Emmanuel Chaco
KINSHASA, Sep 27 2011 (IPS) – Every quarter, more than a hundred women with fistulas including many younger than 20 years old are admitted for surgery in Maniema province, says nurse Julie Mawazo. The number of affected women who don t have the means or awareness to come in must be far greater.
Each year, sexual violence, early marriage and complications in childbirth lead to some 12,000 recorded cases of vaginal fistulas in which a hole develops between either the rectum and vagina or between the bladder and vagina according to the Democratic Republic of Congo s Ministry of Public Health.
A quarter of the national total is recorded in the province of Maniema alone, in the east of the DRC, says Jules Mulimbi Kaboyi, who directs the United Nations Fund for Population office in Kinshasa, the Congolese capital. UNFPA works to provide medical care and support for these women.
This assistance is badly needed: just 3.5 percent of the DRC s national budget is allocated to health, and in a country facing massive challenges from diseases like malaria, tuberculosis and AIDS, this leaves scant resources to treat women suffering from this debilitating and stigmatising condition.
Bernadette Kabukulu is a shopkeeper in the Bandalungwa neighbourhood of Kinshasa. For nearly two years, I had persistent pain in my abdomen, and a reddish discharge from my vagina. And a smell, especially when I went to the toilet or if I remained seated for even a few minutes, she told IPS.
I had to wash all the time. I avoided drinking or eating in order to avoid going to the toilet. I was ashamed to go out, I felt as though people could smell the odour that I carried with me.
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Vaginal fistulas are accompanied by the deformation, followed by abnormal swelling, of the private parts of a woman and the creation of openings in the form of small abnormal ulcers between the vagina and the anus, creating a connection between the pathways for urine and faecal matter, says gynaecologist Elie Makuza.
These ulcers and deformations produce strong, persistent odours in the lower parts of the sufferer, Makuza adds. This smell is often the cause of rejection or stigmatisation by the community.
Fistulas can be caused by extended pressure against soft tissue in the pelvis during childbirth young women or girls giving birth are particularly vulnerable or by extreme sexual violence.
Relief for the afflicted
Germain Musombo, a human rights defender with the non-governmental organisation Maniema Libertés, says poor education plays a key role, particularly in Maniema where he estimates that nearly half of women have little or no formal education. In Maniema Province, the increase in the number of affected women is essentially due to four causes. Poverty, early pregnancy, sexual violence, as well as women s poor education and ignorance (of factors that put them at risk).
Thanks to awareness campaigns organised by the UNFPA, in collaboration with the government, women are becoming more aware of the dangers of this condition, says Jean Bertin Epumba, Director of Research and Planning at the Ministry of Public Health. Modeste Shabani, a campaigner at the Sauti Ya Mkaaji community radio station in Kasongo (the name means voice of the peasants in Swahili) is less upbeat.
Here in Maniema there is a practice against which public education can make little headway: early marriage. And once a little girl is married, often as the second or third wife, it is difficult to speak to her about the negative effects of this issue.
Mawazo, who works at the general hospital in Kindu, Maniema s provincial capital, says she herself developed a fistula after the birth of her first child. She was only 15, and went through the delivery without medical assistance. She went through reconstructive surgery two years ago at the Kindu hospital, thanks to doctors brought in with support from the UNFPA.
I m happy to serve other women who suffer from fistula now, and help them to quickly get screening and care, so they can avoid the worst consequences, she told IPS.
Too often, poverty and ignorance puts young girls without resources in a position of weakness with regards to men or young boys , to the point where many get pregnant or marry early, or give birth in dangerous conditions which can be at the root of fistulas.