"The sun should not rise or set twice on a woman in labour” - African proverb
It’s Wednesday afternoon and a small crowd of doctors, nurses and patients have gathered around a tasty spread of local dishes laid out at the nursing station of the vesico-vaginal fistula (VVF) unit. The music is lowered for a few short speeches that are themed with thanks and gratitude. The music is then turned up again as the large 90’s style sound system is moved outdoors to the courtyard so as to carry on with the dancing portion of the party.
Today is a celebration for the VVF patients on the last day of Dr. Geert Morrens most recent mission. Known to us in Jahun as “Baba G,” Dr. Morrens has just finished a 6 week surgical mission and has dedicated much of his career to repairing obstetric fistulas – one of the most serious consequences of long obstructed labour.
Many of these young women have similar stories. They were pregnant at a young age. They had no obstetrical care. They laboured at home for days. They eventually delivered a stillborn baby. They started leaking urine. They became alienated from their husband and community. They found their way to the VVF ward – the positive twist in the tragic story.
It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. Women who experience obstetric fistula suffer from incontinence, shame, social isolation and multiple physical and mental health problems. The VVF program in Jahun has cared for over 2500 women, offering them surgery, physiotherapy and emotional support.
Outside, the women wearing brightly coloured wrappers (African cloth) are dancing in a large dynamic circle, moving one of their hands in the air to the beat while holding their urine catheter bags in the other. Large buckets of water are also scattered throughout the grounds. “Resting the bladder,” which is accomplished by keeping a catheter in the bladder to allow it to drain for several weeks, as well as drinking lots of fluids, are key components to surgical recovery.
The VVF ward is an empowering place where women shunned from their communities can begin to reclaim their lives. At the very least, the women learn they are not alone in their suffering, supported by one another. It was incredible to watch them dance, many of them so young, just teenagers. I watched shyly from the sidelines until one of the patients grabbed my hand and whisked me into the circle!
Most simple fistulas are treatable, but prevention is key. Obstetric fistulas can largely be avoided through education. A simple educational message such as the African proverb “The sun should not rise or set twice on a woman in labour” can go a long way. Timely access to obstetrical care, and cultural changes that empower women (such as delaying the age of first pregnancy) are the other essential components.
The patient who invited me to dance was celebrating. She was healing from her recent operation and was waiting for a final test to confirm if the surgery was a success. She is optimistic; many of her fellow patients have been cured.
Giving birth to a baby is supposed to be a happy time, a new beginning. For women who develop an obstetric fistula it can feel more like the beginning of the end. The VVF program in Jahun gives these incredibly resilient women a much needed second chance.