Obstetric fistula, a silent oppressor of women in Uganda

Obstetric fistula is a silent condition destroying the lives of thousands of women in Uganda. It is an injury that involves constant flow of urine or stool through the vagina following obstructed labour.

Victims are presented with a foul smell that leads to discrimination and isolation.

At the age of 16 years, Irene Ayinyo suffered a fistula that came about due to a prolonged labour and the lack of funds to have an emergency C-section birth. 

A year earlier, at 15 years of age, Irene’s mother died. This meant that she came into the care of a stepmother who mistreated her. In a search for survival, Irene got into a love affair, but when she fell pregnant, her boyfriend abandoned her.

“I was very poor and could hardly afford food,” Irene said. “Because of lack of money, I delayed going to hospital when labour started, and my uterus ruptured, and I lost my baby.” 

Terrewode Women’s Community Hospital is one of the few hospitals providing specialised treatment and surgery to women suffering from obstetric fistula in Uganda. 

MAF flies Ethiopian fistula surgeon Dr Fekade Ayenechew from Uganda’s capital, Kampala, to Soroti, where he restores women’s dignity through surgery.

“When I fly with MAF, I have a full working day,” Dr Fekade said. “If I drive, I won’t do anything on the travel day.”

The MAF flight transforms a six-hour road journey into a one-hour flight, allowing the surgeon to effectively step off the plane and into the operating theatre.

Even though the Terrewode team treated Irene’s fistula, she still bears the pain of her inability to bear children.

“The removal of my uterus made me feel useless because I can’t get married,” she said. “No man will want to marry a woman without a uterus. For so long I prayed and fasted for God to give me another uterus. I also tried to commit suicide several times.”  

In Irene’s culture, a woman without children is considered worthless. This reality is what drives most of these girls into depression.

Amoding Harriet got a fistula during an emergency C-section in 2022. While Harriet made it, her two months premature baby died two days later.

Three weeks after surgery, Harriet started leaking urine.

“I sold my only cow to have the surgery that got my uterus removed because the doctors told me that I would develop a cancer if it had not been removed,” Harriet said. “But my situation got worse.

“My own mother rejected me, and I became an outcast.”

Irene and Harriet suffered their humiliation until they learnt about Terrewode Women’s Community Hospital. 

“The day the doctors removed a catheter after my surgery at Terrewode I was very dry,” Harriet recounts. “I thank them for saving me.”

The two girls are now caretakers at Terrewode and have become champions who encourage other women in similar situations.

Terrewode has operated on a wide range of patients. The youngest was a 10-year-old victim of defilement by a stepfather who suffered a perenial tear, while the oldest was a 64-year-old who had lived with fistula for 17 years. 

On average, Terrewode carries out four fistula surgeries a day, seven days a week. The hospital has so far treated over 1,329 women and girls, but there are many more in need. 

“We have over 75,000 women living with fistula in Uganda today,” said Alice Emasu Sseruyange, the executive director and founder of Terrewode—and another of MAF’s regular passengers. 

Alice flies between Kampala and Soroti many times a month, as she tirelessly works to help women to receive dignity through reconstructive surgery at Terrewode. 

Her role also involves lobbying with Uganda’s health ministry for policy improvements and developments that can curb the high fistula numbers in the country.

MAF is privileged to partner with Terrewode in their ambition to transform the lives of women like Harriet and Irene. 

“I thank Terrewode because they operated on me without asking for any money,” Irene said. “It is because of them that I still live.”