Crucial surgeries for women with fistula as Beyond Zero expands scope

Teressa Nyagwaya, 58, at Jaramogi Oginga Odinga Hospital in Kisumu County. Ms Nyagwaya, is among women that have undergone surgery to repair obstetric fistula during the Beyond Zero Medical Safari on November 22, 2018. [Photo: Allan Mungai/ Standard]

For two decades, Rehema Obuya lived a lonely life. The community shunned her and simple activities that she had done since childhood became humiliating experiences.

The birth of her first child in 1996 brought her great joy. The happiness, however, was short-lived due to the injuries she suffered during delivery.

Then aged just 20 and in the hands of an inexperienced birth attendant, she was left with an abnormal opening between her genital and urinary tracts – known medically as an obstetric fistula.

While her child survived and she went on to have four more, Ms Obuya was left with serious medical issues and, more tragically, stigma.

“I became an outcast. I could not go to the market or to the river. It was difficult for me to pass stool or to walk,” Obuya told The Standard from her home in Homa Bay.

It was not until 22 years later that she finally got the surgery she required to rectify the condition.

But Obuya is not alone in this struggle. Thousands of women, especially from poor or rural backgrounds, are affected by fistula but continue to suffer in silence.

The lack of skilled medical practitioners means that women sometimes have stillbirths and might even lose their lives.

In many instances, they are left with a hole that leaves them incontinent of urine or faeces, or both.

Caesarean section

This is caused by obstructed labour, when the foetus is unable to descend through the birth canal and the mother has no access to specialised healthcare for procedures such as caesarean section.

Many women, like Obuya, are now getting the necessary surgical intervention, thanks to support from First Lady Margaret Kenyatta's Beyond Zero Campaign.

Like Obuya, 58-year-old Teressa Nyagwaya lived a miserable life due to the condition that had her passing stool through her urinary tract.

But unlike Obuya, who developed the condition during her first pregnancy, Nyagwaya had a fistula when she gave birth to her last child.

“You know, those days we used to give birth to many children and we did not go to the hospital,” she said.

Unfortunately, Nyagwaya was also diagnosed with cervical cancer.

The cancer, she said, was discovered during a medical camp at Jaramogi Oginga Odinga Hospital where she had joined Obuya and 28 other women for surgeries to treat their conditions.

In the operations conducted on November 22 last year, with support from Amref Health Africa, six women were treated for rectovaginal fistulas while four had surgery for vesicovaginal fistulas. Twenty-four others were treated for other debilitating gynaecological complications.

According to the Kenya Demographic Health Survey 2014, cervical and breast cancer among women remain a major cause of death among women.

About 37,000 new cases are reported each year, yet screening of women between the ages of 18 and 69 is at a paltry 3.2 per cent.

Kisumu was the second county after Narok to host the Beyond Zero Medical Safari, which attracted more than 5,000 patients during its inaugural tour.

For five years, the initiative, which was driven by a simple tagline – ‘No woman should die while giving birth’ – provided free screening and treatment, and made referrals where needed.

The Beyond Zero Campaign also donated 52 fully kitted mobile clinics to the 47 counties.

While the number of women who die during childbirth has drastically reduced from the jarring figures reported before the campaign was started, there are many more who are living with conditions such as fistula.

HIV infections

On the back of success in reducing the number of women who die in childbirth and preventing new HIV infections among children, the Beyond Zero Campaign is taking on a bigger challenge.

New HIV infections among children reduced from an estimated 13,000 in 2013 to 6,100 in 2016 while the percentage of mothers delivering without a skilled health provider decreased from 56 to 34 per cent respectively.

The initiative is adopting a new framework that will guide its approach to healthcare for the next five years with a view to making it more people-centred and resilient.

“Our work is not done. The framework adopts a life-cycle approach, addressing challenges at different stages of life as people move from childhood, through adolescence, to adulthood and old age,” said the First Lady.

“It promotes equal access to quality health services, reaching those that are left behind, including decentralised management of obstetric fistula, and breast and cervical cancers, along with nutrition during early childhood and equitable opportunities for children living with disability.”

The Council of Governors said it was looking forward to the second phase of the project.

The council’s health committee chairperson, Mohammed Kuti, said counties were in short supply of human and financial resources, technology and the know-how to achieve their healthcare goals, so the partnership would aid in improving the quality of care.

"The impact of partnerships is being felt especially in vast and marginalised counties such as Isiolo. The clinics donated in the first phase have helped make healthcare mobile and accessible," said Dr Kuti.

This phase, to be unveiled at the March 10 Beyond Zero marathon, will also champion Kenya’s commitment to end mother-to-child transmission of HIV and syphilis, and mobilise partnerships for adolescent health programmes.

Furthermore, said the First Lady, it would mobilise the engagement of men in HIV, sexual and reproductive health, and advocate comprehensive healthcare for older persons.