Remembering my fistula patients as Kenya observes FGM Day

I couldn’t help remembering my two fistula patients in the 1970s as Kenya observed the International Day of Zero Tolerance to FGM on February 6 2012. For Kenya, this was barely four months since President Mwai Kibaki on September 30, 2011, signed into law a bill outlawing the practice of FGM. Generally, in communities where it is practiced, FGM is not viewed as a dangerous act or violation of rights, but more as a necessary step to raise a girl, and in many instances, as a rite of passage, even though it is mind-boggling how this can apply to children as young as 5 years!

Female Genital Mutilation has both immediate and long term consequences to the health of women which depend on the type performed, the expertise of the circumciser, the hygienic conditions under which it is conducted, among others. The most severe complications are usually associated with infibulations. As a means of minimising these risks the phenomenon of “medicalisation” of FGM has manifested in many countries including in Kenya, whereby these procedures are carried out by trained health professionals in health facilities. For example, a survey carried out in Kenya just over a decade ago indicated that one-third of the circumcised women admitted to being cut by a health worker (KDHS 1998). However, while medicalisation my result in fewer complications and perhaps save some lives, it must be condemned because it justifies a torturous practice built on gender discrimination and non-respect of reproductive rights of women.

Source: http://www.middle-east-info.org/league/somalia/fmgpictures.htm

One of the long-term medical complications associated with FGM, especially infibulations, is obstetric fistula- vesico-vaginal (VVF) or recto-vaginal (RVF), or both. I keep thinking about some of my fistula patients in the 1970s. During my active practice in the Department of Obstetrics and Gynaecology at the Kenyatta National Hospital (KNH) I happened to be one of two gynaecologists (the other was Dr Balwant Singh Khehar), with special interest in the treatment of urinary incontinence, the commonest cause of this being VVF. At any given time there would be one or two such cases in my ward. This condition, which arises mainly from prolonged obstruction of labour during childbirth, is a preventable problem if only all pregnant women had access to skilled care during labour and delivery. Yet it has remained a persistent problem- Dr Peter Candler, one of the gynaecologist at the King George VI Hospital (now KNH) has reported that in 1954 the commonest gynaecological condition encountered was obstetric VVF. How sad it is that decades after our independence, a substantial proportion of Kenyan women remain at risk of this tragedy.

Urinary incontinence is one of the most frightful afflictions of human kind and often results in the sufferer becoming a social outcast. Surgical treatment can be technically difficult and demanding and by no means guarantees success. I remember two teenage girls (Halima and Fatma) who were transferred from Wajir District Hospital with very large fistulae, which we had to repair in stages over several weeks. These girls almost became permanent residents of Ward 23 in the old KNH, and to occupy them they were provided each with a knitting kit and encouraged to make whatever they wanted. One morning, as I conducted my ward round one of the girls, Halima presented me with a blue knitted sweater. I was very moved by this deed. I guessed this was her way of expressing gratitude, perhaps for our compassion towards her, because she was, as yet, not cured!

The case of Halima is typical of the continuing violations of reproductive rights of young girls under the banner of culture and tradition. In terms of treating Halima’s condition, clearly we were working at the tail end of the chain of events that resulted in a damage that should never have happened. In the first place, Halima was only 14, too young to be someone’s wife and to have begun childbearing. She had been subjected to FGM-infibulation, before a forced marriage. In both situations her reproductive rights had been denied; she had been abused by the society she lived in. Then when she got pregnant she was further denied the right to health care- an opportunity to have access to skilled attendance during the antenatal period, as well as care during childbirth.

The image in this post was sourced from  Middle-East-Info.org where the strong-hearted can find more pictures of the gruesome operation.

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