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“I didn’t think that my condition could be cured”

Chad / 26.07.2012

Khadija, who had surgery for an obstetric fistula, being interviewed by local radio in Chad © Mikhael de Souza / MSF

Khadija’s first child was stillborn, and Khadija herself was left badly injured after delivery. She has since undergone surgery to close up her obstetric fistula in the women’s village managed by Médecins Sans Frontières in Abéché, eastern Chad.

“The first time I gave birth was very difficult. I was barely 15 years old. I was in labour for more than five days before they took me to the health centre but, by the time we got there, the child was stillborn,” recalls Khadija. “That’s when the doctors told me that I had a fistula. I suffered from this for six years.”

Obstetric fistulas are most often caused by a prolonged, obstructed labour, where the foetus’s head compresses the mother’s pelvis. Circulation is cut off for a long time, and this can cause cells in the tissue to die, resulting in a hole between the vagina and the bladder. It can also cause an abnormal connection between the rectum and the vagina. The women become incontinent, and often live in shame, ostracised by their family and community.

“I’d already heard about fistulas before I became affected by the condition. In my village, there was an old lady who would constantly leak urine. She died, and that was when I saw that it was possible to die from the condition,” adds Khadija.

“I was lucky”

“I was lucky. I was cured and, above all, my husband stood by me. For six years, no one except my husband and my child would come close to me because of the smell of urine. I spent a lot of money trying to get rid of the smell – my husband would buy me two or three bottles of perfume every month, as well as huge amounts of soap.

“When I learned that I had a fistula, I went to the capital N’Djamena six times. Not a single doctor would see me. We had three cows at home, as well as a small amount of savings. We sold everything, and my husband quit his job, but I couldn’t get the help I needed.

“I was about to wait for the doctor yet again when my uncle heard about the MSF project in Abéché. Honestly, I didn’t think that this condition could be cured. I always thought back to that old woman who died from it.”

Women’s village in Abéché

Next to the general hospital in Abéché, a town in eastern Chad, Médecins Sans Frontières has built a “women’s village” to care for patients suffering from fistulas. Women can stay there for a number of weeks. After initial consultations, each woman receives a health report. One of the main aims of the report is to assess patients for malnutrition. This initial screening is essential before any surgery can take place.

Following surgery, the women receive post-operative care, including psychological support, which helps them to find a way back into their community.

A fistula can usually be remedied with just one operation, but sometimes multiple procedures are necessary, particularly if poor surgical work has been performed on the patient previously. Although the success rate is usually very high, it is lower for these patients.

Fistula operations are highly specialised procedures, and there are very few surgeons who are qualified to carry them out. Since 2008, Médecins Sans Frontières has operated on 650 Chadians suffering from fistulas.

“When I got to the women’s village, I saw more than 100 other women there for the same reason as I was. Some of them had already had operations, and I realised that this condition could be cured. That gave me the encouragement to wait there in Abéché with the rest of the women,” explains Khadija.

Six months after her operation, Khadija fell pregnant again. She said that she was worried that the fistula might come back, but she went to Abéché, where her baby was delivered by caesarean section, and “everything went well”.


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