FREETOWN, Sierra Leone – “The effects of women and girls living with obstetric fistula are much more than the physical pain. The condition often leaves them rejected by their husbands, stigmatized by their families, and left alienated by their communities,” said Aminata Jalloh, an obstetric fistula supervisor at Aberdeen Women’s Centre in Freetown. The discrimination suffered often results in the women fleeing their homes to unknown destinations and ultimately jeopardizing their livelihoods.

Obstetric fistula is one of the most serious and tragic childbirth injuries a woman can experience. It is often caused by prolonged, obstructed labour, without access to timely and high quality medical treatment. As a result, a hole between the birth canal and bladder or rectum is often developed leaving the woman incontinent, either unable to control her urine, faeces or both.

According to UNFPA, the United Nations Population Fund, an estimated two million women in Sub-Saharan Africa, the Arab, and Latin America and the Caribbean regions are living with fistula, with approximately 50,000 new cases every year. More than 2000 women in Sierra Leone die as a direct result of obstetric conditions.

Katimu (right) at the Aberdeen Women’s Centre, Freetown © UNFPA Sierra Leone 2018/Angelique Reid

Katimu Kanneh, a 19-year-old obstetric fistula patient from Malema chiefdom, Kailahun; a Sierra Leone-Liberia border district, recently visited the Aberdeen Women’s Centre.  As she sat on a patient bed awaiting to undergo surgery, she explained that she was forced to abandon her home after her husband and her community rejected her. “I fled my home in search of treatment, after being persistently ostracized. For the last four months, my family are unaware of my whereabouts,” she said.

“When I became pregnant in December 2016, I never attended a health clinic. I drank traditional medicines supplied to me by traditional birth attendants in the community,” said Katimu. As a result of the inadequate care, she delivered a stillborn. “It was only after the delivery that I started leaking urine and my life hasn’t been the same since. Some people in the community have associated my condition with witchcraft,” she said.

Psychosocial counselling

After receiving distressing news that she could no longer become pregnant, Katimu stared aimlessly at a wall at Aberdeen Women’s Centre for several minutes. Doctors at the centre had just informed her that after delivering her stillborn, that she no longer has a uterus. Filled with anguish, Katimu said emotionally, “The doctors said I can no longer have babies because my uterus was removed without me knowing.” Upon hearing her tragic news, Katimu received psychosocial counselling at the treatment centre.

Katimu is one of 53 women and three girls under the age of 18 who were living with obstetric fistula and recently attended the two-week fistula camp at Aberdeen Women’s Centre. The fistula camp, which is funded by UNFPA, provides free surgery and essential post-operative care and counselling to all patients to ensure their full recovery. In 2018, UNFPA plans to support the treatment centre to perform 175 surgeries. The fistula patients are identified for treatment from all the districts in Sierra Leone.

Fistula champions

Fistula programme officer at the Aberdeen Women’s Centre, Alie Kamara, said the 56 clients were identified after two screening trips were conducted in the north and east of the country. Some of the patients were referred by Haikal – a non-governmental organisation also supported by UNFPA - which identifies women and girls living with fistula, provides them with technical and vocational skills after treatment, and assists them to reintegrate smoothly back into their communities. Katimu is among those referred by Haikal.

“It’s quite challenging getting patients to come for screening because of the stigma surrounding fistula. Many of them are not confident to leave their homes to get screened,” said Alie. To tackle the issue, a new concept of ‘fistula champions’ consisting of previously treated Haikal patients who serve as living testimonies in communities was incorporated into the programme.

Alie Kamara, fistula programme officer at the Aberdeen Women’s Centre, © UNFPA Sierra Leone 2018/Salim Kamara

The fistula champions will help identify girls who are ostracized in their communities and encourage them to undertake screening and receive treatment. Having undergone a similar process themselves and reintegrated back into their communities, the fistula champions are best placed to encourage women and girls suffering from fistula to receive help.  

Vital screening

Whilst screening is initially undertaken to detect fistula, the process is also beneficial in identifying if patients are suffering from other pelvic, uterine or vaginal conditions. Aminata Jalloh, the obstetric fistula supervisor at the Aberdeen Women’s Centre said people should not overlook cases of fistula. “When a client is screened for fistula, and you see how the condition has damaged their birth canal or bladder, you want to ensure you do your utmost to help them regain their dignity.  When I think of 19-year-old Katimu who can no longer give birth, it makes me realise I have an important role to play in helping these women recover so they can truly live their lives,” said Aminata.

Following their surgeries, the fistula survivors will receive technical and vocational skills training at Haikal, in addition to receiving incentives such as start-up kits to aid their reintegration back into their communities.

“I can’t wait to go home to reunite with my family and restart my life”, said Katimu.

Aminata Jalloh, obstetric fistula supervisor at the Aberdeen Women’s Centre © UNFPA Sierra Leone 2018/Salim Kamara

Prevention is key

Fistula is easily prevented if access to emergency obstetric care, such as family planning, and cesarean sections are available across the country. UNFPA is committed in supporting the recruitment and training of midwives, to ensure a workforce exists in a health system with adequate equipment and supplies, to bolster the availability of emergency obstetric care in all districts.

With the recent establishment of a National Obstetric Fistula Committee in Sierra Leone, it is hoped that gaps in fistula programming will be addressed and have a positive impact on helping women and girls regain their lives through concerted action.  

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About The United Nations Population Fund: UNFPA is the United Nations reproductive health and rights agency. Our mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled.

For more information, please contact:

Ms. Angelique Reid, Communication Specialist

UNFPA Sierra Leone  

M: 078 340044                E: areid@unfpa.org