Tales From the Field - Part 6
Their girlish voices echo down the hallway. Every morning I hear them counting in Hausa – "diya, biyu, uku." It’s helped me learned my numbers so I can ask a pregnant woman how many months she is. Maternity is surprisingly quiet so I head over to thefistula, to see them.
In two rows facing each other, the girls do their morning physiotherapy to strengthen their pelvic floors. Most of them have urinary catheters and carry around their bag of urine in a colorful plastic bowl. Some of them limp, some grimace in discomfort, but I can only imagine how much worse it’s been for them.
Obstetric or vesicovaginal fistula, what happens to a young woman or girl who gets pregnant too early and/or whose pelvis is too small to give birth. She labors for days and eventually tries to push her baby out. Maybe family members push and lean on her belly to try and force it out. But the baby cannot come and at some point dies. The mother is left with a stillborn, stuck, putting pressure on her pelvis and the wall between vagina and bladder and vagina and rectum. The tissue loses circulation and becomes necrotic. A hole forms. A c-section may save her life but the sequela can be disastrous. She leaks urine or feces or both from her vagina, a steady stream that make her reek and prone to infection. She becomes ostracized. Her husband almost always leaves her.
Even as a new midwife, I couldn’t quite comprehend the concept of fistula. How could this possibly happen to so many women? And yet it does, especially in countries where girls are married off at young ages and have limited access to health care. It is estimated that there are up to 100,000 new cases of fistula every year. And many women never have the opportunity to recover. They live a life of loneliness, alienation and pain.
Here I look at the girls’ faces as they stretch their legs and count. Some are 12 and 13, the perfect age for summer camp. And that’s what it looks like. Many are Fulani and have cat whisker scarifications around their mouths and up their cheeks. There is the strong aroma of urine but they are all used to it. They sleep next to one another every night for weeks, waiting for surgery, or recovering from it. We do up to 30 fistula repairs a week.
They laugh at me as I try and count and do the exercises. Their smiles give me chills I know we are doing a good thing here. A woman arrived just a few weeks ago. She’d been leaking urine for over 10 years. She wouldn’t socialize at first and was sad and withdrawn. Now I watch her as she joins the group of girls singing in a circle now.
One of the girls is finally leaving today. She’s undergone her 7th surgery and it seems like this one may have worked. The girls gather around her and touch her arms and back, 50 little voices saying good-bye to a new friend they will likely never see again.
They finish their exercises with a song, the VVF song. I don’t understand the words but can imagine the message: there is hope for me, now I can live again.
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