Ama is a 70-year old woman who lives in the Brong Ahafo region of Ghana. Ama has had eight pregnancies, but has only two living children. Her first baby died after being born at home in the village. For women in Africa birth in the village with untrained birth attendants is common. The reasons are socio-cultural and economic. Lack of knowledge of the risks of childbirth, distance from health facilities and, above all, poverty, influence the decisions women make about the place of birth. For her second pregnancy, Ama had a long labour, which became obstructed. Eventually she was transferred to a major hospital in the city where she had a Caesarean birth. This baby also unfortunately died. As a result of the long, obstructed labour, Ama developed a vesico-vaginal fistula (a hole between the bladder and the vagina). After this experience Ama had four miscarriages. For her seventh and eight pregnancies she sought professional obstetric care and had planned Caesarean births at the hospital. These babies survived.
Ama has had her fistula and has been leaking urine through the vagina for at least 50 years. She gets painful skin rashes because of the leaking urine. She told us that although her husband was supportive, she felt she had to divorce him because she was so embarrassed. Because she is leaking urine all the time, Ama has to protect herself against wetness and cannot socialize with her friends. Ama is very dignified and dressed carefully for her meeting with us. She feels very embarrassed when she is wet. Although her family has accepted her condition because she was not born with it, Ama feels very alone. She does not know anyone else with the condition in her village.
Ama would like to have her fistula repaired, but money is a problem and she does not know where to get treatment. Ama is only one of many older women in Africa and other developing countries who have suffered from fistula almost all their lives.
The Story of Yaa
Yaa is 29 years old. She lives in the village of Akuma in mid-west Ghana. She has had three babies. Her first baby was born at home in the village. Yaa kept her labour quiet and did not call for help until it was too late. The traditional birth attendant arrived after the baby was born. In labour, Yaa started pushing to deliver her baby too soon, before the cervix was fully dilated. She started leaking urine after the birth of this baby, especially when she coughs or sneezes. She has never been assessed by a doctor except for the Caesarean birth and never for leaking urine. The midwife at the health centre noted her condition and also noted she had had a severe laceration between her vagina and rectum during her first labour. For her second labour Yaa went to the local health centre and delivered her baby there. During the third pregnancy she was referred to the hospital and her baby was delivered by Caesarean birth.
All her children are alive and well. Yaa did not know that treatment was available for her problem and would be grateful for help. We are hoping that Ama and Yaa will be among our first patients at the Mankessim Birth Trauma centre.
(Ghanaian mothers interviewed with their permission by Prof. Kay Matthews, MaterCare Nursing Consultant. 2004) (Cover photo courtesy of Marie Wadden, CBC Radio, Canada 2004)
Fifty years of suffering