of women in his area had fistula but chose to suffer in silence.
He decided to do a survey and managed to find out the exact number of women with the condition.
This is how Musanabera was discovered.
“We were able to identify 13 women last year with fistula, out of that, nine of them got treatment and they healed completely,” says Karemera.
He adds that three of them have not been cured completely but they are waiting for more treatment next month. The rest are in the process of being treated.
He notes that this problem comes about when women delay to go to the hospital while in labour.
However, Karemera says, it will all come to an end as they have different programmes that aim at educating women concerning their reproductive health, among other things.
One of them is an immediate SMS which will be activated when they go for antennal check-ups.
“When a mother goes for a check-up, the doctor will put her in the system and see what time she’ll be expected to give birth. They will receive reminders to go to the hospital,” he says.
According to World Health Organization (WHO), each year between 50,000 to 100, 000 women worldwide are affected by obstetric fistula, a hole in the birth canal. The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.
However in Rwanda, Dr Ntwari Ndiziye, Director General at Muhima Hospital and one of the experts who operates cases of fistula, says that although there is no clear data on fistula, according to Ministry of Health (MOH), around 3,000 cases of women have been operated in the previous years.
He adds that because it’s a mobility situation, it’s hard to come up with clear data concerning the condition.