CHINHOYI – “Every day for the past 19 years has been a social and emotional struggle for me – but today I am a new woman with dignity,” said Tuwede Adam (35) recently at Chinhoyi Provincial Hospital’s Obstetric Fistula Repair Camp, in Zimbabwe’s Mashonaland West Province.

Tuwede is one of thirty women who, having lived with the debilitating condition for many years, now have the chance to undergo free life-changing repair surgery thanks to UNFPA Zimbabwe and its partners the Ministry of Health and Child Care, and the Women and Health Alliance International (WAHA).

With USD100 000 committed to a Campaign to End Fistula under the H4+, the first of a series of repair camps, ran from 19 August and 18 September 2015 repairing 30 women from Mashonaland West province and other parts of the country. The repairs included 25 Veisco – Vaginal repairs, 4 combined CCF and RVF repairs and 1 Recto-Vaginal Fistula.

Dr. Jean Yunga, a Fistula surgeon with WAHA, led a team of local doctors supported by the Ministry of Health and Child Care, as well as theatre and ward staff from Chinhoyi Provincial Hospital where the Camp was held. Social Workers from WAHA provided patients with counselling and support prior to and post-surgery.

“I never thought I would feel this way again”

Tuwede walked into the Obsteric Fistula Camp with no self-worth having suffered from the marginalisation that is associated with fistula but left the hospital with her head held high following the life changing surgery.
For almost two decades, Tuwede had been living with the condition which rendered her incontinent following an agonising 4-day labour which resulted in a forceps, still born delivery. Compounding her grief after the loss of her child, she was left socially ostracised within her community in Rusape – a fate faced by the many women who suffer from the condition. 

Today, Tuwede looks forward to her future, returning to her community with a new found confidence. “I feel fresh and clean, there is no bad smell around me. I do not have to panic among my peers for fear of wet clothes when I stand. I have left all of that fear behind me; I am a grown woman again, dignified. Now I shall look for a job, now I know I will be okay!”

A denial of rights and dignity

Tuwede was lucky as her husband stuck by her side all of these years. Many women and girls living with obstetric fistula are left marginalized and neglected by their partners, families and communities due to the debilitating condition which renders a woman completely incontinent.

It is estimated that 2 million women worldwide are living with the condition, with an estimated 50,000 to 100,000 new cases developing each year, yet it is almost entirely preventable and treatable. The persistence of obstetric fistula is a sign of serious inequalities and the denial of girls’ and women’s rights and dignity. According to Dr. Edwin Mpeta, UNFPA Zimbabwe Programme Specialist, Reproductive Health, “Many women with Obstetric Fistula in Zimbabwe, are socially isolated and may be unaware that the condition can be repaired. Until now, and for a number of reasons including lack of capacity to deliver the service, there has not been a huge drive to address the problem.”

The partnership between the Ministry of Health and Child Care, UNFPA Zimbabwe, and WAHA is therefore starting to change the momentum while ensuring sustainability by capacitating health personnel with the necessary skills to repair more women after the programme comes to an end.

Repairing Injustice

Women like 18 year old Aisha who has suffered from fistula for 8 years following a sexual assault when she was only 10 years old. “I was raped by my uncle and no-one believed me. Just before my 11th birthday I suffered a difficult and traumatizing labour at home.” After three days of agonising labour, Aisha’s family finally brought her to the hospital but it was too late. Aisha delivered a still born child by caesarean and developed fistula as a result of the protracted labour.

“I began to leak urine through my vagina. No-one wanted to be around me.” Upon returning to her community, Aisha was also ostracised. “My school friends all progressed to become wives and mothers, my own life was one of isolation and sorrow.”

Reaching women through innovation

However things began to look up for Aisha when she heard a radio announcement about a free Obstetric Fistula Repair Camp in Chinhoyi. The camp recruit patients through mass media advertising on local radio stations, flyers at local health facilities and through social media platforms, particularly WhatsApp. Upon hearing the advert Aisha immediately phoned the hotline number. “I was so excited, I begun to pray that I got a date for the surgery soon.”

Aisha’s prayers were answered when she received a call from Fortunate Mabhande, WAHA’s National Outreach Coordinator informing her she had received a placement for free surgery at Chinhoyi Provincial Hospital in August.

As well as receiving repair surgery and counselling, patients are also provided with money to assist with transport costs to attend the camp. Money is sent to the patients through EcoCash, an innovative mobile payment system that allows for cash transfers to those without bank accounts or those living in rural Zimbabwe using one of the three major mobile network service providers in the country.

“My shame is gone!”

Now a new woman, Aisha is filled with self-confidence and hopes she will meet ‘Mr Right’ and start a family of her own. “Look at me today, I am a woman, complete and dignified, my shame is gone!”

In changing the lives of women, the campaign initiative has been welcomed by the community, and resolved the associated matter of social exclusion. “It has been an eye-opener for us”, said Dr. Collett John Mawire, Medical Superintendent at Chinhoyi Provincial Hospital. “The campaign has brought women out in their numbers. After the success of the first camp, our aim is to make the initiative as sustainable as possible and also create public awareness of the condition, especially that it can be repaired. If the number of women with Obstetric Fistula grows, and the partnership allows, the hospital may become a centre of choice for Obstetric Fistula repair in the country. ”

UNFPA Country Representative Dr. Cheikh Tidiane Cisse said that UNFPA is committed to working with the Ministry of Health and Child Care and partners to address the problem of fistula in Zimbabwe.  “As UNFPA, we are committed to ensuring every woman lives a healthy reproductive life, in a state of physical, mental as well as social well-being at every stage of their life. That is why it is important for us to address the condition known as Obstetric Fistula.”

The Campaign to End Fistula is being implemented under the H4+ Programme funded by the Swedish International Development Cooperation Agency and Department of Foreign Affairs, Trade, and Development of Canada.

By Victoria Walshe