In June 2018, women arrived in Mandritsara from the surrounding area for the month-long surgery and recovery programme subsidised by the Fistula Foundation.
Dr. Ambaye, a surgeon from Ethiopia, flew with MAF from the capital, Antananarivo, to Good News Hospital (HVM) in Mandritsara. The experienced fistula surgeon shared her considerable knowledge with the HVM surgical team.
A fistula is a hole between the birth canal and the bladder or rectum that occurs during prolonged childbirth. The condition affects an estimated 2 million women worldwide and is prevalent in countries like Madagascar, where only 44% of births are attended by skilled birth attendants.
The risk of developing a fistula are increased by: poor nutrition, early marriage, prolonged childbirth, lack of maternal healthcare. Women who give birth at home without medical assistance and have many children are at higher risk.
Fistula is easily prevented and 90% of cases can be treated surgically. But for every woman who receives surgery, 50 more women have to wait, battling the ongoing symptoms and stigma of a condition which causes them to constantly leak urine.
Three-day trek to hospital
45 women made the trip to HVM, hopeful that the years of misery and stigma would soon be at an end. ‘These ladies will have surgery for free,’ shared HVM nurse Hilde Vlaminckx, part of the team that welcomed the women as they arrived. ‘They stay for one month at least.’
Two of the ladies came together from a village near Mananara (a town on Madagascar’s coast) after they heard about the camp from relatives in Mandritsara. ‘We walked from our village for two days and two nights and then on the third day, we came by motorbike. If we wouldn’t have come by motorbike, it would have taken four days,’ patient Miora explained.
Trauma and loss
The surgeon completed 11 operations in the first three days. By the time they finished, 39 women had had successful surgeries.
Three of the women shared their stories. All had developed fistulas after an extended labour in which their babies had tragically died.
'The baby that cause my fistula died.' Miora
Thirty-seven-year-old Miora* has two children aged 10 and 18. She has lived with fistula for 18 years. ‘I had the children after I had the fistula. The baby that caused my fistula died,’ she explained. ‘It was a long labour. I was unconscious for a time, so I don’t remember how many days. I stayed in the village to give birth. I was brought to a medical centre after I had given birth.’
Aina*, thirty-two, was in labour for two days before seeking help at Mananara hospital, where her stillborn child was delivered by cesarean section. ‘I had the fistula after that,’ she said. Now six months pregnant, Aina has been told she will have to wait until after her child is born. But after eight years living with fistula, she has made the crucial first step in seeking help.
65 % of Madagascans live more than 3 miles from a basic health facility.
44% of Birth are attended by a skilled birth attendant
Madagascan women have an average of 4.1 babies
The youngest of the three ladies Lina*, who is thirty, was in labour for four days. ‘I eventually gave birth but the baby was dead. The midwife couldn’t do anything,’ she says. ‘I have already had three operations here in the hospital but they did not succeed, so I am here for the fourth time and I will have surgery again.’
‘How can I stay dry?’
‘These ladies have this constant urine leak,’ Hilde explains. ‘You don't really need to be a medical person to understand that it's very embarrassing! They smell of urine all the time, even if they wash or bathe.’
‘First, they are rejected by their husband, and then also by the community. If they have still their mother or so and the mother can look after [them]. But they still they live on the edge, on the outside of the community in every respect.’
‘Many are very young because they've been married off as a child. They can't study anymore because they have the fistula. Many have hope that after the operation they might start studying again,’ Hilde continues. ‘Others hope to have a normal life again in the community, not being rejected but really being part of the community and not all the time looking at “how can I stay dry?”’
On the edge of society
The ladies have experienced rejection because of their condition. ‘There are people that are accepting me, others that are not accepting me,’ Miora confides. ‘I have a husband. Not the one that was with me when I first had the problem - he came later. He is helping me to survive.’
With less support, Lina continues to struggle and is only just able to make ends meet. ‘I live in a village but I am not really accepted and I have to look after myself. My husband left me when I had the problem and I have no children yet. I am now 30 years old,’ she said.
‘I am cultivating rice and vegetables, just what I need to live. I don’t have anything to sell. I have no parents, they are both already dead. I have brothers and sisters and they are all younger than me so they can’t help me yet.’
‘I would like to say thank you to MAF and to all the people supporting MAF. I can't thank you enough!’ Hilde
Removing the stigma
When asked about the future, Miora is cautious in her optimism. ‘I haven’t thought about that yet,’ she says. ‘I think I will continue like before.’ The prospect of living a fuller life in her home community, where she makes a living growing vanilla, is enough for now.
All the fistula patients will benefit from them holistic care provided by HVM. Healing happens because they are focused on the on the person behind the medical condition and recovery of body and of soul. ‘The idea is to reintegrate them back into society by fixing this leaking this problem with bladders and at the same time offering them the hope of Jesus Christ,’ Matt Sherratt explains.
‘The hospital has twin aims to treat people's health needs but also to treat their spiritual needs as well. So we were able to pray with patients before we operate. We're able to counsel them after the surgery, and then we have hospital chaplains who come around and share the Good News with them too.’
‘I live in a village but I am not really accepted and I have to look after myself.' Lina
Flying for Fistula
HVM can be reached by road from Antananarivo but it means a journey of days compared to just over an hour in the MAF plane. The time saved means the hospital can make the most of the skills of visiting specialists like the Dr. Ambaye.
MAF flights serve many of the hospitals staff including Hilde who has been a frequent flyer over many years. ‘I flew for the first time with MAF to Mandritsara in 1997, so I've got very good memories from MAF. We're very, very happy to have MAF here in Madagascar.’
‘I would like to say thank you to MAF and to all the people supporting MAF. I can't thank you enough!’
An end to fistula
Praise God for the 39 patients that received the surgery last year and for those who have received surgery in the intervening time thanks to the training received by the HVM surgeon.
Pray for the ongoing recovery of fistula patients including Miora, Aima and Lina. Pray that they would experience life in all its fullness after so many years of struggle and shame.
Lift up the staff team at HVM hospital who are providing essential and lifesaving services to women in medical need. Pray for an end to obstetric fistula through effective education, better maternal healthcare and timely surgical interventions where needed.