Never, in her 34 years of life, did Maria Simbeyi imagine that she would, one day, be forced to bear the pain of using a tube to empty her bladder.
Little did she know that life had other ideas for her.
Come 2022 and the unexpected happened.
“I Maria Simbeyi, from Traditional Authority (T/A) Basambo in Karonga District— am among few patients that were diagnosed with obstetric fistula and admitted to Bwaila Fistula Centre in July this year,” she said.
Not that Simbeyi is worried for the future; far from it. She has been to the centre before, seeking medical attention, such that she knows that she has always gone back to good health.
What worries her, and makes her uncomfortable, is the fact that women with fistula continue to face discrimination and stigma when they go back to their societies before and after getting treatment.
“People do not want to associate with us because they say we produce a foul smell. We continue to battle with stigma that starts with men avoiding us. It is not easy to get married again. It’s hard even to participate in group activities,” Simbeyi said.
Obstetric fistula is a child-birth injury that destroys a woman’s life. It leaves her humiliated and, all too often, shunned by her community and surgery is the only cure.
But such is no longer a thorn in her flesh. She says her first stay in the hospital brought hope to her life because she was enrolled into a social reintegration programme that the centre runs.
Through the programme, she was empowered with social and economic skills that have helped her deal with the impact of the stigma she experiences.
“When we are here, we are exposed to skills such as tailoring, which prepare us to be self-reliant once we get out. The hospital gave me a solar panel system and a sewing machine, which have been helping me earn money for household use,” she said.
She added that fistula patients that are admitted to the hospital are given social and economic support so that, when they return home, they should become ambassadors and encourage others to seek treatment.
Simbeyi is also an ambassador who has supported women in her area and others access fistula care and social support.
“We are able to make bags, clothes and sanitary pads here at the hospital. Once we are done, we are given materials as business start-up capital,” she said.
Simbeyi said, through the tailoring business, she earns K10,000 on a good day while the solar system, which she uses for charging people’s phones, earns her not less than K2,000 a day.
She is not alone. 46-year-old Linesi Banda, a mother of three from T/A Lukwa in Kasungu, is also fighting stigma, eight years after she was treated for the condition.
“I got a sewing machine and solar power system in 2017, which I have been using to sustain my life. I also underwent adult literacy classes, where I learnt how to read and write. The classes helped me a lot,” she said.
But Simbeyi and Banda are now local ambassadors and have been instrumental in convincing other women to access fistula treatment
Freedom for Fistula Foundation, a Scottish charity organisation, runs the Fistula Centre at Bwaila Hospital in collaboration with the Ministry of Health.
Health experts say women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems. It is estimated that more than two million young women live with untreated obstetric fistula in Asia and sub- Saharan Africa.
National coordinator for the centre, Margaret Moyo, said, through reintegration, the centre strives towards empowering fistula-affected women economically.
They also give back lost dignity and instil confidence in the women, she enthused.
“A fistula woman is always seen as a useless person in the community; one that cannot participate in activities. As such, we take them through a process to understand what fistula is about, misconceptions and how to deal with it.
“As part of the empowerment programme, we also run literacy classes. 90 percent of the patients have not gone to school; so, we talk about reading and writing. We also offer business and cooking classes using local food stuffs, especially those that are available within their localities,” Moyo said.
Moyo said the programme has been impactful as materials that are given to patients not only benefit their households but also surrounding communities, especially girls, thereby propelling the government’s school retention goals.
“We have done over 3,500 surgeries and we have women who have integrated so well in the society and play a key role in identifying patients. Annually, 50 percent of patients that we get come from patient ambassadors,” she said.
Moyo, however, lamented increasing cases of fistula among young women due to increased cases of teenage pregnancy, school dropout and continued home delivery despite the centre operating in the country for close to eleven years.
Annually, the centre provides medical care and social reintegration support to about 400 women.
“It is sad for us because we do not know where we are heading to. After being here for close to 11 years, the condition should have been improving but it seems that we have being getting nowhere,” she said.
Health rights advocate Maziko Matenda said the country must step up efforts to ensure that women with fistula are economically supported.
“There is a need for some ministries, for instance the Ministry of Health, to take part, more so because it provides social cash transfers. It can, therefore, accommodate such women.
“The other ministry that can come in is that of education. Globally, they are promoting the One Health Approach, which integrates everyone,” Matemba said.
Ministry of Health spokesperson Adrian Chikumbe also underscored the significance of the programme, stressing that it is enabling women to integrate in communities and reduce stigma associated with fistula.
“The Ministry of Health supports this by lobbying for partner assistance [as regards] the availability of necessary commodities and materials,” Chikumbe said.
The United Nations Population Fund (UNFPA) says, in Malawi, 0.6 percent of women of child-bearing age are reported to have an obstetric fistula.
As such, UNFPA pushes for mobilisation of resources in the country to increase access to treatment services and address growing backlogs.
The World Health Organisation (WHO) indicates that, each year, between 50,000 and 100,000 women worldwide are affected by obstetric fistula, an abnormal opening between a woman’s genital tract and her urinary tract or rectum.
The development of obstetric fistula is directly linked to one of the major causes of maternal mortality. Needless to say preventing and managing obstetric fistula contributes to the attainment of Sustainable Development Goal 3, which is premised on improving maternal health.