Fistula treatment, rehabilitation and re-integration program
Regaining Women’s Dignity
One of the most common complications in pregnancies is obstructed labor. This type of labor can last many days where the pressure of a baby’s head in the birth cannal causes a loss of circulation to the delicate tissues of the area. These issues later die and rot away leaving an unnatural hole between the reproductive and excretory organs. This will result in fecal and or urinary incontinence. The incontinence remains permanent unless the woman undergoes a surgical procedure.
Unable to control their bodily functions, women suffering from obstetric fistula (OF) live with the constant pungent smell of urine and feces. As a result, these women are often divorced, shunned, and blamed for their condition by their families and communities.
In The Gambia, the prevalence of obstetric fistula is put at 0.5 per 1000. However, the high fatality rate from childbirth recorded in health centres and the mystification of the disease as well as the isolation and stigmatisation of survivors of fistula, compelling them to conceal their conditions, indicate a much higher prevalence of fistula in the country.
Contributory factors to the phenomenon of fistula in The Gambia include lack of education, early marriage and pregnancy, the practice of delivering at home, untimely arrival at health facilities, inequitable access to health facilities and limited emergency obstetric care. Poverty, bad roads, lack of transportation, and many other factors.
BAFROW in collaboration with the Islamic Development Bank (IDB) and other funding partners such as the Ecowas Gender and Development Center (EGDC), is implementing a nationwide Fistula Treatment and Rehabilitation Project in The Gambia since June 2010. The goal of the project is to reduce the prevalence of obstetric fistula by launching a massive campaign establishing and operating a fistula treatment and rehabilitation centre, and reintegration of survivors.
Project Impact and achievements
The impact of the project over the years is evident by the contribution of its outcomes to the improvement of the quality of life of the Gambian people and the realisation of the health policy goal of the reduction of morbidity and mortality in the population. It is also clear that the project has significant potential impact in terms of contributing towards the attainment of the MDG targets of reduced infant and maternal mortality. Some of the main achievements of the project so far are:-
- BAFROW’s comprehensive, holistic and integrated approach to development work has proven effective in raising awareness on the scientific causes, contributory factors, preventive methods and feasibility of successful fistula treatment as well as, the rehabilitation and re-integration of survivors. The impact of the sensitization activities has infact gone beyond borders as patients from Guinea Bissau, Senegal and Sierra Leone have been seeking registration for treatment. Approximately 20,000 people directly and 100,000 indirectly in more than 120 communities have been sensitized and additional patients in need of OF services have been identified and registered for future treatment.
- 80 BAFROW Community based Counsellors (CBCs) have been trained on how to conduct sensitization and provide social support to patients using the obstetric fistula manual developd by BAFROW. They were also provided with mobile phone to improve the identification of women with fistula and their referral to BAFROW
- Through the sensitization of communities on OF, the CBCs have also been able to address issues such as FGM, early marriage, malnutrition, the importance of girls education and seeking maternal health services such as ante natal care and skilled attendance at birth.
- Over 300 student nurses received training, information and education on fistula prevention treatment and rehabilitation
- IEC materials promoting fistula prevention have been developed ranging from posters, handouts, tee-shirts, simple readers and training manuals.
- Surgical repairs has been performed so far on 110 women with a success rate of 75%.
- Nurses engaged in the project received refresher training on OF clinical management. Collaboration was established between BAFROW and the University of Kolebu in Ghana, and WAHA for Uro-gynecologists and Urologiststo conduct treatment surgeries on patients.
- This partnership is not only helping to develop the capacity of three Gambian physicians through on the job training but they have also helped to raise awareness of the condition among medical students through lectures at the University of Gambia School of Medicine.
- On the job training on fistula care and management is ongoing for nurses and doctors involved in surgical treatment
- One of our specialist in OBGYN has received training on fistula training on fistula surgery in Tanzania sponsored by FIGO
- A fully fuctional operating theatre is in place at the treatment center in Mandiaba
The rehabilitation program focuses on helping fistula survivors to acquire the necessary social and economic skills to participate in society upon their return to their communities. A support group of fistula survivors has been formed. Members of the support group have become strong activists in raising awareness on obstetric fistula and in identifying and referring women to BAFROW and providing support during surgeries. OF patients are integrated into activities at the rehab center such as functional literacy, counselling, sewing, baking, tye-dye, pottery and short courses on business development and management. Participating in such activities with women from the community who are not suffering from OF supports their social reintegration as it is essential for them to feel a part of society again.
Through the psychosocial support provided at the center each patient develops a reintegration plan shortly after being registered into the program.
Once the women are ready to return to their communities, BAFROW provides extensive support to them by helping them to settle back in their communities and with their families and maintaining regular communication and monitoring with them to follow up on their health, social and economic status
The story of Kanja
MY name is kanja I come from a village in Upper River Region (URR). I was born into a family of musicians, locally known as ‘’griots’’. My family are very popular griots and do not believe in educating their children. When I started singing I was very popular among my peers and even the elders. I had many friends, and I was invited to sing in almost all ceremonies in my village as well as other commuities. I lived a happy life until I got married. I was married off at the age of 18 to my uncle. I never agreed to the marriage but had no way out.
I was not happy in that marriage because he never treated me with respect neither did he show me any love. That same year I got pregnant and had a child, after two years I got pregnant again for our second child. This labour was different from the first one as I was in labour for one week. When I was finally taken to the hospital, I spent another day before I finally delivered. I had the baby at the hospital but unfortunately, the baby died. After my delivery, I found out that I was leaking urine uncontrollably and continuously and I was therefore, hospitalized for three months. During the period I was hospitalized, my husband came to visit me a few times only during the first month.
After that I never saw him again and so when I was discharged I returned to my mother’s house. After about a year with fistula, my husband divorced me and married another woman. I thought my life had come to an end. I actually felt like dying. My carrier as a musician had also ended.
A year after, I was lucky to have another husband to whom I explained my situation before we got married. He promised to help me but after six months he disclosed to me that he could not cope with my condition. I felt even more hurt with the second divorce. I felt used, dumped and exposed. I cried day and night, and I kept asking myself what wrong I have done for me to be going through this problem. Friends deserted me, no one wanted to marry me, I was a mockery in my community.
My family tried very hard to raise money for my surgeries it was not easy because my father had to sell one of his land for us to pay for the surgery in Senegal. My first surgery was performed but unfortunately, it was not successful. I had to go back to my village. After three years , I had my second operation at the main hospital in my region but nothing changed. I was still leaking. I lived with this situation for years praying and dreaming of the day when I will wake up and not wet my entire bed, the day when I will be able to sit among relatives, eat with them and attend functions. Alas! Dreams do come true! My mother at a naming ceremony met one of BAFROW’s community based counsellors who told her about BAFROW’s fistula treament program and that it was free. We decided to try again.
When I came to BAFROW, things where far different. The nurses were kind and sympathetic. They encouraged me and I was able to cry my heart out to the nurses. After my operation, things were not the same any more. Two weeks after the operation,I realised that I was only leaking a bit compared to before. After another examination by the doctors, I was told that I would go for a second surgery. After the second surgery, I could not believe that I was dry. I visited the rest room over and over again to be sure that I was not leaking. My life has really changed? I could not believe.
BAFROW’s rehab center was like home to me, I had not experienced love and care for years. I came to know other women at the center with the same condition. It was the beginning of a new life for all of us. At the rehab center, we were taught different skills like soap making, baking, sewing, and tie and dye etc. We now understand the problem of fistula and we can make informed decisions and chioces. I am a member of the fistula support group and I assist in educating other women about the problem. Due to the reintegration program, I am now loved and respected by my family and members of my community. I am now engaged in small business and I am happy to be singing again at functions and ceremonies.
Today after fifteen years living with fistula, I can see hope for other women and I always love to share my success story.
Thank you BAFROW.
How can you assist?
To assist in support the fistula program, we would kindly appreciate receiving funding support and short-term volunteers who would work with us and also provide on the job training for some of our medical doctors.
We will also appreciate receiving clinical equipment and materials including the following if possible:
- Complete Obstetric Fistula Surgical Packs with instruments
- Disposable operation gowns; Drapes; Incontinent Pads
- Urinary Catheters (Various sizes); Surgical Gloves; Urine bags
- Sutures various types and sizes; Suction Machines; Given Sets
- Cannulas; and Urine Bag holders