Dr. Khisa Weston Wakasiaka, a fistula expert from Kenya working with the African Medical And Research Foundation, recently returned from Garissa, a city in the North Eastern Province of Kenya where he conducted several fistula surgeries on refugees from Daadab. The largest refugee camp in the world and the second largest urban conglomeration in Kenya, Dadaab hosts nearly 500,000 people.
“One of the patients, a 17-year-old girl, Madina, touched my heart,” he says. “We just celebrated the 7 billionth baby, but what this girl went through is so shameful that looking at her would make you cry,” he says.
Madina was pregnant when her family and other villagers left Somalia for the refugee camp. At the height of the crisis in July, about 1,500 people were arriving in Dadaab daily, fleeing a ravaging famine and one of the world’s most enduring conflicts. Madine went into labour somewhere between Somalia and Dadaab. “She can’t remember exactly, but she told us that she was in labour for about 15 days. She couldn't push due to exhaustion and her baby got stuck in the birth canal for days,” Dr. Weston.
A villager helped her deliver, but the baby was dead. “The birth was followed by hemorrhage and by the time they reached the camp she was in shock,” he explains. “Her sister told us that they almost abandoned her in the way but her husband voted against it.”
When Madina reached Daadab, she was immediately referred to the Garissa hospital, a 3-hour drive that ultimately saved her life. In Garissa, she was attended by a visiting gynecologist from the Rotary doctors.
“The family tried to suffocate her, a common practice in some nomadic cultures when one is too sick and can't migrate with the rest of the group,” says Dr. Weston. “Had it not been for the hospital staff, she would be dead by now.”
Madina was examined under anesthesia for the bleeding. The doctor who examined her found an extensive fistula and uterine atony, a condition in which a woman's uterine muscles lose the ability to contract after childbirth. Fortunately the bleeding was controlled and doctors were able to stabilize her with blood transfusion.
Later, she received a colostomy to facilitate the healing of her birth canal. However, this treatment failed and she had to be transferred again to the Kenyatta national hospitals, 8 hour-drive from Garissa. After some time, she was taken back to the camp.
“When I examined her, I found an almost empty pelvis,” says Dr. Weston. Madina had an extensive double-fistula with hardly any tissue left. It took the doctors four hours to repair her urethra and her rectum. Madina also has footdrop in both legs, a consequence of nerve damage sustained during obstructed labor, leading to an inability to use the lower limbs. As a result, she can’t walk without help.
Madina is supported by a doctor (far right), the nurse in charge of the fistula ward (middle) and her sister (back), who brought her from the refugee camp in Daadab to seek treatment in Garissa. Photo: Dr. Khisa Weston Wakasiaka, Kenya, 2011.
Madina’s story is a sad reminder about how poor access to reproductive health can so negatively impact the lives of women in many developing countries.
Through local partners in the Horn of Africa, UNFPA is providing supplies including reproductive health care kits to hospitals, primary health care facilities and communities. Clean delivery kits are distributed to most vulnerable pregnant women among affected communities to ensure clean and safe deliveries.
The Fund has also trained midwives and other health workers and provided them with the necessary medical supplies for improved quality care. Hygiene supplies are also being provided to most vulnerable women and girls to cover their unique needs and maintain their dignity.
“It is not enough to shout that we need safe motherhood. It demands much more. Unnecessary conflicts, early marriages and no education, compounded with extreme poverty and lack of access to health care, especially for pregnant women, today, in this century is a shame,” argues Dr. Weston.
“Madina is dry and healing but we pray that she remains that way and no more women have to endure the same ordeal,” he adds.
Alexandra Sicotte-Levesque contributed to this report.