Zenabas story
For several hours already everything has been quiet in her belly – deathly quiet. She cannot feel the baby anymore – she, Zenaba*, a young woman from Sudan. Her body used to be strong and full of life, but since the day when a severe pain pierced through her body and announced the birth of her first child, everything has changed.
These last few days she has been pacing the small round hut of straw, pausing still when the labour pain struck her. Her whole body bending under the force of the pain, her breath panting, sweat running down her body. Now the flood of pain has ceased and all her strength is drained from her.
It is the rainy season. The showers of rain are refreshing, but the air in the hut is very stuffy. At this time of year, the farmers get their fields ready for planting. Zenaba’s mother and her brothers and sisters are in the bush too, where they are farming, cooking and also sleeping. Zenaba is alone with her grandmother, who gives her a drink of Medide (millet) now and then.
Nobody was happy, that Zenaba was expecting a baby. She is not engaged or married, and will not let anyone know who the father of the child is. The old woman who is with her, cannot help her either. Zenaba can feel that the baby is very low down, but she cannot summon the strength to push it out. Now she has been lying for hours or days, and in her belly everything is quiet, deathly quiet.
I am called to the hospital late one evening. I open the heavy door to the small maternity room and see a young woman lying on the old bed, drenched with sweat. It is my first meeting with Zenaba. Insects swarm around her and collect on the kerosine lamp. The air is filled with a terrible stench, which makes me fear the worst. The manual examination and the information I receive from Zenaba’s grandmother and the nurse-aid confirm what I suspect.
Zenaba must have suffered for many days. She is totally exhausted. Her womb does not show any movement anymore. Although the baby’s dark hair is already visible, its life cannot be saved. I pull the dead baby out manually, and also the placenta. After all this strain, Zenaba needs time to recover physically and emotionally.
In the days to follow, Zenaba must realise that the prolonged, unrelieved labour not only killed the baby, but also brought about more suffering. She cannot control her urine anymore. It trickles out constantly, and sometimes fecal matter is mixed with it too. Zenaba stays in the hospital for a long time, but things do not improve. I explain to her, that the pressure of the baby’s head which lasted for days destroyed a lot of the tissues around her vagina, bladder and rectum. She cannot imagine returning to her village in this state.
When the day comes for her to leave the hospital however, the young, thin woman walks out with a straight back, her head held high to balance a bundle of things. Looking at her, nobody would guess, that she still has a large wound in her body that will not heal. It would have been better if she could have stayed in the hospital for longer, but the fields are ready for the harvest.
However, Zenaba is often too weak for the hard work in the fields. She often has infections and a high fever. Urine wets all her clothes constantly and spreads a bad smell around her. She tries to catch it or wipe it away with old rags. There isn’t enough water to wash frequently, and new clothes cost too much money. Zenaba knows that people avoid her and she cannot share a mat with her friends anymore, as she leaves a smelly puddle wherever she has been. She often sits on a sack in front of the hut, lonely and very ill.
Twice she underwent surgery in the hospital of Adré, but her fistula could not be closed successfully. A team of specialists from Addis Abeba even refused to operate on her, and so, after two years of suffering, Zenaba lost all hopes for healing.
We stayed in touch with Zenaba ever since that first meeting. We took care of her medically, but also visited her family and she visited us. Her suffering is representative for the suffering of many young women in Tschad with Vesico- and Recto-Vaginal Fistulas. Zenaba’s story tells us a lot about what it is like to live with urine and stool incontinence. We couldn’t look away, and decided to take Zenaba with us to Ethiopia, to have her examined at the “Fistula Hospital” and, if possible, registered for surgery.
When Zenaba hears of this possibility, she is ready to leave her family and village and to travel to a completely foreign place. Nothing can stop her. She bravely travels a thousand kilometres with us, climbs into an aeroplane for the first time and settles down in the “Addis Abeba Fistula Hospital”. Five days later we have to leave her and return to Switzerland. Zenaba stays in Ethiopia for several months. She is operated on three times, and finally leaves the hospital after half a year of treatment. Her complicated fistula is almost healed, except that she suffers from a slight urine incontinence. At the hospital she was taught how to train her pelvic floor muscles, to reduce the urine incontinence. She is completely healed from stool incontinence.
The latest news we received from Zenaba is, that she is now actively involved in the care of women whose fistulas have been operated on. This is what she learnt during the months she spent in the hospital in Addis Abeba. Her own suffering makes her capable of helping others and understanding their situation. The self-respect and dignity that Zenaba has regained, encourages every woman with an obstetric fistula that there is hope, that a new life is possible.
Claudia Leimgruber-Neukom, Midwife
in the District of Adré/Tschad 1999-2002
* the name has been changed
