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Jane, 15 years old
Kisii Fistula Camp, Kenya

The youngest case of fistula that we have seen so far.

One of the predisposing factors to fistula is teenage pregnancy.  Adolescent girls are particularly susceptible to obstructed labour, because their pelvises are not fully developed. Jane Kwamboka who is only 15 years old is in this situation.  She got pregnant last year and gave birth in March 2009.  She sat her class eight exam while she was pregnant and did not perform well. Jane’s labour went on for two days, with heavy bleeding. Finally, it resulted in a still born baby and fistula.

Jane’s parents enrolled her is school again after she developed fistula. They informed the school’s staff about their daughter’s condition.  She has had to limit her liquid intake, but even so her school uniform skirt is often soiled. She really hopes this problem can be resolved so that she can progress in her studies like any other child.

The teachers and the pupils understand this situation and have come to accept her as she is.  She is a good student in mathematics, and other pupils often ask Jane for help.  Jane’s mother took her to a private hospital in Kisii and they were referred to Kisumu and then back to Kisii and Kenyatta National Hospital. However the family did not have enough money for the operation and transport cost, nor did they feel sure that an operation would be successful. Therefore other gave up trying to get Jane treatment until one of the nurses in Nyacheke hospital, about 150km from Kisii told them about the Fistula Camp.

As is typical of teenagers Jane is worried about her image that she has and leaking urine all the time has taken its toll on her confidence. Despite the fact that the ward is full of women, both young and old, and that she had found it comforting to meet other patients with the same condition; Jane was almost silent all the time at the hospital  and just stared into space. Jane psychological state implies that youth services and psychological care are particularly crucial for young patients.

Jane did not know anyone with this kind of problem and so she was surprised to find her close cousin in the same ward as her with a similar problem. Illustrating that fistula occurrence is often under-reported in this region. More extensive that focuses on encouraging people to seek treatment is necessary if we are to address fistula prevention, management and reduction in this community.

It is apparent that education and teenage counseling can help restore self-esteem after surgery. Information on family planning and, the need for skilled attendance at birth is essential for these women.