24 March 2009

Malawi: Fistula Turns Women Into Outcasts

interview

Lilongwe — Pilirani Semu-Banda interviews LAUSI ADAMU, fistula patient

Women suffering from obstetric fistula in Malawi received free medical care to reverse their condition during the country's Fistula Week.

Between Oct. 12 and 18, the Malawian government, with technical and financial assistance from the United Nations Population Fund (UNFPA), treated more than 130 destitute women who have no or little access to health care services.

Lausi Adamu, from Makanjira in Malawi's lake district of Mangochi, who does not know her exact age, has suffered from fistula for the last 25 years. Her affliction came to an end last week, when she received an operation free of charge to stop her ailment.

Adamu told IPS reporter Pilirani Semu-Banda about her life with the disease as she recuperated in hospital after the operation.

IPS: How did you develop fistula?

Lausi Adamu: It was 25 years ago, when I was in labour for three days while giving birth to my first and only child at home.

I received no medical care throughout pregnancy, and it was only my mother who was with me during delivery. There was no midwife or doctor available. It was a very long and painful labour and the baby was stillborn when he eventually came out.

I have been unable to control the leakage of both urine and faeces from my body ever since and I haven't had the courage to have another child.

Why did you not receive medical care during pregnancy and delivery?

It takes four hours to walk from my village to the nearest hospital, and no vehicle goes into my area because the road is in a very bad condition. Most births therefore happen at home, and women rely on their mothers, their mother-in-laws or traditional birth attendants to help them during labour.

The culture in my area also demands that the first baby has to be delivered at home for elders to ensure that the husband is indeed responsible for the pregnancy. There is a belief that most women have more than one relationship after they just got married -- so the women who help at birth ask the woman in labour to mention the (name of the) real father of the baby. The belief is that if any complications develop during the process of giving birth the woman has been unfaithful.

What did you know about fistula before you developed the condition?

I thought I was bewitched, but everyone else in my community thought I had been unfaithful to my husband. It was a very strange affliction. My mother took me to five different traditional healers who told me that the condition was incurable and that I should accept to live with it for the rest of my life.

However, there have been many such cases in my area over the years, and most of the women have been treated by community members the same way as me (with contempt).

Government and UNFPA staff have in the past year been coming to my area, and they have been carrying out community meetings where they are telling us that the condition is medical and that it is repairable.

I decided to come to the hospital to see if indeed I can be helped after one of the women from my community, who had a similar condition, came back cured after visiting the hospital.

How has fistula affected your life?

It has been a terrible nightmare. My husband left me two months after I developed fistula and my mother died soon thereafter. All of my relatives, including my own brothers and sisters, deserted me.

I have been living a very lonesome life since no one wanted to be close to me because of the appalling smell that emanated from my body at all times. I could never attend any social gatherings within my community, not even funerals of my own relatives.

I have been selling mats, which I weave, to make a living, but I never got close to my customers even then. I leave the mats by the roadside and speak to them from a distance about the price.

Do you still believe fistula is caused by witchcraft?

Not any more. After listening to the community meetings being carried out by UNFPA and government and after my visit to the hospital, I believe that fistula occurs due to prolonged and hindered labour during which the baby's head puts pressure on the bladder and rectum, thereby causing holes. This causes the woman to leak urine or faeces or both uncontrollably.

Looking back 25 years, I do agree that this is what really happened.

Are many members of your community now changing their perceptions about fistula due to the meetings?

It is very difficult to change people's perceptions because most of us have not been to school. Our culture is strong and it's not easy to sway people away from what they have believed in for a long time.

Of course, there are quite a number of us that have now come to accept how fistula occurs, but it will take a lot of sensitisation before most people start to believe that fistula is indeed a medical condition.

Now that women with fistula are able to access medical treatment, what other challenges are they facing?

The medical personnel carrying out the repairs are men and because my community is very traditional and conservative, most women are not willing to be treated by men, especially since the condition has to do with private parts.

Given a choice, I would have opted to be operated on by a woman. However, we are being told that it is only men that are qualified to carry out fistula repairs, so we don't have a choice.

Will you play a role in educating people in your community about fistula?

I have had fistula for a very long time and I have experienced unimaginable torture from this condition -- I know the terrible feelings that women with fistula have to live with.

When I go back home, I will encourage women with fistula to go and seek medical help. I will also be advocating for hospital deliveries and try to change people's thinking. The best way to avoid fistula is to encourage pregnant women to go for antenatal care and to have their babies delivered in hospital.

Do you think that organisations working to combat fistula are doing enough?

They're trying their best. But apart from aid organisations we need government to help us in the reduction of poverty as well because I now understand that fistula happens mostly among poor people.

Communities like where I come from do not have easy access to proper health care and good roads because they are mostly poor. We also need education so that we can understand issues and to get rid of harmful traditional beliefs.

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