Introduction
All cases of obstetric fistula are associated with childbirth, specifically long obstructed labor. As I mentioned earlier, mine is not a "real fistula" but a 3rd-degree perennial tear. During my 24 days of hospitalization, I witnessed more severe types of fistulas, such as rectovaginal fistula (RVF) and vesicovaginal fistula (VVF), which require more complex reconstructive surgeries. Most women who suffer from a "real fistula" lose their babies due to long obstructed labor (more than 24 hours) and are unable to reach the hospital for quality care in a timely manner during labour. By the time they reach the hospital, they are left with the double tragedy of losing their baby and dealing with the fistula condition. However, third and fourth-degree tears receive fistula-related surgeries due to urine and stool leakage, but at a more manageable capacity than fistulas, including passing gas. It's also crucial to note that childbirth is not the only way women acquire fistulas hence other types of fistulas are classified this way.
Birth of Fistula
My journey with obstetric fistula began with the birth of my first child six years ago. My water broke around 2 p.m. when I was at home. It took approximately 40 minutes to get to the hospital since we didn't have a car, and there were no Uber's in our town then. We had to wait for a taxi from town. Upon arrival at the hospital, I was only dilated 2 centimeters and not in pain. Six hours later, with no progress in labor, I was induced, and it took an additional seven hours for my baby to be delivered. My baby was delivered 13 hours after the water broke, and I experienced a perennial tear. My baby weighed 3.6 kilograms, slightly larger for a first-time mother. Complicating matters was the absence of my regular obstetrician, who was out of town at the time when I got into labour. Fortunately, another compassionate obstetrician, whom I had only chatted with on Facebook and never met before, arrived four hours later to assist in delivering my baby and repairing the tear.
Life After Childbirth
After returning home (I can't recall the exact duration, but it was less than a month), I began to notice challenges in holding my urine. Initially, urine would leak before I could make it to the toilet. Additionally, I experienced urinary leakage when I coughed, sneezed, jumped, or ran, and stool occasionally leaked with time. Initially, I believed these issues were a normal part of the childbirth experience, and I kept my struggles as my new life reality. It took two years to realize that I had a fistula-related complication when I attended a fistula camp in my town for screening.
I don't blame my obstetrician because I know of friends who had perennial tears that he repaired, and they completely recovered. I have also been thinking about what went wrong, perhaps how I managed my post-repair period, such as the duration before resuming intercourse, diet, or strenuous activities. After my recent repair surgery, I was given many precautions by the doctors, nurses, and physiotherapist to observe for at least six months; otherwise, leaking would recur. I can talk about the recovery process at a later date.
Why Did It Take Me 6 Years?
It also now takes me by surprise. This is a question I was asked a lot in the hospital and even by friends why did it take me that long?
First, when I was told (during the first screening ) that after the repair, I could only give birth via cesarean section (CS), I opted to wait as I had just conceived. Although I ended up delivering via an emergency CS. In my second birth, I had an obstructed labour and a cord on the neck and if I was not in the hospital and with quality obstetric care I would have lost the baby and gotten the "real" fistula.
I thought I could heal naturally, you know, as a prayerful woman :)
I also feared going through another surgery and staying in the hospital, away from my young babies.
Fundamentally, I honestly didn't know where to get the reconstructive surgery; I thought I had to wait for another one-week camp in my town. Late last year my obstetrician referred me to the renowned researcher and fistula surgeon, Dr. Khisa. Later, early this during self-research on obstetric fistula for a project to raise awareness in churches on obstetric fistula, I learned about the Fistula Foundation. I opted to have the repair done by Dr. Mabea due to proximity and his more reliable availability, meaning I didn't have to wait long for the surgery (it happened on the fourth day of hospitalization).
In conclusion, fistula is not a curse or witchcraft and there is no other way to "heal" fistula apart from reconstructive surgery. One had to be prepared to be hospitalised at least for 4 days, mine was 24 days. There are seven hospitals in Kenya where women can get free/fully funded surgeries by the Fistula Foundation in Kenya.
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