Life for Sarah Samuel has been a series of deaths — and stillbirths. She had her first baby at 16, but five months later, she lost it.

That would be the first of four babies the young woman from Sumbawanga in western Tanzania would lose in as many years.

She would lose another baby, through a stillbirth, when she got married at 17. At age 18, she conceived, just as she did at age 19, and in both cases she had stillbirths.

On her fifth pregnancy, she developed obstetric fistula. Fistula is Latin for “hole.”

The hole occurs between the vagina and rectum (rectovaginal fistula) or vagina and bladder (vesicovaginal fistula), due to prolonged, obstructed labour, leaving a woman with little or no control over her urine or faeces or both.

“I went into labour early. I was seven months pregnant,” she said. “When I got to the hospital, after hours of labour, the doctor decided to operate on me.”
This was another stillbirth.

This was too much for not just her husband — who abandoned her — but also her mother and grandmother, who believed that she had been cursed.

She sought help from her local healthcare centre for her Caesarean wound.

“The wound had opened because I was coughing so much and I had noticed fluids coming out,” said Sarah.

It is then that she met a doctor who broke the news to her: She was not cursed and the fluid was urine.

“He took me back to the theatre, opened my wound, then cleaned and closed it properly,” she recalled.

The doctor then referred her to a “hospital” in Dar es Salaam — the Comprehensive Community-Based Rehabilitation in Tanzania (CCBRT).

Not only does CCBRT lead in the treatment of fistula, it is also home to some of the best fistula surgeons and specialists in the country.

Other centres that offer obstetric fistula treatment in Tanzania are Selian (Arusha), Bugando (Mwanza), KCMC (Moshi), Peramiho (Songea), Nkinga (Tabora) and Kabanga (Kigoma).

“I am now here in the hope that I will be treated,” she said.
Sarah’s day at CCBRT begins with a general clean-up and breakfast. She then picks up her file from the nurse’s station and waits for the first round of the doctor’s visit.

“After the doctor’s visit, those who are scheduled for surgery are taken away for surgery prep and the rest of us go about our day doing various things. Some of us can’t read and write so CCBRT has been generous enough to allow someone to teach us,” she said.

Some learn crafts such as knitting and crocheting while others do some hairdressing, she added.

For hundreds of women living with obstetric fistula in remote parts of the country, there is finally a light at the end of this dark tunnel.

On the International Day to End Obstetric Fistula marked on May 23, Tanzanians converged at CCBRT.

The day is set aside to help raise awareness about the hidden injury that has caused so much devastation and distress for affected women.

For many of the women at CCBRT, hope for a better life has been restored.

With the new skills they are learning while awaiting treatment and discharge, many hope to take care of themselves once they are back home.

Sarah is looking forward to opening her own business. She is also glad to be learning basic reading and writing which she believes will be an asset in the future she seeks.

Once women are discharged from the hospital, they can lead normal, full lives once again.

“They become ambassadors, telling other women and men about fistula” said Dr Peter Majinge. “They are free to have more children in the future through elective caesarean section to avoid stressing of the former injured tissue.”

The majority of fistula patients at CCBRT are women from remote areas in the country with limited or no access to medical facilities.

Some of them are afraid to seek medical attention because of myths such as witchcraft or ancestral punishment.

“Fistula is treatable” said Dr Majinge, “However, we face a lot of challenges, the biggest one being unqualified surgeons trying to repair a fistula and instead, causing more damage to the wound.”
So how does fistula occur?
Some women experience obstructed labour, which can last up to six or seven days. The labour produces contractions that push the baby’s head against the mother’s pelvic bone.
The soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow.

This causes this delicate tissue to die, and where it dies holes are created between the labouring mother’s bladder and vagina and/or between the rectum and vagina. This is what produces incontinence in a fistula patient.

“Fistula is treated by means of surgery that repairs the hole(s),” said Dr Majinge.
The World Health Organisation recommends that an institution attain at least a 75 per cent success rate for fistula treatment.

CCBRT has sustained a success rate of 83 per cent for the past three years. A success rate in this context does not refer only to successful surgeries but to the number of women who are discharged completely dry and rehabilitated.

“Women with fistula tend to be discriminated against, stigmatised and mistreated... this is why we are proud of our success rate because we are able to restore the dignity of these women and they can go on with their life stronger,” he said.

CCBRT provides fistula treatment free of charge. Patients are provided with transport money to and from the hospital, accommodation, clothes and toiletries, food and other basic necessities while they receive treatment.