The Sunday News
Robin Muchetu, Senior Reporter
WHILE other women celebrate the birth of their children, Ms Josephine Sibanda (37), has been hiding from crowds as she has been nursing a medical condition, Vesicovaginal Fistula, that has seen her leaking urine for the past few months following the birth of her baby.
The mother of seven said the problem started after the birth of her last child on 22 October 2022 at Nkayi District Hospital.
“I realised I was leaking urine when I was discharged from the hospital. Initially, I assumed it was normal to leak after an operation as I had never given birth via a caesarean-section,” she said.
Ms Sibanda said she quickly returned to the health centre to seek help and she was given tablets that never assisted the situation. She returned for the second time and got some more drugs that still did not work.
“I then requested that I be referred to another health centre where I could get further assistance as I was still leaking urine and some foul-smelling fluids such that I began to worry even more. I decided to go to Mbuma Mission Hospital in Nkayi where I was seen by doctors there who said I had a damaged uterus and bladder,” she said.
Ms Sibanda was referred to United Bulawayo Hospitals as Mbuma Mission Hospital indicated that they had no capacity to carry out the surgery to repair the damaged organs.
Due to financial incapacitation, Ms Sibanda could not travel to Bulawayo readily as she had spent all her savings trying to get help to stop the leaking. She was however, assisted by the hospital which allowed her to be ferried in an ambulance to UBH to see specialists.
Typical of what causes vaginal fistula, Ms Sibanda suffered prolonged labour before she reached a health facility.
“I was in labour for a long time; it started at about 4 AM. I was only taken to the clinic at 12 noon via an ox-drawn cart. During labour, I would try to push, but the baby would not come out and I was ferried at about 8 PM to Nkayi District Hospital via ambulance. Finally, at 12 midnight, that is when I delivered my son via a caesarean-section,” she said.
When the leaking started, life turned for the worst as Ms Sibanda went into ‘hiding’ in her own home.
“I had been living a difficult life since the operation. I had to wear sanitary pads every day to absorb the urine and smelly fluids.
My husband was also taken aback as he didn’t know what was wrong with me. I stopped visiting. Even people who would come home would not see me as I would hide fearing the smell and the urine. I couldn’t explain the leaking to people as I was always wet so I decided to avoid people at all costs,” said Ms Sibanda.
She said she feared the stigma that would be attached to her for constantly urinating on herself hence the decision not to go out.
Ms Sibanda also feared her uterus would rot since she was excreting a smelly fluid. She thought she would eventually die.
However, doctors at UBH gave her a new lease of life following the repair of the fistula in mid-February. She is no longer leaking, thanks to the operation which saved her dignity.
Dr Harrison Rambanapasi, an obstetrician-gynaecologist who is also the acting clinical director at UBH explained what Ms Sibanda was experiencing.
“In medical terms, a fistula is an abnormal (pathological) passage or hole or communication between two organs. An obstetric fistula is a fistula that develops following a difficult and prolonged labour. So, you find that the woman in question had a hole between her reproductive organs and the bladder which led to her leaking. At least 97 percent of fistulae we see in developing countries are caused by obstructed labour just like she experienced,” said Dr Rambanapasi.
He explained further.
“In other words, the labouring mother who needs some intervention by the midwife or doctor is unable (for one reason or the other) to access assistance in time. The result is the baby is trapped in the mother’s birth canal for a long time and that results in damage to the bladder, rectum and vagina causing the development of the hole,” said Dr Rambanapasi.
United Nations Population Fund (UNFPA)
He added that the typical patients they see with fistula are poor, rural young (teenage) mothers.
“We also have a problem with certain apostolic sects that insist on their members giving birth at their shrines where a labouring woman is monitored by untrained people and there are no facilities for advanced intervention like caesarean section.
This is a challenge as these women sometimes then present to a health facility with obstructed labour and can develop fistula,” he explained.
Dr Rambanapasi said a woman who develops fistula and is not corrected lives a lonely miserable life and most often suffers in silence.
“Because of the smell from incessant leakage of urine and or stool, she suffers from embarrassment and the natural reaction is to withdraw from all social engagement. A patient with a fistula is ‘socially dead’ in most cases, she can’t go to church or funerals. She can’t visit neither does she want people to visit her,” he said.
Dr Rambanapasi further explained that in some extreme cases, some husbands abandon their wives when they have such conditions, and some women even lose their jobs.
United Bulawayo Hospitals (UBH)
He said at UBH, they now have a team of dedicated gynaecologists who have devoted their lives to helping women in such situations and have the capacity to do four procedures per month.
“The operations are delicate and they are time-consuming, but our success rate is around 88 percent, which is comparable to colleagues in other countries. To prevent this condition, we continue to encourage pregnant women to register their pregnancies early at a clinic or hospital. They must be followed up by a trained nurse or doctor and more importantly, they must labour and deliver within a recognised health facility where they can have access to skilled birth attendance,” he added.
Dr Rambanapasi however, said the hospital is undersubscribed with very few women coming forward for assistance. He said they were hoping to increase information dissemination on the availability of the service at UBH.
International Day to end Obstetric Fistula is commemorated annually on 23 March and the UNFPA has been calling on ending the problem and helping restore the dignity of women and girls who have an obstetric fistula in Zimbabwe. – @NyembeziMu.
