Alicina, 54 years old
Kisii Fistula Camp, Kenya
Born in 1955, Alicina is enthusiastic and full of positive energy – she attributes this to the psychotherapy she had with fellow patients in the ward during her short stay at the hospital. At the time of the interview, it was the third day that surgery was being done at camp. Alicina was still on the waiting list due to the overwhelming numbers of patients who came to the hospital for the Kisii Fistula Camp.
She has had the fistula for 14 years, having given birth to her five children at home. The last child is an adult already (27 years old). Although fistula, mostly occurs during the first pregnancy, a significant numbers of women will have had more than 4 children at the time they develop fistula indicating that labor can become obstructed even in women who have previously delivered a number of babies.
After Alicina’s fifth child, she accidentally got pregnant again in 1996 and although the pregnancy was uneventful, she experienced obstructed labour for days, before she delivered a dead baby and developed fistula. She sought treatment in local hospitals the following year and was hospitalised for three months, before being discharged and followed up for four years. Despite her efforts to get treated but the fistula remained and after a long time she gave up. There was no improvement in her incontinence and all the treatment was so expensive – most of the family assets had been used up to pay for her treatments, at the expense of their children.
My fourteen years of living with this problem have been pathetic. You need to use improvised pads (old pieces of clothes) to protect against urine leaking onto your clothes. These need to be washed and sometimes there is no soap. I live in the same compound with my husband, but I have been forced to stay in the kitchen hut while he lives in the main house. I sleep on the floor while he enjoys our marital bed alone. We quarrel every morning and evening ‘hakuna raha’ (there is no joy). He is a farmer and I am barely able to help as I can do little in this condition.
Fistula is a debilitating condition that affects women in many ways including limiting the role that they play in social and family life. This can lead to a loss of intrapersonal skills and confidence as a result of losing an occupation or a hobby. For instance, Alicina longs for the days she used to work on her farm from morning to evening; to attend church and church meetings, women’s groups, and weddings. She painfully remembers her church wedding in 1984, in a white dress, and how active she was in church activities before the wedding and afterwards. She is ashamed and can’t cope with the fact that she can no longer worship inside the church. Sometimes she gathers the courage and to sit outside church just to listen to the service, but then she quickly disappears and returns home.
Alicina has travelled far and wide to seek treatment for her fistula, including Kisii, Tenwek, Tabaka & Kilgoris. All these hospitals require payments up to KSH 30,000 (around 260€) for fistula treatment. At one point, she was advised to sell a plot of land so that she could have the money to pay for the treatment in one of these health care facilities. The sub-chief in her area told her about the Fistula Camp and she also heard announcements about it on radio. She is amazed that AMREF through the local hospital is willing to treat her for free (she breaks into a smile and a dance!).
Alicina told us that she is happy to be sleeping on a bed for the time she has been at the hospital even if she has to share with another patient. She also told us that most women coming to the ward are shunned by their spouses, like her, and sleep without mattresses on bare floors at home.
Following surgery, the patients are managed with a catheter that drains urine into a plastic bag, offering them relief from leaking, as they recover. Alicina had the following to say about this I can’t believe that I will spend warm nights in a dry bed! I have slept restlessly in the wet and cold for what feels like a lifetime.
Alicina is amazed that this condition affects so many women including young girls. Until recently, she had thought she was suffering alone. However, unlike many other women she had made a lot of effort to seek treatment, even if it had been in vain until this point.
She talks in a low voice and says:
Mzee (husband) sleeps well, dresses well in his best ironed clothes, goes wherever he wants and eats well with no worries. As for me I have struggled for more than ten years, sleeping in wetness, wearing pads and being conscious of my diet all the time, preferring to skip meals to control the urine leakage. My turn to enjoy life has come!! Thanks to WAHA & AMREF (she dances a lot more now).
Alicina intends to embark on small scale business and lead a fulfilled life after surgery.