Evelyn Makena @evemake_g
In a small rented house in Mwihoko, Kiambu county, Monica Chege’s voice is barely audible as she speaks in a hushed tone. She sits on a mattress neatly spread on the floor at a corner staring at her window suspiciously.
Monica who has been narrating to a friend about her battle with fistula has realised that some of her neighbours have been eavesdropping on the conversation. Flashing a strained smile, she expresses concern that those standing at the window would unleash a fresh bout of ridicule.
Such is the life of the 37-year-old woman who has lived with the condition for 19 years. A life of constant ridicule, mocking laughter from people she even considers friends, unending stigma and ultimately isolation.
Though she can barely hide the pungent odour that she suffers once in a while due to urine and feaces incontinence she chooses to keep the details of what ails her as a secret from most people she interacts with. “It reduces the stigma if less people know about it,” she says.
In 1999, Monica was excited about becoming a first-time mother having carried her pregnancy to term. At only 18 years, she was young and naïve. When the labour pains started she left home in Kenol, Murang’a county and went to Thika sub-county Hospital hoping to deliver her baby safely.
But for the next five days, Monica was in excruciating pain, but every time she went to the doctors they would turn her away saying that it was not yet time for the baby to be delivered.
Her waters broke on the fifth day, but what Monica did not know was that the baby had been on breech position. The baby’s legs were delivered first as opposed to head-first. “The doctors realised that when it was too late and resorted to forcefully pulling the baby.
They successfully removed the baby, but it was dead,” she says her voice slightly cracking. In the midst of all the strain on her body she lost consciousness and when she finally woke up her feet were numb with pain and she was leaking urine and feaces. Prolonged labour and the strain caused on her body, left Monica with severe fistula.
According to gynaecologist Charles Muriuki, fistula is a hole between the vagina and the bladder or rectum that causes patients to leak urine or stool. “Obstructed labour during childbirth is the most common cause of fistula among women,” he says.
It would take a year and one month before Monica left her hospital bed and was able to walk again. Before she was discharged, her local church organised a fundraiser and she underwent the first surgery to correct her condition.
One end of her large intestines was diverted to an opening in her abdomen in a procedure known as colostomy to prevent feaces incontinence. “It meant I would need a colostomy bag to hold the waste that came through the opening,” she explains. Her woes were far from over.
On further examining her, a doctor said that the hole in her bladder was too big and required a major surgery, which he could not perform on his own.
The urine incontinence persisted. A surgery she underwent in 2001 at Kenyatta National Hospital to correct the hole in her bladder was not successful. “The doctors asked me not to despair and recommended that I attend clinics at the hospital,” she says.
Subsequent surgeries at Kenyatta National Hospital and Jamaa Mission Hospital, Nairobi also failed to curb the urine incontinence.
Still hopeful, she underwent another surgery in Aga Khan Hospital, which slightly improved her condition. “From leaking urine throughout, now I could slightly hold it, especially at night,” she says.
There have been three more surgeries in various hospitals with little success; a situation that has left her grappling with shame and physical weakness.
Despite getting a meagre earning from washing people’s clothes, Monica has to buy adult diapers to contain the urine. She cannot afford to buy a colostomy bag that costs about Sh500 each and instead relies on polythene bags, which she wraps around her stomach.
“I have been using new polythene bags to avoid infection on the wound,” she says. But with the plastic bags ban, Monica is worried that it may be hard to access the bags that have been her only alternative.
The condition has not only taken a toll on her physical, but also social wellbeing. Due to the condition, Monica, who is an orphan, has given up on a chance to settle down in marriage opting to live alone. “I have suitors, but I turn them down because I am worried they would not put up with me.
My boyfriend left me after hearing about my condition,” she says. As the world marks International Day to End Obstetric Fistula on Wednesday, Monica remains hopeful that one day her condition will be fully treated and she can escape the ordeal of living with emotional, psychological and social fistula scars. According to Dr Muriuki most cases of fistula are treatable through surgical repair.