Women with fistula discriminated against in South Sudan

By, Dhieu Williams (Juba, Southern Sudan). Views expressed are the author’s own.

Many people in southern Sudan have never heard of a fistula. Few understand what you are talking about if you asked but for thousands of women who live with it, living is a daily nightmare.

Fistula caused by inflammation, leads to abrasion or tear in the lining of the rectum and vagina. Fistulas vary depending on which part of the body they affect. Some are gastrointestinal anal, rectal and vaginal. Some of symptoms of fistulas are peritonitis, faecal incontinence, vaginal discharge, inflammation and dermatitis.

Agnes Diago, 24 year old got a fistula in 2007 when she was 20 years. She had been married for a few months before she started experiencing pains before developing a vaginal fistula. She visited one of the hospitals in Torit, Eastern Equatoria for an operation which didn’t eliminate the problem.

She later had a second operation in Rumbek in Lake State, one of the towns that was heavily affected by the 21-year north-south civil war.  After that operation Diago says the leakage of faeces stopped but the urinal problem remained.

On May 27, she travelled to Juba teaching hospital, she had heard a team of Ugandan  gynaecologists were carrying out free surgeries for women with fistula. She said she was lucky that she’s still married and her family still cares for her, which many women like her have not got.

“I still had a good relationship with my husband and the relatives, though the disease gives me bad smelling that chased them but they did not abandoned me” said Diago lying on a hospital bed.

The Ugandan and Sudanese doctors are conducting a medical camp funded by Isis-Women’s International Cross Cultural Exchange (Isis-WICCE) to provide reconstructive surgeries for hundreds of women from different states as well as attending to general reproductive complications of men.

Most patients at the camp have been largely on their own with no attention from relatives and community.  Duku Adam is another patient I met at Juba Teaching Hospital three days after the second operation and she was more than happy to talk to me.

“I was cuts with a scissors by midwives during birth at home. I came here in the middle the night with urine flowing out unstoppable. I am happy that to get back a normal life.” Due to this complication, Duku’s husband and her in-laws abandoned her but her parents were there for her.

Duku is only 19 years old. Doctors said she and many girls who are married off early face a high risk of developing obstetric fistula. Vesicovaginal and rectovaginal fistulas are also as result of several rapes especially gang rapes. Older women in South Sudan suffer from fistula as a result of rape during the long civil war.

Angelina Aduer, age 20 was married at 17 years. When she was pregnant with her first child she went through labour for four days before delivering safely. But it wasn’t long, two days after birth Aduer experience pains and in the coming weeks she could no longer control the flow of urine. Like many young women, she was abandoned by her family once the operation they tried in Khartoum didn’t work.

Dr Fred Kirya, a senior specialist in Gynaecology who headed the team of five specialists said that because of the lack of health services during the war, many women have been condemned to live with fistulas and many in isolation.

The Executive Director for Toto Chan Center for Trauma, Jim Long John who partly coordinated the initiative said this initiative came after a research on fistula in some states.

He says there are still thousands of women who need such surgeries in order to live normal lives. It will take 2-3 days for Aduer and the women to be able to control their urine flow. It doesn’t take long to see how such surgeries make a difference in the self-esteem of women. Aduer looks forward to the respect she will regain from her community.