Every Tuesday and Friday, a bus leaves Langata suburb, 5km south of Nairobi city centre, to pick up women from various points in the city and take them to Jamaa mission hospital in the eastern Buruburu suburbs.
The bus belongs to the charity, Freedom From Fistula Foundation (FFFF), and all the woman are obstetric fistula patients. At the hospital, they receive free surgical services.
"Fistula is really about not being able to get a caesarian section," Lucy Mwangi, FFFF’s Kenya director, told IRIN. "This could be due to delays in accessing the hospital at the village, delays in referrals. You can also be in a hospital but develop fistula because of a delay in diagnosis."
Obstetric fistula is a hole in the birth canal caused by prolonged and obstructed labour, leading to urinary incontinence.
Some of the women travelled hundreds of kilometres from their rural homes after contacting FFFF via a mobile hotline regularly advertised on radio stations.
"Whoever gets the number calls, flashes [beeps], or texts and we call them back and ask a couple of questions to establish if they are fistula patients. When in doubt there are incontinence issues," Mwangi added.
"Trust is such a big issue for a woman who has never in her wildest dreams thought of travelling to Nairobi. The women are sometimes also doubtful as they have gone to hospitals and been told they can live with fistula yet repair is possible."
Sometimes, FFFF facilitates the women’s travel to Nairobi by sending cash via M-Pesa, a mobile phone money transfer service.
According to experts, Kenya records at least 1,000 new fistula cases annually, with thousands of cases pending surgery. Globally, fistula affects at least two million women and girls in developing countries, with 100,000 new cases each year.
Those with the problem constantly suffer shame and stigma, said Lucy Karimi*, from the eastern region of Meru, who recently underwent a successful fistula repair surgery at Jamaa.
"I had suffered incontinence for 23 years," she told IRIN. "It started after I had a still-birth in 1985 but the problem became worse after I had my lastborn in 1988. Even telling people about my experience is embarrassing; I would be standing and discover my shoes full of faeces."
Cultural aspects
Experts say ignorance and some cultural factors contribute to fistula. According to Khisa Wakasiaka, a reproductive health and vesico-vaginal fistula repair specialist with the African Medical and Research Foundation, some women avoid delivering in hospitals because they believe they will be given injections that will make them infertile.
"In some areas, corrosive stones are sometimes inserted into the vagina after a woman has given birth to return her to her pre-birth virginal state, but the caustic stones retract the vagina and in the process cause corrosion and a fistula," Wakasiaka told IRIN. "Some women also insert a hot rod hoping to stop the leakage."
According to the UN Population Fund, most fistulas occur among women living in poverty or in cultures where status and self-esteem depend almost entirely on marriage and the ability to bear children.
In Kenya, Machakos and Kitui in Eastern Province are the most affected areas, as well as Northeastern Province.
"Fistula points to poor health systems," the Kenyan director of public health, Shahnaaz Sharif, said.
According to the Kenya Demographic and Health Survey preliminary report for 2008/2009, only 43 percent of deliveries in Kenya take place in health facilities. The numbers are lower in remote areas where infrastructure is poor.
"The best ambulance in the arid parts is a camel because of the sandy terrain,” Wakasiaka said. "You can have a woman who has travelled from Kitui to Machakos only to be referred to KNH [Kenyatta National Hospital in Nairobi] where there is a queue of 10 women waiting for a CS [Caesarian section] operation. Unless you have a ruptured uterus, you will not be rushed for a CS."
*Not her real name
aw/eo/mw
The bus belongs to the charity, Freedom From Fistula Foundation (FFFF), and all the woman are obstetric fistula patients. At the hospital, they receive free surgical services.
"Fistula is really about not being able to get a caesarian section," Lucy Mwangi, FFFF’s Kenya director, told IRIN. "This could be due to delays in accessing the hospital at the village, delays in referrals. You can also be in a hospital but develop fistula because of a delay in diagnosis."
Obstetric fistula is a hole in the birth canal caused by prolonged and obstructed labour, leading to urinary incontinence.
Some of the women travelled hundreds of kilometres from their rural homes after contacting FFFF via a mobile hotline regularly advertised on radio stations.
"Whoever gets the number calls, flashes [beeps], or texts and we call them back and ask a couple of questions to establish if they are fistula patients. When in doubt there are incontinence issues," Mwangi added.
"Trust is such a big issue for a woman who has never in her wildest dreams thought of travelling to Nairobi. The women are sometimes also doubtful as they have gone to hospitals and been told they can live with fistula yet repair is possible."
Sometimes, FFFF facilitates the women’s travel to Nairobi by sending cash via M-Pesa, a mobile phone money transfer service.
According to experts, Kenya records at least 1,000 new fistula cases annually, with thousands of cases pending surgery. Globally, fistula affects at least two million women and girls in developing countries, with 100,000 new cases each year.
 Even telling people about my experience is embarrassing; I would be standing and discover my shoes full of faeces |
"I had suffered incontinence for 23 years," she told IRIN. "It started after I had a still-birth in 1985 but the problem became worse after I had my lastborn in 1988. Even telling people about my experience is embarrassing; I would be standing and discover my shoes full of faeces."
Cultural aspects
Experts say ignorance and some cultural factors contribute to fistula. According to Khisa Wakasiaka, a reproductive health and vesico-vaginal fistula repair specialist with the African Medical and Research Foundation, some women avoid delivering in hospitals because they believe they will be given injections that will make them infertile.
"In some areas, corrosive stones are sometimes inserted into the vagina after a woman has given birth to return her to her pre-birth virginal state, but the caustic stones retract the vagina and in the process cause corrosion and a fistula," Wakasiaka told IRIN. "Some women also insert a hot rod hoping to stop the leakage."
According to the UN Population Fund, most fistulas occur among women living in poverty or in cultures where status and self-esteem depend almost entirely on marriage and the ability to bear children.
In Kenya, Machakos and Kitui in Eastern Province are the most affected areas, as well as Northeastern Province.
"Fistula points to poor health systems," the Kenyan director of public health, Shahnaaz Sharif, said.
According to the Kenya Demographic and Health Survey preliminary report for 2008/2009, only 43 percent of deliveries in Kenya take place in health facilities. The numbers are lower in remote areas where infrastructure is poor.
"The best ambulance in the arid parts is a camel because of the sandy terrain,” Wakasiaka said. "You can have a woman who has travelled from Kitui to Machakos only to be referred to KNH [Kenyatta National Hospital in Nairobi] where there is a queue of 10 women waiting for a CS [Caesarian section] operation. Unless you have a ruptured uterus, you will not be rushed for a CS."
*Not her real name
aw/eo/mw
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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