The New Times (Kigali)

20 May 2012

Rwanda: Giving Hope to Women With Fistula

In her first marriage, Alice Mutoni was happy and peaceful. She automatically thought that life would continue the same way especially if she had a baby with her husband.

After one year, Mutoni conceived. She says that they were both excited as they expected to have their first born.

"I was treated like a queen not only by my husband but also his relatives especially my mother-in-law. At some point, I sympathized with my maid because they could not let me help her even with the simplest house work," Mutoni says.

After the nine months, she went to a hospital to give birth and according to her; she had some complications that later forced her to consult the doctor.

"It took me a long time to give birth and I felt extra pain during the process and after, I realized that something with not right," she recalls.

She explains that: "I was just lucky that my baby survived but my health condition worsened something that forced my husband to abandon me."

Mutoni, a resident of Masaka in Kicukiro district is among many women faced with the fistula problem. Fistula is in two categories; the obstetric and vaginal fistula. These are severe medical conditions which results into women developing a hole either between the rectum and vagina or the bladder and vagina.

Among other causes, this might be as a result of inadequate care given to women during childbirth.

"It is really hard for me to explain what exactly happened to me during that time, but what I can let you know is that women with fistula are abandoned and isolated not only by their husbands and family members, but even the community," Mutuni laments.

She also notes that because of the effects, fistula patients tend to avoid other members of society in fear of public embarrassment.

"But the Almighty God is always there for every one," Mutoni says in a soft voice and a smile on her face.

"As we talk, I am very fine and I have no such problem having got treatment at the Central University Teaching Hospital of Kigali (CHU/K)."

"I lost my marriage as my husband could not tolerate the situation I was in and never did he believe that my life could change to normal like it is today," adds Mutoni.

Mutoni is one of the beneficiaries of EngenderHealth, a non governmental organization partnering with public hospitals in the fight against fistula.

However, even after getting better, the 30 year old says she will never engage in a relationship or get married again.

"Whenever I remember what I went through, I do not imagine getting married or giving birth."

Dr. Jeanne d'Arc Kabagema, Senior Medical Associate working with EngenderHealth, says that so far, 1140 operations have been carried out.

"We support fistula patients in many ways including transporting them to and from the hospitals where they have to get treatment," Kabagema says.

He pointed out that the organization that is supported by United States Agency for International Development (USAID), works in collaboration with CHU/, Kanombe Military Hospital and Ruhengeri district hospital.

"We have very few people with the capacity to handle complex cases of fistula and for that reason; we bring in experts from various countries to repair such cases," Kabagame explains.

She says that fistula cases are complicated and sometimes after repair, there are cases that some patients do not completely get cured.

Kabagema adds:"We have also come up with a strategy of training our own doctors so that they help in the fight but we still experience challenges as they are not yet to the level of handling complex cases."

She explains that not every surgeon is capable of repairing fistula, adding that there are only two in Rwanda with the skills to repair such cases.

Among them is the Director of CHUK, Dr. Théobald Hategekimana, who notes that ever since EngenderHealth started supporting women suffering from fistula, cases have been declining.

However, he calls on mothers to always report for medical services during pregnancy to avoid complications during childbirth.

Fistula can not only be treated but also prevented by getting access to emergency obstetric care such as a cesarean section.

A United Nations report released in 2010 dubbed "Supporting Efforts to End Obstetric Fistula" emphasized the need to heavily invest in cost-effective interventions to encounter obstetric fistula.

At that time, fistula was estimated to be affecting 3.5 million and about USD 750 million was required to treat new and existing cases.

It recommended that sustainable support be provided to countries' national plans, UN entities, and other global initiatives dedicated to engage in fighting against the disease.

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