As surgeries triple, Kenya aims to end shame of fistula

NAIROBI (Thomson Reuters Foundation) - Kenya’s hopes of ending incontinence caused by fistula, one of the most serious childbirth injuries, are rising as more women are receiving surgery, more local surgeons are being trained and awareness of the stigmatizing condition grows.

Fistula repair surgeries have tripled to 1,500 a year nationwide since the start of the decade, said Hillary Mabeya, who founded Gynocare, one of Kenya’s leading fistula treatment centers.

“The surge in numbers is due to the fact that we now have more surgeons and centers for the surgeries,” he told the Thomson Reuters Foundation in a phone interview.

At least two million women globally live with fistula, which is caused by prolonged labor without access to caesarean section. Tissue dies due to pressure from the baby’s head and a hole forms in the birth canal through which urine and/or faeces leak.

Women with fistula are subject to severe social stigma due to odor, which is constant and humiliating, and in many cases drives their family and friends away.

Kenya only had three internationally recognized fistula surgeons in 2014, plus seven to 10 surgeons who could perform simple operations, Mabeya said.

A $2 million grant to The Fistula Foundation from Japanese pharmaceutical company Astellas proved a gamechanger, enabling the U.S.-based charity to train six more surgeons with a target of providing 1,200 free surgeries in three years.

“We more than doubled what we set out to achieve,” said Kate Grant, The Fistula Foundation’s chief executive, with almost 2,500 operations performed by 2017 thanks to funding by the organization.

“We know that we cannot get rid of fistula in five or 10 years but we hope to end it in a generation.”

She attributed the project’s success to an increase in centers offering routine surgeries and outreach to identify and bring women in for treatment.

Kenya’s First Lady Margaret Kenyatta, who runs a charity focused on improving maternal health, told a conference this week that prevention was key.

“I urge that we seek out more of our mothers who are hidden away while suffering this condition,” she was quoted as saying.

Kenyatta called for all women in Kenya, where around half of births take place at home, to receive skilled care while giving birth and emergency treatment for complications.

Gynocare’s Mabeya said the government must do more to equip hospitals and provide free deliveries in remote areas.

“If this does not happen, the problem will persist,” he said, speaking by phone from Eldoret, 300 kilometres (186 miles) northwest of the capital Nairobi.