Fistula patients and nurses

Fistula; in Uganda, it’s not a foreign word


Patients and nurses of the fistula ward at Mulago National Referral Hospital in Uganda, including, at far left the young “daughter on the ward,” and at back, third from right, STM’s Academic Director Dr. Justus Barageine, fistula surgeon. 


Fistula. To most inhabitants of the Global North, the word is foreign.

To Dr. Justus Barageine, Save the Mothers’ Academic Director and renowned fistula surgeon, the word is second nature.

Within the second week of arriving in Uganda, my ears had perked up at the word’s unfamiliar sound spoken casually by Dr. Justus during our weekly roundtable discussion. The look of confusion and curiosity on my American face must have been what prompted Dr. Jean Chamberlain Froese to provide some cultural context on the topic. She explained that an obstetric fistula is a hole that develops between a woman’s vagina and rectum or bladder as a result of obstructed labour—labour that might have lasted as long as six or seven days. Typically, the baby dies and the woman is left leaking urine and feces.

Until two weeks ago, I was satisfied with that simplified explanation. However, the surprise visit from Dr. Jean’s children, Liz, John, and Hannah, reignited my curiosity on the subject. The Froese siblings had decided to gift their savings to fistula patients at Mulago National Referral Hospital. As a facilitator in ensuring that the money was distributed to the requested recipients, I accompanied Dr. Justus to Mulago Hospital, eager to build rapport with these mothers and enhance my understanding of their complex condition.

Tucked away in the fifth floor corner of the hospital was the fistula ward. Small but well lit from the light of the windows, the ward had about a dozen beds. Dr. Justus introduced me to the team of four nurses—who worked long hours with little pay to care for these mothers. Upon explaining the purpose of our visit, the nurses gathered together the seven mothers whose fistulas had been repaired by Dr. Justus and were now recovering from their surgery.

According to the Fistula Foundation, for every woman who receives treatment for her fistula, at least 50 are awaiting care. (Fistula Foundation, 2017)

In that moment, I was looking at seven mothers who had been blessed to receive a surgery that, statistically speaking, 350 mothers would never receive.

One mother, in particular, stood out to me. Perhaps it was because her youth and innocence posed a stark contrast to the older, more mature mothers, or perhaps because I saw myself at her age—just 16, just six years ago—imagining what it would be like to be in her position. She was known as the daughter on the ward, although she had no daughter of her own.

In Dr. Justus’ recounting of her story, I learned that she had undergone a cesarean section by an untrained doctor in a rural hospital that left her baby dead and bladder and uterus cut, resulting in a fistula. In an unconscious state, she was transferred to Mulago just in time for Dr. Justus to perform live-saving surgery. Once recovered, she returned back to her village. However, her family was disgraced by her condition, and her father chased her out. She returned to the fistula ward at Mulago Hospital, the place she now calls her home and the people that work in it, her family.

For women with fistulas, this type of isolation is not uncommon.

Women are often rejected by their husbands and kicked out of their communities because their incontinence results in a foul smell. The location of the fistula ward at Mulago Hospital, hidden in the corner of the fifth floor next to the cervical cancer ward, is a reminder of how the rest of society views these women.

Thus you can imagine their reactions when Dr. Justus told them that a group of three Canadian children had donated a portion of their savings to gift the ward with a teakettle to boil water, along with a small sum of spending money for each mother (equivalent to $18 CAD). When asked what most of the women would do with the money, many said they would buy sanitary pads and food. However, the daughter on the ward said with a radiant smile that she was going to buy an Easter dress to make herself look as good as she now feels.

I felt that same emotion of excitement and gratitude for the opportunity to share in that moment. How fortunate I am to have grown up in a country whose last fistula hospital shut down in the late 1800’s due to the improved quality of obstetric care. How fortunate I am to learn from a team of Save the Mothers clinical experts like Dr. Justus, who sacrifices the pay of working at a privately-funded hospital to save the lives of mothers who cannot afford anything but free healthcare.

How fortunate I am to work at Save the Mothers where financial contributions, big or small, make a significant impact on the people they serve.

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