By Kazungu Chai
In the tiny village of Kokwanyo in Homabay County, a jovial Rehema Akinyi Obuya belts out a sweet popular Luo cultural song as she goes about performing her daily domestic chores at her matrimonial home. The 42 year-old mother of five is brimming with energy and goes about her activities with gusto.
But things have not always been this perfect for Rehema. Her optimism, vibrancy and cheerful disposition are all a newly acquired phenomenon in her life, a complete metamorphosis, actually.
Just a few months ago, six to be precise, Rehema was down. She was rejected and dejected. Her life was gloomy. And she recalls vividly when it all started.
“I remember very clearly. The year was 1996 and I was pregnant with my first-born. After the normal nine months gestation period, the time came and a traditional birth attendant was called to assist me deliver at home. That is when the problem started,” Rehema, who was now almost shading tears, narrated to this writer.
She says the baby was big and she went through a prolonged period of painful obstructed labour. When the ordeal was over, the baby was delivered but Rehema was left with a devastating condition that completely broke her hopes, her dignity and her very existence. She had developed obstetric fistula, a condition of uncontrolled urinary incontinence and leakage of feaces.
“Life was hard, very hard for me because of fistula. I could neither perform normal tasks like washing clothes nor interact freely with people because I was passing stool anywhere anytime because of this condition,” Rehema recalls with sadness.
She says undertaking simple activities like fetching water from the river, visiting neighbours, going to the market and even to church was difficult for her.
The foul odour that accompanied Rehema wherever she went made people to avoid her. She was shunned and discriminated against. Obstetric fistula had completely obliterated Rehema’s self-confidence, undermined her self-respect and pushed her into a life of misery and despair.
At the home front, although her family embraced her even in her condition, life was not easy either. She could no longer play her complementary role as a provider to her family, leaving the whole burden to her husband who is working as a brick maker in Nakuru.
In Rangwe, about half-an-hour drive from Kokwany, Lillian Ochieng went through worse tribulations than Rehema. She was in labour for two days and when attempts to deliver at home failed she was rushed to hospital on the third day. Unfortunately by the time she got to hospital, it was already too late. She lost the baby.
But that was not all. She had developed obstetric fistula. Unlike Rehema, Lillian’s marriage took a beating because of the condition. Her husband abandoned her and focused all his attention to her co-wife.
“I had no peace at home. My husband used to say he cannot stay near a person who is stinking,” says Lillian, a 32-year old mother of three.
But while Rehema and Lillian were undergoing those tribulations brought about by obstetric fistula, a ray of hope was also beaming in the horizon. In November 2018, they heard from the radio that First Lady Margaret Kenyatta’s Beyond Zero Medical Safaris had partnered with AMREF Health Africa to offer free treatment for fistula at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu.
They grabbed the chance with both hands and were among the first to undergo fistula surgery at JOOTRH during a Beyond Zero free medical safari camp in Kisumu. In fact, Rehema and Lillian were among the 60 women recuperating from fistula surgery that First Lady Margaret Kenyatta visited last year when she was in Kisumu to officially launch Beyond Zero’s second Medical Safari.
Speaking during the occasion, the First Lady said: “Today these women have been given hope. They will no longer suffer from stigma and shame. They are mothers, wives and sisters and I ask that we embrace and reintegrate them so that they too can contribute to the development of their communities.”
Thanks to the fistula treatment they received, Rehema and Lillian are now healed and re-integrated into the community. Rehema belongs to a merry-go-round group in her village while Lillian is an active member of her church choir in addition to other social engagements.
“I thank First Lady Margaret Kenyatta and AMREF for helping me to get treatment. I have nothing to give but God will bless them for what they did for me,” Rehema says.
On her part, Lillian urges other women not to suffer in silence. “There is cure for fistula. There is no need to hide any more. Seek treatment from hospital and your condition will be restored like mine,” she advises.
The first Beyond Zero Medical Safari, a new model of integrated medical camps that is geared towards scaling up the delivery health services to Kenyans, was held in Narok County in September 2018.
The Medical Safaris are at the core of the First Lady’s Beyond Zero 2nd Strategic Framework (2018-2022) that is anchored on the principle of “leaving no one behind”. The framework is pegged on a life-cycle approach targeting pregnant women and newborns, infants and children, adolescents and young people, men, older persons and people with disabilities.
The initiative brings together a large array of medical service providers to offer free specialized services to the public at designated locations. It is through the Medical Safaris initiative that Beyond Zero has teamed up with AMREF Health Africa to address the obstetric fistula problem. The wider objective of this initiative is to contribute towards the achievement of Universal Healthcare Coverage, one of the key planks of President Uhuru Kenyatta’s legacy project – the Big 4 Agenda.
Dr. Elizabeth Wala, the Programme Director for Health Systems Strengthening at AMREF Health Africa, commends the First Lady’s Beyond Zero Initiative that puts the health and wellbeing of women and children at the top of its agenda.
“We have partnered with the Beyond Zero Initiative to address the problem of fistula,” Dr. Wala says.
“I also want to really appreciate the support of the partners who are working with the Beyond Zero Initiative because we are restoring dignity to very many women,” she adds.
AMREF Health Africa, under the support of various partners including UNFPA, Bayer Healthcare and Beyond Zero Initiative, is focusing on a systems strengthening approach to ending obstetric fistula in line with the current drive towards Universal Health Coverage in Kenya. AMREF Health Africa is also working with County Governments to ensure access to high quality, sustainable and relevant specialist services at the grassroots level.
Fistula is a preventable condition and the preventive measures are cost-effective and accessible where maternal health inequalities are adequately addressed.
Dr. Wala points out that fistula is a very debilitating condition that occurs when a woman experiencing obstructed labour either does not access healthcare services from skilled health workers or she delays in seeking this service.
“What happens is that the reproductive organs of the woman are affected during the difficult delivery and you find the woman leaking urine, stool or both,” she says.
In most cases, the difficult delivery also leads to loss of the baby and sometime the women may even lose their uterus. So a woman with a fistula condition is marginalised and stigmatised because of the fact that she is smelling of urine and stool.
According to the Fistula Foundation, a not-for-profit organization dedicated to providing obstetric fistula treatment, a majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their foul smell.
Dr. Wala emphasizes that there is a lot of pyscho-social support required by the women in addition to the free surgeries that are performed to repair the fistula.
It is for this reason that in Narok County, 26 women who benefitted from the fistula surgeries during the first Beyond Zero medical safari in September, have come together to form the Narok Fistula Survivors Women Group.
Ruth Samante Punyua, a fistula survivor from Narok East, is the Chairlady of the group which was registered with the Department of Social Services in March this year.
Mrs. Punyua says her group conducts merry-go-round and raises funds to empower its members. They also meet once every month to encourage each other and discuss ways of initiating income-generating activities.
“So far we have opened a bank account and we intend to start a goats project and selling beads,” she says.
The Narok Fistula Survivors Women Group Chairlady says she is looking forward to visit the First Lady to thank her in person.
“We are glad we are healed and we are now active ambassadors against the fistula disease,” Mrs Punyua says.
Accurate data on obstetric fistula is hard to come by. Nevertheless, it is estimated that there are over 1000 new cases of obstetric fistula annually; and the prevalence of fistula is 1 percent.
Dr. Wala says currently there are no concrete statistics on the fistula situation in the country.
“One of the things that AMREF is supporting the National Government with is the creation of a framework for fistula which has not been there. That is why, for instance, you will see AMREF has its own data that is not visible to other partners making it hard for the Ministry of Health to know who is working where,” Dr. Wala explains.
However, she is optimistic that the National Strategic Framework for the Prevention and Management of Obstetric Fistula that First Lady Margaret Kenya will launch on May 9 in Kapenguria, West Pokot, will bring everyone on board and make it easier to accelerate and sustain efforts towards prevention, quality treatment and rehabilitation.