Life as a Social Outcast - Part 2 of 4 - Angola

Below is the story of a 17 year-old fistula patient at the Clinica CEML. She was quite open about her experiences and very appreciative of the opportunity to share her story with me. Please keep in mind that she is one of many fistula patients currently at CEML. Her story, while unique, is a representation of the lives of many women struggling with fistulas. She has allowed me to share her story with friends and family, but photos and names have been removed,

I have combined her responses to my questions into a story, as opposed to a back-and-forth dialogue. This interview conversation was in Portuguese, and I have translated it into English.

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Her Story:

I am 17 years old and was born on December 1, 1993. I used to live in a small town called Chitembo with my parents and three siblings. My parents do not work. My father has four children, while my mother only has three children. When I was younger, our family moved to Cavango, where we have been living ever since.

In 2008, at the age of fifteen, I became pregnant with my first child. My husband was two years older than me and fathered my baby. After nine months, I started having pains in my body. I remained at home for two days, hoping for the pain to go away. This was in early 2009. As the pain continued by the second day, I was taken to a hospital in Quito. There, I learned the news that my baby had already passed away.

At the clinic I was cut down below to make room for the baby to come out. But the cut was never closed. When my husband found out that my baby had died and I had a fistula – urine was constantly seeping out – he left me. I had a husband. But he didn’t want me anymore. So he left me. I do not speak to him anymore.

My illness began in 2009. I remained in Quito for some time before returning to Cavango. After a while, a family friend suggested I visit Dr. Steve [Foster] when he was visiting in Cavango. My friend had already had a successful operation and her family told me to come here with the same kind of illness.

I decided to go to the Cavango clinic with my father in April 2009. I had my first operation in Lubango with Dr. Steve in October 2009. A second operation happened in late October 2009 because the first operation did not close up the fistula properly. That was my second operation. I had a third fistula repair operation in March 2010. This too did not successfully repair my fistula. A fourth operation happened on June 17, 2010. Following my recent operation this month, I will have my catheter removed and will do a post-operative exam in July. I hope all will be properly repaired.

For the past eight months, I have been living in the patient’s village with my father. [Note: Several other women have expressed concern with her father’s excessive drinking in the patient’s village]. The classes that have been organized by CEML have been very good. I feel great. I really like these classes because I can learn a lot. I want to learn here. I am learning everything here – math, writing and reading. I also like to sew a lot. I have made my own purse, which I use to carry my hospital card and documents.

When I finish with my treatment at the clinic, I want to study math, science and Portuguese. I do not want a husband. I do not want any babies. I will continue to study so that I can be a nurse when I grow up.

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The next part of this series will be another story as another example of another woman who has come to CEML for a fistula repair operation.

Life as a Social Outcast - Part 1 of 4 - Angola

The following details and information about obstetric fistulas are based on an interview with Dr. Stephen Foster, medical and general director of the Clinica Centro Evangelico de Medicina do Lubango (CEML) in Lubango, Angola. Dr. Foster was born in Brantford, Ontario, but spent most of his childhood living in Zambia, where his father Robert Foster, MD, worked as a missionary surgeon. He completed his medical school at McMaster University in Hamilton, Ontario and later completed his general surgical training through the University of Toronto’s Gallie Course. He returned back to Angola over 30 years ago, where he has been serving as a surgeon at his CEML clinic and numerous other hospitals. Earlier this year, Dr. Foster received one of North America’s highest honours in the medical field, the 2010 Royal College Teasdale-Corti Humanitarian Award.

What is a fistula?
A fistula is an abnormal communication between normal structures. The bladder, vagina, urethra and rectum are all normal structures in the body. When there is an abnormal communication between any of these normal structures, this can lead to urinary incontinence or an inability to control the release of stool. A fistula is just a technical term for an “abnormal connection” in the body.

What are the most common causes of obstetric fistulas?
Usually the most common cause of an obstetric fistula is a prolonged labour period for women. Most women do not have frequent medical consultations during pregnancies. Women tend to experience pain, particularly during the process of birth.
During labour, forceful uterine contractions or the pressure of a baby’s head against soft tissues can lead to obstetric fistulas in women. Adolescent pregnancies also tend to increase the risk of fistulas. Pregnant girls between the ages of thirteen and eighteen do not have fully developed female reproductive organs.

How widespread is this issue?
Some sources suggest that there are about two million women in sub-Saharan Africa that live with fistulas. Hundreds of women in Angola suffer from obstetric fistulas. For every woman who presents with a fistula during medical consultations, there are many more women suffering from the same problem. These women are sometimes in the rural areas of Angola, far from clinics, medical posts and other health care facilities.

Presence of fistulas outside of sub-Saharan Africa
In North America and Europe, a fistula is usually a complication of an obstetric misadventure, which can include challenges with Caesarean sections and tearing. Most of the fistulas in this region are caused by lack of proper attention during the birthing process. Globally, it is estimated that 50,000 to 100,000 women are diagnosed with an obstetric fistula annually. This problem affects women of all ages – young and old. However, in North America and Europe, these situations are quite rare.

Women and their communities
Women are usually considered to be outcasts when they have fistulas. In sub-Saharan Africa, including here in Angola, cultural habits result in families marrying off girls at very young ages.

The use of “traditional and bush medicine” to “treat” women
The use of herbal medicines usually results in extended uterine contractions in women. Sometimes this “treatment” works like a charm. But more times than not, this can destroy the uterus.

Cost of Fistula Repairs
For the year beginning July 2010, the Fistula Foundation has provided CEML with a grant that covers 100% of each fistula patient’s operation and associated expenses – travel, lodging in the patient’s village, a weekly food stipend and treatment at the clinic. At present, the total cost for each fistula patient at CEML is about USD $1100.

Fistula Repairs at CEML
It is possible to prevent fistulas. Adolescent girls, and all pregnant women for that matter, should have medical consultations in order to make sure pregnancies move along smoothly. This can avoid surprises during labour periods. 90% of women who have fistulas have a possibility of having simple surgeries to repair the fistulas. These fistulas can be repaired. When he first started, Dr. Foster had about a 50% success rate on a woman’s first repair operation. After having done over four hundred fistula repairs in Angola, his success rate has significantly increased. For some of the patients, the 10% of women requiring more complicated surgeries, Dr. Foster has not been willing to call it quits on them, believing he should try and try again.

From July 2009 to the end of June 2010, CEML has done about 80 fistula repair operations. The recent grant from the Fistula Foundation will fund about 100 more fistula repairs between July 2010 and July 2011.

CEML has only hit the tip of the iceberg. Awareness about the work at CEML is spreading through Angola, and more and more women are finding their way to the clinic for proper treatment.

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Photo credit: Seth Cochran, Founder at OperationOF

The next part of this series will focus on the story of a 17 year-old fistula patient at CEML.

Life as a Social Outcast: The Story of Vesico-Vaginal Fistula Girls

Over the past fourteen days, I have seen over twenty women that share the same problem – vesico-vaginal fistulas (VVF). Each woman not only shares the same medical diagnosis, corrected by an operative procedure, but also the challenges of exclusion and abandonment by families and communities.

When I last traveled to Angola from January to March 2009, the number of VVF cases was particularly astounding. Women of all ages and social classes traveled from across Angola to receive operative treatment for their urinary problems.

The issue was one that I was aware of and had learned about a great deal. However, I never thought of sharing the story of a VVF patient. This time around, while I am back in Lubango, Angola for two months, I have decided to share this story. I have been back for less than two weeks and I have already seen pre-operative consultations, VVF operations, post-operative check-ups and recovery patients. This is a story that needs to be told.

Over the next two weeks, I plan to share this story in a four-part interview series. The first part of this series about vesico-vaginal fistulas will be an interview with Dr. Stephen Foster, a medical doctor and surgeon based in Lubango, Angola to introduce the issue, the extent of its spread across Angola and its impact on lives. The second and third parts of this series will explore the lives of women affected by VVFs and discuss personal issues and societal challenges faced. The final part of this series will take a look at the work of two volunteer workers – a primary school teacher and a labour and delivery nurse and their tireless efforts to help these VVF women integrate back into society.