Fistula Program Restores Dignity to Hundreds of Women Abandoned by their Families

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Nancy Mulbah’s labor pains began at midnight during the peak of the Ebola crisis in 2014. Her husband of five years abandoned her when she was six months pregnant, so Mulbah had no one to transport her to the St. Francis Hospital in Cestos, Rivercess, an hour’s drive from her village.

A trained traditional midwife in her neighborhood tried to deliver the baby, but it was a difficult pregnancy that required a medical doctor. They waited until morning to find a motorbike to take Mulbah, 28, to the hospital. By the time Mulbah reached St. Francis Hospital, she had lost
her first child, a baby girl.

A week later, Mulbah began ‘pooping’ and ‘peeing’ on herself. Family and friends abandoned her because of the stench. They accused her of witchcraft and infidelity. “They told me to confess because I cheated on my husband,’’ Mulbah said, holding back tears.

Mulbah’s experience is neither witchcraft nor punishment. She has fistula, commonly known as the “peepee and poopoo’’ sickness. Fistula, a condition that affects more than two million women and girls worldwide, is an internal injury that occurs due to rape or during childbirth, especially when a woman tries to have the baby at home without trained medical professionals. The condition produces a hole between the birth canal and the rectum and causes feces and urine to leak through the vagina.

For decades, Liberian women with fistula were trapped in a cycle of fear and rejection, but since 2007 Mulbah and hundreds of other women are regaining their dignity, thanks to the Liberia Fistula Project, an initiative that provides life-saving surgery and support services to help reintegrate the women with their families and communities. The Ministry of Health manages the project in collaboration and support
from the United Nations Population Fund (UNFPA) and Zonta International.

Since its inception, more than 1,500 women have undergone surgery and many of them are living productive lives in the communities that once abandoned them, said Dr. John Mulbah, one of the three surgeons in the country that performs fistula surgery. The other two doctors are Dr. Louise Kpoto and Dr. Wilhelmina Jallah.

The lack of access to maternal health care in rural Liberia is one of the leading causes of fistula, Dr. Mulbah said. When women in rural areas cannot reach a health facility, as in Mulbah’s case, they turn to traditional birth attendants, or their grandmothers, to deliver their babies.

“We have managed to restore dignity and brought lasting smiles to the lives of 1,500 women and girls in Liberia who were trapped by years of rejection,” Dr. Mulbah said. “Fistula is a distressing and
preventable tragedy that primarily affects young women who lack the means to access quality maternal care.’’

Nancy Mulbah didn’t seek help until two years after she developed fistula. In August, a friend told her about the Liberia Fistula Rehabilitation and Reintegration Center in Gbarnga. The center was created as part of the Liberia Fistula Project to accommodate women as they prepare for surgery.

“For two years, I have been suffering with this sickness that has taken away my pride as a woman and makes me ashamed,’’ Nancy Mulbah said. “I have to double my clothes when we are going to classes. I
change myself three times in the day and four times a night.’’

Mulbah underwent surgery in September, but developed complications. She’s still under doctor’s care in Gbarnga.

During pre-and post-surgery, women stay at the center where they are enrolled in adult literacy, skills and business training and undergo psychosocial counseling. For six months or more, they take courses in cosmetology, tailoring, pastry-making, soap making and tie-dye.

After they complete the surgery and graduate from the program, women receive US$100 grant to start a small business as part of the plan to rebuild their lives and reintegrate them in their communities. In addition to the grant, they receive equipments for their businesses. For example, women interested in tailoring receive a sewing machine, needles, fabric and other materials.

“Most fistula survivors come from poor communities where illiteracy thrives,’’ Dr. Mulbah said. “The adult literacy program provides them with basic reading and writing skills, while the business management skills help them manage their income when they go back to their communities.’’

Nancy Mulbah and other residents credit the center for giving them hope for a better life. Many said they didn’t know much about fistula. When they began experiencing symptoms, their husbands divorced them and their families abandoned them.
Carolyn Saylee, 29, a resident of Fish Town in River Gee County, said when she began having labor pains in 2012, she walked three hours to the Lutheran Clinic in Jubulecan from her home in
Fish Town. Nurses at the hospital told her that they were too busy, and so she returned to Fish Town. When she returned home, a trained traditional midwife in her community tried unsuccessfully to deliver the baby.

“It was not easy,’’ she said. “We fought very hard because they wanted to save my life, but at the end of the day, I lost my child. A few days later, when I woke up, my entire clothes got wet. I was ashamed
among my friends. In no time, they started saying, ‘peepee and poopoo pot coming.’’’ Her husband abandoned her, saying “I can’t marry peepee and poopoo pot.’’

Saylee struggled with fistula for nearly four years. It was only until May this year that she found out about the fistula program over the radio and decided to travel to Bong County. “This sickness is very terrible,’’ she said. “It made me lose everything. ‘’ In September, she underwent a one-hour surgery to repair her vagina, which was destroyed during a difficult delivery.

Saylee’s condition improved slightly. She no longer urinates as often as she did. “I really thank God that I went through the surgery,’’ she said. “I know that within few months from now, I will be a great person in my community and society.”

Saylee said she will continue to follow the doctor’s orders on sexual abstinence. Women who undergo fistula surgery must abstain from sex for six months. Saylee said she will give herself a year and a half.

Fistula, Saylee said, is destroying many of her friends in rural Liberia because some women don’t have access to radio to hear about the fistula program or lack access to better health care systems.
“In the rural areas, there’s also a lack of access to good road connections to reach health care facilities,’’ she said. Musu Flomo, 31, a mother of three, said she developed fistula after having her last child. She lives in Kondubongay, Lofa County, three hours from Zorzor.

When she started experiencing labor pains around midnight, the trained traditional midwife and birth attendant in her neighborhood said she could deliver the baby. When the complications started, Flomo’s family rushed her to the hospital in Zorzor.

“I almost died in the process because the baby’s head was already out, but God helped me, my people quickly rushed me to hospital,” Flomo said. “I lost my baby in the process.’’

The deadly Ebola crisis which killed 4,806 people in Liberia put a hold on fistula surgeries and care. There was an increase in the number of fistula cases because hospitals were not attending to
pregnant women. After the Ebola crisis, the program began to see women who developed fistula, but couldn’t access care.

Mercy Gargar, 34, of Buchanan is one of those women. Gargar developed fistula in April 17, 2014 during the height of the Ebola crisis. When she went to the Buchanan Government Hospital to have her fifth child, she had to undergo caesarean operation. After she had her baby girl, the doctor inserted a tube for her to urinate. A week later, the doctor removed the tube and discharged Gargar. “Few days later, I started bleeding throughout, ‘’ she said. “Later, it turned to urine.’’

Unlike Mulbah, Flomo and other women, Gargar’s husband and family stood by her. Due to the Ebola crisis, she couldn’t undergo the surgery. “My family and husband stood by me,’’ she said.

Dr. Mulbah performed the fistula surgery on Gargar in December 2015, but she remained at the center with her two-year-old daughter so she could complete the classes and training. Since the surgery, she no
longer urinates and ‘poopoo’ on herself.

“I am very grateful to God and the few doctors we have,’’ she said. “I’m a proud survivor. Like many others, I’m out there contributing to the society because of what I learned from the program.’’
Nancy Mulbah is grateful that she found the center. She’s looking forward to returning to Fish Town after she fully recovers and completes the training.

For now, she’s learning to bake and make soap, “so I can make my own money and continue my life.’’

“I have hope that one day I will regain my pride and go back to my community and contribute to my society and educate others that they should seek medical attention when they are experiencing labor
pains,’’ she added.

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