UNFPA: Refugee girl gets fistula repair

A refugee man in Rwamanja Refugee Settlement accompanies his wife to the washroom. [Edward Echalu/UNFPA Uganda]

By Edith Akiror and Prossy Nakanjako, UNFPA

Seventeen year-old Sarah (not real name) lived with a fistula for three years. It took becoming a refugee in Uganda for her to finally get treatment.

Obstetric Fistula is a devastating childbirth injury which affects any woman or girl who suffers from prolonged or obstructed labor without timely access to an emergency caesarean section.
Sarah remembers a happy childhood with caring parents in her village in Torit, South Sudan. Disaster struck in 2006 when her father, a soldier in the revolutionary SPLA army, was killed in battle in Abiyei. Six years later Sarah’s mother also passed on, leaving the young child alone. With no close relative to care her for or pay her school fees, Sara was forced out of school. 
In desperation, the young girl agreed to a sexual relationship with a man twice her age. At the age of 14, Sarah became pregnant. She never received any antenatal care services. She had no means to travel her to the nearest health center, 32 km away. 
Sarah went into labor at home. For three long days she struggled, attended to only by her father’s relatives. In panic they called the village traditional birth attendant, who forced the baby out. 
In developing countries, between 2 and 3.5 million women and girls are affected. In crisis situations, one in five women of childbearing age is likely to be pregnant. Without access to reproductive health services, these women face an increased risk of life-threatening complications, including obstetric fistula. 
Sarah awoke to the horror of a dead baby boy. She was leaking urine. The stench caused friends and relatives to desert her. The man who had made her pregnant married another woman. All of this crushed and broke her spirit.  
Filled with emotion, Sarah recalls her painful isolation and the abuse, nicknames and insults from her peers. She lived alone in fear, staying in hiding by day and only venturing out in the evenings to a bath late at a communal spring well. 
Sarah lived like this for three years. “Many times I felt like ending my life,” she says. “I was desperate to end it all.”
Eventually her paternal relatives intervened with the family of the man who had made Sarah pregnant. They had a responsibility to care for her. However, it was fleeing the war in South Sudan that, unexpectedly, brought her to a place where treatment would bring back her dignity. 
Sarah arrived in Uganda in April 2016. She stayed at Nyumanzi reception centre in Adjumani district for two months before being relocated to Boroli II settlement. She faced a lot of ridicule from others. Some yelled at her for the disgusting odor.
UNFPA was running an integrated health services outreach camp supported at Biira Health Centre III. With the guidance of Agency for Cooperation and Research in Development (ACORD), UNFPA’s Implementing Partner, Sarah and ten other women with fistulas were successfully repaired at St Mary’s Hospital Lacor, district in July, 2016. 
Three months after surgery, Sarah is a new person, forever grateful to UNFPA for restoring her life and dignity. 
“What happened to me is not what I want for any young girl. Girls should wait to get pregnant until they are old enough to give birth” she says.   
Sarah now, looks to life with a lot of optimism, she looks forward to the time she will meet that true man who will love and care for her. 
Today, UNFPA’s emergency response programme conducts quarterly integrated health service outreach camps in all the refugee settlements and has supported over 5,000 women to access various reproductive health services such as modern family planning methods, Sexually Transmitted Infections (STI) treatment, HIV/AIDS Voluntary Counseling and testing and Obstetric Fistula repairs. UNFPA supports capacity building of regional hospitals like St Mary’s Hospital Lacor to undertake Obstetric Fistula repairs and management.