Mary* lies calmly on her bed in spite of the excruciating pain. Inside the 20-bed capacity unit for fistula surgeries at Narok County Referral Hospital, she is the only teenager.
The unit, where she underwent fistula surgery to correct the condition, was set up in November. At 15, she became a victim of early pregnancies. She recounts that she developed pus months after she delivered her baby last year. "I had a normal delivery and my baby, now one-and-a-half years old, is doing well. Once I get well I want to go back to school and continue with my studies,” says the 16-year-old Form Two student.
Medical experts and county health officials are now worried that high cases of teen pregnancies, early marriages and female circumcision practised in counties like Narok are slowing down the war on fistula and other reproductive health conditions for young girls and women.
“Although the most common cause of fistula is delayed labour, in this county these cases are as result of early marriages and female circumcision. Girls as young as 14 and 16 are married off and when they deliver they are likely to get a fistula since their body organs, especially around pelvic area, are still delicate and not well developed for a normal delivery,” Dr Francis Otula, a gynaecologist and fistula surgeon at Narok County Referral Hospital, tells HealthyNation.
Data from Kenya Demographic and Health Survey (KDHS) 2014-2018 on teenage pregnancy prevalence showed that Narok tops the list in Kenya at 40 per cent, followed by Homa Bay County at 33 per cent.
Women in some communities still rely on traditional birth attendants for deliveries, a situation that has also been blamed for fistula cases because the lack of a professional could result in poor handling of the procedure.
Dr Charlotte Polle-Kaliti, Kenya’s only female fistula surgeon, says female circumcision contributes to cases of fistula. “Female circumcision affects the diameter of the vagina and scars tissue. This tissue is torn by the baby during the delivery,” she explains.
On November 14, Narok County in partnership with Fistula Foundation opened its first unit at Narok County Referral Hospital to offer free surgeries.
In Kenya, there are six other hospitals that offer fistula treatment and training to health professionals in Uasin Gishu, Trans Nzoia, Kisumu, Mombasa and Nairobi counties. “Every year, we have 200 new fistula cases in Narok. It also comes with complications such as cerebral palsy in children,” says Dr Francis Kiio, the Narok County director of health services.
The county official says there is need for more community awareness to curb these practices and promote access to reproductive health services to lower these cases. “Patients have to travel long distances to deliver and delayed labour causes fistula. In the community, early marriages and teen pregnancies result in deaths during deliveries and most of those who survive end up with complications such as cerebral palsy. This also affects mothers physically and psychologically because of fistula,” he says.
Dr Polle-Kaliti notes that lack of adequate female fistula surgeons makes most women shy away from surgeries. “When I moved to one of the hospitals in Coast, there were very few women seeking this service. In most cases, when conservative women find a male surgeon, they will not tell him the exact condition they are suffering from,” Dr Polle-Kaliti explains.
According to Habiba Mohammed, country’s director of Fistula Foundation, the cost of surgeries is highly prohibitive to most women with the condition. “The cost of fistula surgery goes for between Sh80,000 and Sh100,000 depending on the facility. For comprehensive and post-treatment care, it can go up to as high as Sh200,000,” says Ms Mohammed.