BY RACHEAL NINSIIMA, 28 MAY 2013
Christine Katusabe slightly lifts her bed curtain at Hoima regional referral hospital to ascertain if the morning is here.
When the first ray of light shoots through the window, she slowly turns her grey blanket and sky-blue sheets over to the other side, sits up and throws her head into her palms while looking at other patients. Having woken up 20 minutes earlier, Katushabe’s grandmother searchingly peers into her eyes. The look on the grandmother’s face suggests that she sees not the beauty and innocence of her 17-year-old girl, but trauma and shame.
Katusabe is one of tens of thousands of girls and women who pass urine uncontrollably because of obstetric fistula – a tear between the birth passage and the bladder or rectum caused by obstructed and prolonged labour. During this time, the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bones.
Dr Rose Mukisa Bisoborwa, the Country Director for Engender Health-Uganda, explains that the lack of blood flow causes tissues to die, creating a hole between the mother’s vagina and bladder or between the vagina and rectum, or both, resulting in leakage. Although Katusabe survived the fatal childbirth experience where she had obstructed labour for a day and a half, she was left with a stillborn baby and trauma.
“I would want to go back to school, study and become a nurse but because of my condition, I cannot. I have difficulty in walking and sitting and all the time, I want to eat,” the rather jolly Katusabe says as she gets off her bed and slowly moves towards the door.
Outside, there are more than 100 women with basins, pieces of torn cloth and mats. The smell of the urine in their environs is unmistakable.
Like Katusabe, they too have obstetric fistulas. They have come to the hospital for free fistula surgery courtesy of Engender Health – a global reproductive health organization funded by the United States Agency for Development (Usaid). Dr Bisoborwa says that ordinarily, a fistula repair costs $400 (Shs 1m).
The camp, which started on Friday, May 17, runs for two weeks until May 31.
Consequences of damage resulting from obstetric fistula include depression, physical injury where a woman’s birth canal and bladder is ruptured -causing frequent passing out of stool or urine or both, and mental health dysfunction.
“Left with [chronic] leaking of urine and stool, women with obstetric fistula are abandoned or neglected by their husbands and families. They are unable to work and are ostracized by their communities,” says Dr Peter Mukasa Kivunike, an obstetrician working with the United Nations Population Fund (UNFPA).
To contain the leakage, Katusabe uses two scarves interchangeably as pads. Orphaned as a child, Katusabe dropped out of school in senior one at Kigolobya High School, her grandmother unable to afford her school expenses.
She started working in a friend’s grocery where she met a 29-year-old man, who lured her into sex.
“I knew I was not supposed to sleep with him, but it happened accidentally,” she mumbles.
Pregnant, she started living with her boyfriend, moving back to her grandmother’s home shortly before her due delivery date. For the first day of her labour, Katusabe suffered a high fever and loss of blood, but the quickest resort was a traditional birth attendant.
Nonetheless, the labour and blood loss persisted that she was rushed to Kigolobya Health Centre IV, where she had a stillbirth that badly ruptured her. When I meet Katusabe, she is more than ready to undergo the fistula repair surgery, after a comforting hour of counselling.
Like Katusabe, any woman is at risk of fistula if not assisted by a skilled healthcare provider. Young girls like Katushabe are particularly at risk because of pelvic bone immaturity and a small birth canal.
The 2011 Uganda Demographic Health Survey (UDHS) estimates that 140,000 to 200,000 women in Uganda have a fistula problem, with 1,900 new cases every year. Western Uganda leads in fistula rates, with 5.4 per cent, followed by the north at 3.6 per cent, central at 3.4%, eastern at 1.1% and Karamoja with the least at 0.1 per cent.