Controversial hot rod treatment has doctors wringing hands

Every time Abshiro Ahmed lights the fire to prepare meals in her kitchen, the smoke and flames evoke memories of what she has had to endure in search of a cure.

The 29-year-old kindergarten teacher in Hola, Tana River County is ever smiling, but behind that smile is a woman who has endured unbearable pain.

“I could have had six or more children by now or I could be healthier and chubbier, and maybe my husband would not have married another wife,” she says with a wistful smile.

Her problem begun in August 2017, when she noticed she had yellow vaginal discharge, and she felt itchy when urinating.

She went to hospital, where after tests, she was diagnosed with a urinary tract infection (UTI), prescribed medication and asked to return for review once she had completed the dose. She didn’t even start.

Back home, when she told her mother, who lives in the neighbouring homestead, why she had gone to hospital and what she was ailing from, the older lady told her that she need not have gone to hospital.

“She told me that having a urinary tract infection is nothing new and that there is an age-old treatment, that our community used even before the advent of hospitals.

“So she told me to put the medicine away and promised to get a traditional healer to cure me,” Ms Ahmed recounts.

HOT METAL ROD

What she did not know, was that the traditional method involved inserting a red hot metal rod in the vagina to burn the affected area. But even when she found out, she went through with the “treatment”.

“They used firewood to light a big fire, then two women sat near it. One kept the fire alive, and ensured that the rod turned hot, while the other’s work was to put it into the vagina.

“There were six others holding me down – some held my hands tightly, while others sat on me so that I could not move. I couldn’t even breathe,” she recalls.

After the “treatment” session she was told not to eat or drink a thing, as water would slow the pace of healing. Never mind that doctors actually recommend that a person with a urinary tract infection takes a lot of water, to help flush out the problematic bacteria.

The first dose of treatment didn’t work. And not only that, her health worsened.

“I was bedridden for three months. My husband took leave from work to nurse me and bought me several drugs from the pharmacy (without a doctor’s prescription) to heal the wounds.”

SECOND DOSE

Even after she was able to leave her bed, she wasn’t feeling any better and she had lost quite some weight. Her mother and other women recommended a second dose of the burning rod.

“They said I needed to get better and add weight, so that my husband wouldn’t think of marrying a second wife.

“It was very painful!” she winces as she talks of the second time. I couldn’t bear it. I managed to hit one of the women who was holding me down, and the treatment was stopped. The second time round, I was bedridden for five months.”

She was burnt a third time, as a way to open up her womb, as she hadn’t had another child after giving birth to her three-year-old lastborn.

It was all in vain. She still hasn’t gained weight, she is still sick and she still has not added to her brood.

“I always have an urge to urinate. I can no longer control my urine. It leaks,” she says, adding that she agreed to be burnt a second and third time because culturally, it is unheard of to go against one’s mother’s word. “You’ll be cursed!”

POSSIBLE FISTULA

Weston Khisa, a gynaecologist at the Kenyatta National Referral Hospital in Nairobi, worries that Ms Ahmed could be suffering from fistula following the hot rod treatment.

Fistula is a hole that links body parts that are not normally linked together, such as the rectum and vagina, through injury or surgery.

“The hot rod could have burnt her bladder or rectum, causing fistula that would lead to leakage of urine and faeces. She needs to be examined so that if there is fistula, she can get surgery to close it,” says Dr Khisa.

For 24-year-old Fatuma Abdullahi, who lives in Marereni, Kilifi County, the pain began when she suffered a urinary tract infection at age 9.

Her mother, Halima Genya, a traditional birth attendant who doubles up as a traditional healer offering treatment for urinary tract infections and infertility, was the one who burnt her.

“After being circumcised (female genital mutilation), I started feeling itchy in my vagina and my urine had a funny colour. When I told my mother, she gave me the traditional treatment (the hot rod),” says Ms Abdullahi, adding that she got the hot rod treatment a second time to help her conceive.

Ms Genya, who hails from Tana River, the home of the hot rod treatment, now lives in Kilifi, where she continues to offer the hot rod treatment. She has been at it for 36 years.

“We never had doctors. I learnt the trade from my mother, who was also a traditional birth attendant,” says the mother of 11.

She adds that after the cut (female genital mutilation), women and girls in Tana River suffer from urinary tract infections, for which they seek the hot rod treatment.

TRADITION

According to the World Health Organisation, women and girls who have undergone female genital mutilation (clitoridectomy, excision and infibulation), face long-term health risks.

One such risk is urinary tract infections, due to obstruction of the urethra (the hollow tube that carries urine out of the body), which can lead to recurrent infections. If not treated, the infection can ascend to the kidneys, leading to renal failure.

“Back in the day, the treatment was done in the forest with firewood, but now many healers use charcoal in jikos. For young girls who have faced the knife (female genital mutilation) and been sewn up, leaving only a very small opening for passing urine, we place a piece of plastic in their vagina to open it up, before we put in the hot rod.

“For married women who are trying to conceive, we use a thicker rod; for a married woman with with children, we use a red hot tablespoon. After burning, the wound takes about two weeks to heal. If the infection is still present, we burn again. That’s our tradition,” says Ms Genya.

Girls are charged Sh2,000, while married women pay Sh5,000 for the procedure.

Ahmed Hassan, a nurse at the GK Prisons Dispensary in Tana River, where they see three to five patients with urinary tract infections every day, is exasperated because locals shun modern medicine for the ailment.

“Once we give them medicine, they don’t take it. They insist on the traditional method because when the burn heals, they are left with a scar, which to them signifies healing. And they believe that once you get the scar, the infection will not recur. When you give them medication, they say that because the medication doesn’t leave a scar, then healing has not occurred,” says Mr Hassan, adding that the much sought after scar makes it even harder for the women, most of whom have undergone FGM, to have a vaginal birth.

“When they hear that in hospital they have to be operated, they resort to giving birth at home, where they face complications,” he adds.

TREATING INFERTILITY

One in two women will get a urinary tract infection at least once in their lifetime. UTIs are more common in women because they have a shorter urethra, and it is closer to the anus, which makes it easier to bacteria to go up and cause infection.

UTIs are treated with a seven-day dose of medication, and if the patient still has symptoms on follow-up, therapy can be adjusted accordingly.

In another part of Hola – Malindi ya Ngwena Village – Amina Gamalo, says that her mother, an 85-year-old traditional birth attendant, uses the stick method to treat infertility, an “art” she has perfected over 30 years.

She cuts two sticks from a local tree known as muhumbi, which is used to “create a birth canal” in women who are having difficulties conceiving.

Many don’t know why they can’t conceive, and they turn to the traditional healers for answers. The healers say that their birth canals are blocked and need unblocking.

“It’s a two-day process. The first day, the thin stick is inserted into the vagina and used to stir it to create the canal. On the second day, the healer introduces the second stick, a thicker one, until she has successfully created the birth canal.

“You can feel the sticks all the way to your stomach. It is a very painful process, but when you remember the ridicule and stigma that comes with being childless and your own urge to have children, you suck it up,” says Ms Gamalo, adding that the unblocking goes on for a month.

While some women swear by this unconventional and dangerous methods, Dr Khisa explains that the fact that someone says she was able to conceive after having a hot rod or stick inserted, doesn’t mean it worked.

“There could be months when the woman didn’t ovulate, so she couldn’t conceive. You can fail to conceive because your ovaries are not producing an egg, or your (fallopian) tubes are blocked. If the woman is having sex, it means her cervix (birth canal) is open. When she produces eggs, it means she is ovulating and the tubes are open, so she can get pregnant. If you are not getting pregnant, it doesn’t necessarily mean that your birth canal needs unblocking. It is best to seek medical advice,” adds Dr Khisa.

HARD PILL TO SWALLOW

But this medical advice is a hard pill for the women to swallow.

Dayaa Women Group, a community-based organisation that focuses on eradicating child marriage and female genital mutilation, has been trying to use medical advice to fight the hot rod treatment.

“During our forums, women tell us about having been burnt more than three times, without results. We advise them to go to hospital, but they are reluctant. They hold on to the hope that burning is the best way to treat infections and infertility,” says the group’s coordinator Sadia Hussein, adding that there is a belief that a urinary tract infection is a growth that affects fertility.

Ms Hussein adds that trying to bring on medical practitioners to talk about the importance of seeking healthcare from hospitals for infections hasn’t worked either.

“They refuse to open up to the doctors, even when they are suffering complications. It is a taboo topic that they won’t discuss with health workers,” she says, adding that the community still believes that infertility is a women’s issue that can only be solved by burning the vagina, with no consideration that it could be the man with the problem.

At first, when they learn what the treatment involves, most women want to run away, or actually run away, but many bear it because they see it as a permanent solution for infertility, or as the culturally accepted way to treat urinary tract infections, to avoid a curse.

Ms Ahmed is still not feeling better, but she is yet to seek medical attention. Her family insists that her only way out is to get another round of burning, but she is not willing to go through the torturous pain again.

“I might just have to go to hospital. It might be the only solution left,” she says.

***

Urinary Tract Infection (UTI)

Urinary tract infections occur when bacteria from the skin or rectum enter the urinary tract and travel up the bladder.

The most common type of urinary tract infection affects the bladder; it can also affect the urethra (the hollow tube that carries urine from the bladder to the outside of the body). If it spreads further up, it can affect the kidneys.

Urinary tract infections are more common in women than men, because women have a shorter urethra and it is closer to the anus, with an abundance of E. coli bacteria, which can easily find their way into the urethra.

Risk factors

- Previous infection (UTI)

- Sexual activity

- Changes in the vagina caused by menopause

- Pregnancy

- Age (older adults are more vulnerable)

- Reduced mobility after surgery or prolonged bed rest

- Using a catheter

- Kidney stones

- Prostate enlargement in men

- Compromised immunity e.g. due to diabetes

Symptoms

- Pain or burning when urinating

- Frequent urination or urge to urinate

- Dark, cloudy or bloody urine

- Smelly urine

- Pressure or cramping in the pelvis or lower abdomen

- Back or side pain

Complications if left untreated

- Recurrent infections (four or more UTIs in a year)

- Kidney infection and damage

Prevention

- Drink a lot of water

- Urinate regularly – don’t hold it in

- Take showers instead of baths

- Avoid douching, sprays or powders in genital area

- Wipe from front to back after using the toilet

- Wear cotton underwear and loose-fitting clothes

- Clean the genital area before and after sex

- Urinate before and after sexual activity

The infection is treated with antibiotics, painkillers to relieve pain and a recommendation to drink a lot of water to flush out the bacteria. Doctors also recommend that the patient finishes the course of antibiotics even after she starts to feel better.