New Vision (Kampala)

9 December 2012

Uganda: The Menstrual Cup Eased My Woes

Her silver earrings dangle as she speaks and on her wrist, a gold-coated watch and a silver bangle slide up and down as she gestures. This is Regina Nilele, 23, a Rwandan national living in Kamuli, Uganda.

"Men keep making moves at me - they want love, but I know my problem. I cannot get into a relationship because I am sure it would not last," she says, adding: "What I want is to be healed of this problem - I am not myself, I need to be better than I am and live happily like others."

Nilele is battling fistula, resulting from a pregnancy due to rape in 1998. During the 1994 genocide in Rwanda, her parents fled, leaving her behind with a brother, who later died.

"I wandered with other people as internally displaced persons. A certain man volunteered to look after me," Nilele says. She lived with him and another young man for four years - his wife had fled with his children.

Saviour turns traitor:

In February 1998, Nilele's caretaker began sneaking into her bedroom at night.

"He would knock or kick in the door. The last time, he kicked it open at 1:00am," she recalls. He told her he had looked after her for years and needed to sleep with her.

"I made an alarm, but no one came to my rescue. Rwanda at that time was insecure," she explains as she wipes tears streaming down her face.

"After raping me, he went back to his bed and snored away," she says. A bleeding and emotionally damaged Nilele dragged herself out of bed and went outside the house for a while. In the morning, she went to the local authorities to seek redress.

The culprit disappeared, but his relatives were ordered to take care of Nilele. She soon found out she was pregnant. After some time, the man's relatives turned against her. Faced with rejection, Nilele got some money from an old woman and travelled to her parents' home, but she found nobody there.

"I was told my people had died. I lived in the kitchen and started gardening on our land."

When the labour pains descended, she neither had a kit nor clothes for the baby. A neighbour escorted her on foot, but she weakened on the way.

The neighbour hired a motorcycle to take her to Ngarama Hospital in Mutura unfortunately, her child was pronounced dead on arrival at the maternity ward. "I was told the child had got tired and died. I was operated on the next day at 12:00pm."

Fistula nightmare:

However, after the catheter was removed, she had a continued urine flow. She remained in the hospital for two months and returned home with the condition. Where she heard about a fistula camp in the area in 2003, she got a caretaker and went to Gahini health centre, where she was operated on. There was no change.

"Actually I was operated on three times that year, but there was no change," Nilele recounts. At the end of the year, she was referred to Kumuhima Hospital, where she was operated on two months later. There was a slight change.

By 2004, the problem had worsened and the urine turned bloody. In panic, Nilele went to Sehashika National Hospital, where she had another operation and was admitted for a year.

"I was discharged, the urine still flowed, but a little," Nilele says with downcast eyes, stating: "I stayed home, I never thought of going to any hospital again - I was tired. I lost hope."

Coming to Uganda:

In 2009, some Rwandan girls living in Uganda visited Nilele's village and convinced her to come to Uganda to work. They lived in Kyampisi in Kayunga district and Nilele started working as a house girl.

But in the two jobs she found, the work was too much for someone in her condition and it was not long before the employers stigmatised her because of the leaking urine.

By coincidence, Nilele met a Rwandan man, who took her to a community of Rwandans in Nawankulo, in Kiyunga and she lived with them, doing casual work. However, at the end of 2009, the man's wife began gossiping about her urine problem.

Hurt, Nilele left and went to Kamuli. She told her story to a retail shop owner who linked her to a job at a small restaurant.

"I ensured that customers did not know my problem. I heavily padded myself with clothes, which I would change almost hourly," she explains. "I could not sit near customers, but would retreat behind the restaurant immediately after serving them."

Menstrual cap relief:

In June this year, Kamuli Mission Hospital held a fistula camp, which Nilele attended.

"I was told I had a small hole. So, I only needed medicine and it would close up. I was also given November 24 as the date for the review," she explains, adding that the medicine did not work.

It is at this time that Valvision Foundation came in handy with the menstrual cap, which has offered Nilele a moment of relief.

Nilele says she no longer has a foul smell coming from her. She has been trained on how to use the caps and keep hygienic to avoid infection.

"I now feel okay and freely mix with people," she says.

Where to get help:

Maternal and infant mortality and morbidity although declining, remain relatively high. The current maternal mortality rate of 438 per 100,000 live births translates to about 6,000 women dying every year due to pregnancy-related causes.

Current estimates indicate that for each woman who dies from pregnancy-related complications, another 15 to 30 suffer other conditions such as obstetric fistula, yet they are preventable and treatable conditions.

The exact prevalence rate of obstetric fistula in Uganda is not well known, however, the estimated number of women suffering from obstetric fistula is in the range of 140,000 to 200,000, with about 1,900 new cases annually.

The most vulnerable groups are the young, poor, illiterate and rural women, who fail to give birth under supervision of a skilled health provider. In Uganda, obstetric fistula symptoms are more prevalent among the western and central regions.

While about 2,000 repairs are done annually, a good proportion of women affected by obstetric fistula are not receiving the treatment required, leaving a huge backlog in the communities.

Through the Government's efforts in partnership with developmental partners like UNFPA, Engender Health and other stake holders, treatment for fistula is available free of charge in the national/regional referral hospitals.

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