Chemutai eight-year battle with fistula

Metrine Chemutai, a resident of Binyinyi Town Council in Kween District, lies on the verandah with an emaciated body. She turns slowly on the mat, but the grimace betrays the pain she is enduring. As she squeaks, she is careful not to open her legs.

When Chemutai got married, she never imagined she would undergo female genital mutilation (FGM). Nine years down the road with five children, her husband forced her into FGM in 2008, which left her with grave effects.

At the age of 14, she gave birth to her first child. A year later, she got another baby and another. According to medical reports from Kapchorwa General Hospital, FGM destroyed the free-flow of waste from Chemutai’s body and she passes out urine and faeces from the same space. 

The diagnosis

Chemutai lives roughly 100 kilometres from Mbale Regional Referral Hospital. “I visited the facility and doctors informed me that I had developed fistula,” she says. Chemutai has endured an obstetric fistula for eight years now.

“I cannot go to the market or visit friends and family. I am always home,” she adds. 

Moses Okwi, a medical officer, says Chemutai suffers from obstetric fistula.

He says delays in accessing maternal care and home birth are some of the major causes of fistula.  “Women with a low socioeconomic status, who live in the remotest areas, lack funds to access better health care. This coupled with cultural practices cause fistula,” says Okwi.

Chemutai was injured by traditional birth attendants (TBA) during antenatal visit and when her condition worsened, she was taken to hospital.  But it was already too late. After being isolated by her family and community, Chemutai sought refuge at the Kween gender-based violence shelter.

Women are increasingly undergoing FGM and the practice is often performed by traditional birth attendants   during antenatal visits or at childbirth.

 FGM, an incision on the woman’s clitoris, is a form of a rite of passage into adulthood among the sabiny and Pokot, both sub-tribes of the Kalenjin ethnic group.

According to experts, severe forms of FGM may predispose women to fistula. Contextual and socioeconomic factors may increase the likelihood of fistula. FGM is an internationally recognised violation of the rights of women and girls and, while the prevalence is declining, according to United Nations Children’s Fund (Unicef) survey carried out in 2020, the practice affects about 200 million women globally.

In Uganda, FGM is mostly practiced in Sebei region- Kapchorwa, Kween and Bukwo and districts in Karamoja such as Nakapiripirit and Amudat.

Hundreds of women have fistula

Fistula is a hole between the birth canal and bladder or rectum caused by prolonged or obstructed labour. The condition results in chronic incontinence- loss of voluntary control of urination or defecation, infections and, all too often, discrimination.

The medical condition creates a hole in a woman’s urinary and rectal canal, causing a constant leak of urine and faeces. Women in this condition cannot fend for themselves or be seen anywhere in the public.

The health ministry estimates that more than 100,000 women and girls in the country are suffering from fistula.

If left untreated, the condition can cause infection, pain and a host of other problems, including social isolation and depression.  

Obstetric fistula afflicts those who lack access to the timely, high-quality and life-saving maternal health care that they so desperately need.

In most cases, it can be repaired with a simple surgery, but in many areas, women lack awareness of or cannot afford the procedure, and not many doctors are properly trained to perform it. 

The United Nations Population Fund-UNFPA is also working with its partners to raise awareness of the condition.

In rural areas, many women and girls living with fistula do not receive any family support and never seek treatment, because they do not know what is wrong with them and where to seek the right services.

“Life with fistula is very costly. I sold all my belongings to seek treatment and buy adult diapers. It is hell on earth. At one point, I was in hospital without a caretaker,” Chemutai recalls.

Reconstructive surgery

Chemutai was one of the women that received free reconstructive surgery from the UNFPA-supported campaign in Mbale regional referral hospital during the fistula camp but she missed the surgery.

The camp was funded by UNFPA through the Ministry of Health and it was rolled out to the 12 regional referralh across the country.

UNFPA provides technical guidance, medical supplies, training, conducts awareness campaigns and funds for medical camps and treatment.

With funding from various donors, UNFPA also strengthens reproductive healthcare and emergency obstetric services to prevent fistula, as well as campaigns to end FGM.

 At least 45 women and girls, especially from Bukwo district were operated during the five-day fistula camp held at Mbale regional referral hospital in November, last year.

According to experts, fistula can be avoided by delaying the age of first pregnancy, the cessation of harmful traditional practices, and timely access to obstetric care.

Zaituni Cherukut Sisco, a social physio support officer at the Kween gender-based violence shelter, says like Chemutai, women in such condition, suffer from depression and other medical, psychological and sociocultural challenges that may even trigger suicidal thoughts.

Prolonged and obstructed labour

Mbale regional referral hospital fistula focal person, Jane Frances Acam, says FGM is a harmful practice that causes prolonged and obstructed labour that leads to fistula.

And because the practice is still common in the Sebei sub-region, despite being outlawed, the area also has the highest cases of fistula.According to Acam, the hospital also struggles with lack of medical supplies used in the management of fistula and specialised surgeons.

“We have some specialised doctors   from Kitovu Hospital, Soroti and Busitema universities in specialised hospitals,”she says. 

Acam adds that Mbale hospital has registered an increase in fistula cases. She say at least three fistula patients check into the hospital every month. The cases mainly come from Sebei sub region and they are attributed to the female genital mutilation.

The most affected are girls between the age of 14 and 19, who get pregnant and experience problematic deliveries. 

Increasing cases of fistula

According to experts, fistula is one of the most serious injuries women face during childbirth in the country. Statistics from the Uganda Demographic Health Survey (UDHS, 2016) indicate that the prevalence of FGM has come down from 1.4 per cent in 2011 to 0.3 percent in 2016.

In 2015, more than 2,560 fistulas were repaired across the country but there are new cases occurring every day. Globally, at least two million women live with the condition and 50,000 to 100,000 new cases occur every year.