NAIROBI, KENYA – Anne Akinyi was 15 when she became pregnant.
She was living alone after her parents died and her elder sister got married and was attending primary school in Kisumu, a port town in southwestern Kenya.
When she went into labor, her elderly neighbor, who claimed to be a traditional midwife, came to attend to her. Akinyi recalls that the plump, dark-skinned woman, who used to wander her neighborhood with baskets of herbal medicine, told her to close her legs tightly every time she felt the labor pangs.
The pain disappeared within one hour, Akinyi says. Then, the elderly woman told her to go to sleep.
The next morning, Akinyi’s entire body was swollen, and her stomach had turned black. The old woman told her there was nothing to worry about, and she remained in the same state for three days.
On the fourth day, the woman gave her a concoction of traditional herbs meant to induce labor. They worked.
Akinyi pushed to force out twins. But by then, they had died.
The woman quickly fled when the dead infants were born, afraid she would be accused of the deaths, Akinyi says. The teenager had no idea what to do.
It was not long before Akinyi realized that she could not control the passing of her urine and stool. When she went to a local hospital a week later, she was diagnosed with obstetric fistula.
A fistula is an abnormal hole that forms between the bladder and the vagina or, as in Akinyi's case, between the rectum and vagina as well. The most common cause of fistula is obstructed labor, say doctors at Kenyatta National Hospital, Kenya’s largest public hospital, in Nairobi, the capital.
Akinyi underwent several surgeries at a local hospital in Kisumu, but the condition persisted, she says. As is the case with many fistula patients, the condition cut her off from society.
“I could not go back to school, market or attend church because of the stench I carried around,” she says. “To trap the urine, I used old pieces of clothes, which I changed and washed often.”
Akinyi, now 23, lived with the condition for six years. She resigned herself to the fact that she would never have children or get married because of it.
But then she learned about an opportunity for free corrective surgery at Kenyatta National Hospital’s fistula clinic.
Akinyi was among the 113 women who underwent surgery in June and July 2013 during the clinic’s annual fistula camp, which aims to raise awareness about the condition. She was surprised at the number of women admitted with a condition like hers, she says.
“I thought I was alone,” she says. “I had never heard about the condition before, and I never told anyone that I had it.”
When she heard the hospital’s radio advertisement calling on women with the condition to go receive free treatment, she knew it was her best chance to get her health and life back, she says. She borrowed money from a neighbor and traveled the 350 kilometers (220 miles) to Nairobi.
Two weeks after the surgery, Akinyi was able to pass urine and stool normally, she says. Doctors told her she could have children in the future, though her past experience has dampened her desire to. After years of solitude, the chance to live a normal life again excites her most.
“I want to start my life over, go back to school, make new friends and attend church,” she says. “I really missed going to church.”
An increasing number of teenagers and women with obstetric fistula are seeking free corrective surgeries at the fistula clinic at Kenyatta National Hospital, the only major health care institution to offer this opportunity year-round. Beneficiaries say the awareness that other women suffer from the same condition and the correction of it are enabling them to reintegrate themselves into their communities and to regain their lives.
Surgeons attribute the increase in patients at the fistula clinic to a rise in incidence because of issues such as early pregnancy and delivery outside hospitals. Surgery sponsors cite awareness campaigns, such as the annual camp, that educate women about the condition and encourage them to overcome stigma so that they seek care. The fact that surgery at the clinic is free also makes it more accessible.
Eighteen percent of girls in Kenya become pregnant between ages 13 and 18, according to the Kenya Demographic and Health Survey 2008-09.
Teenage girls are at an especially high risk of developing fistula during childbirth because their bodies are not fully developed, says Dr. Weston Khisa, a fistula surgeon at Kenyatta National Hospital.
Each year, 3,000 new cases of fistula occur in Kenya, according to a 2011 report by Campaign to End Fistula, a global initiative by the United Nations Population Fund and various partners. But only about 7 percent are able to access care.
Khisa estimates the number of new cases to be 1,000 per year. As most patients do not receive treatment until years later, it is difficult to tell what percentage of women get fistula as teenagers, he says.
“Most of them get used to living with the condition and withdraw from the society,” he says.