Overcoming fistula with spousal support

Weston Chalingana of Chiwembe Village, Traditional Authority Kapeni in Blantyre surprised people gathered at Queen Elizabeth Central Hospital (QECH) grounds in Blantyre to commemorate the first-ever International Fistula Day on May 23 2013.

When his name was mentioned people whispered: “What does this man know about the ‘feminine’ condition?”

Indeed, he took up the microphone to talk about obstetric fistula, a condition caused mainly by pregnancy complications that leave a woman with injuries on the birth canal, often as a result of prolonged and obstructed labour that does not get timely and adequate medical care.

Contrary to cultural norms whereby women’s reproductive issues are discussed among women secretly, Chalingana told the gathering, which comprised dignitaries from various government sectors and non-governmental organisations, that his wife Esther had fistula after the birth of their fifth child.

Esther, a “survivor” of the condition medics call obstetric fistula, understands the emotions that it causes all too well. The condition has become so prevalent that doctors say something has to be done to stem it, fast.

Prolonged labour and obstructed delivery—in most cases because the woman is unable to access medical care in time—puncture a hole between the birth canal and the excretory system, resulting in an abnormal connection.

“It is a poor woman’s illness,” said Jean Mwandira, United Nations Population Fund’s (UNFPA) national programme specialist for reproductive health. “Its victims are usually women and girls from poor communities who are predisposed because of early pregnancies and lack of skilled care when giving birth.’’

Mwandira, who spoke prior to the International Fistula Day commemorations, said UNFPA has been holding fistula camps since 2007 and so far, about 500 patients have been repaired successfully.

She said victims of the condition live in shame, ostracised and excluded by families and communities because the condition leads to an uncontrollable leakage of urine and, in extreme cases, even stool.

As a result, affected women live with a sense of shame and lack of self-confidence. Afraid to mix with other people, they keep to themselves as they attempt to hide the shame of stench caused by the uncontrolled leaking.

“Because of the embarrassment that comes with the condition, most victims isolate themselves,” said Mwandira.

But Chalingana did not let his wife suffer in alone—he supported her all the way and encouraged her that help would come.

When help is slow coming, some commit suicide. Esther would have been part of that statistic had her husband not been there for her.

After living with the condition for two “harrowing” years, she says she felt life was not worth the daily stress and contemplated ending her life.

“Looking back, I am still not able to understand how my husband managed to put up with me. Every night, I would wake up and plead with God to take away my life, but it never happened,” she said.

Despite the situation, however, Chalingana said he continued to sleep in the same bed with his wife.

“The moment she got discharged from the hospital, I realised something was wrong. She was not the same, she was leaking urine,” he said.

He said he decided to stay true to his marriage vows, that they would be together for better or for worse.

“I believed that this was going to pass, although I did not know when and how. I believed God would help us,” he says.

He explained that when he took his wife to Limbe Health Centre, they were referred to QECH where she was admitted for sometime before being transferred to Mangochi District Hospital for surgical repair.

Esther said she was grateful for her husband’s love and support while she had fistula.

“My husband gave me all the support. Fistula is discomforting, I could not participate in any social activities, not even at any social gatherings,” she recalled.

Since she got repaired, Esther said, she has peace of mind and freely socialises with friends and does her business.

But Tangu Mkandawire (30) of Nkhungulu Village, Traditional Authority Nkanda in Mchinji, did not have such an understanding husband. When she developed fistula in 2005, the husband left her for another woman.

“I knew it was because I was leaking and smelling urine,” Tangu says, recalling that at social gatherings such as weddings and funerals, people could just leave one by one immediately after she joined them.

She had been living in isolation for nine years until last month, when she got repaired at QECH Fistula Camp held from May 6 to 24.

“I was not interested in getting married again because I felt what my husband did was not fair,” she said in an interview at QECH gynaecology side ward after having her fistula repaired.

Mkandawire was one of the 74 women from eight districts who had their fistula repaired during the camp.

UNFPA country representative, Athanise Nzokirishaka, says while industrialised countries have eliminated fistula, an estimated two to three million women and girls are still living with it in developing countries such as Malawi.

“The condition is preventable, but 50 000 new fistula cases occur each year. Although this is so, less than 20 000 receive treatment annually,” he says.

In Malawi, early pregnancies, poverty and gender inequalities are among the major predisposing factors to fistula, according to Nzokirishaka.

“The persistence of fistula is a result of human rights denied. Most women with this condition suffer from both the consequences of the condition and social relationships. Patients have reported abandonment by their husbands,” he notes.

But Chalingana advised men to support their wives with fistula since this is the time they need their love and attention the most.

“If I had divorced my wife, I would have been ashamed because she is fine now and looking as beautiful as ever,” he proudly said of his wife.