Surgery brings hope for women pushed to the margins of society because of health challenge that they didn’t know could be treated.
Story by Jenny Davies
At the three times a year outreach, supported by MAF flights, Dr Achai Riek plays a key role in screening new patients and providing care after surgery. But she admits she grew up knowing nothing about the hidden problem that affects thousands of women in South Sudan.
‘I had no idea about obstetric fistula before I went to med-school because people don’t talk about it here in South Sudan,’ said Dr Achai, Medical Director of Reconciliation Hospital in the capital Juba.
Reconciliation hospital is the flagship ministry of the Evangelical Lutheran Church Mission in South Sudan – known as ELCAMSS which is the driving force behind the treatment of fistula supported by medical NGO AMREF South Sudan.
An obstetric fistula happens when women experience tearing giving birth without help. The condition disproportionately affects poor women in remote rural communities where healthcare is non-existent and negative attitudes push fistula sufferers to the margins of society.
‘The places where these things occur are very, very remote areas, where they have no connection whatsoever with the outside world. And in this setting, cases mostly go underdiagnosed. They don't know that this problem has a solution. Most of them, they don't reach out for help.’ Dr Achai is determined to shed light on the appalling prognosis facing tens of thousands of women and the harmful beliefs around why it occurs.
Some women are told that they have been bewitched by someone. Or maybe you did something wrong and God is punishing you for that. This is the mentality of the majority of people,’ she said.
The patient Dr Achai will never forget is a woman in her 60s who developed an obstetric fistula around 1980 and was subsequently rejected by her family.
‘When she would talk, you would feel the sadness in her voice. Like a heaviness that had been buried for 40 years - since she was 18 years old. Imagine living with this condition for so many years! If I were in her place, I don't know what I would have done,’ Dr Achai said.
At the back of Dr Achai’s mind, there is always a question, ‘I wonder to myself, what could have been her life if she was treated on time?’
Thanks to the ELCAMSS Fistula outreaches, many of the women who fly on a MAF plane to Juba for treatment are receiving help in a much timelier way.
My hope is to go back to school and study. I would like to be a doctor.
Christine Simon (22) developed an obstetric fistula following a botched operation, after her baby was delivered, stillborn. She laboured for three days at home before coming to the hospital for help.
‘I have been living with this problem [fistula] for the past three years. I was referred last February. The first fistula surgery was partly successful but sometimes I still had problems,’ she said.
‘This is the second time I’ve been operated. The surgery is painful, and the recovery is hard, but the result is worth it.’ ‘My hope is to go back to school and study. I would like to be a doctor.’
There are an estimated 60,000 women living with fistula in South Sudan according to the UNFPA, the UN agency championing good reproductive health for women. It is a seemingly overwhelming number for the fistula specialists, who can operate on just 40 patients on a typical outreach due to the complexity and skill required.
Dr Achai is motivated to celebrate what’s been achieved and inspired by the example of leading fistula surgeon Dr Andrew Browning.
‘I get fired up and inspired because of the way Dr Andrew Browning handles their trauma. Every time he greets them. He doesn't wear gloves just to touch them. He handles them with love and dignity,’ she said. ‘If I were in their place, I would feel respected. I would feel valued.’