Jamaa Fistula Project

In 2004, Jamaa Mission Hospital received support to launch a program to perform fistula repairs on women with obstetric fistula and to train health care providers in pre and post-operative care and rehabilitation.

The initial support came from a German Foundation (The Johanniter Unfall- Hilfe E.V), Verona Fathers, AMREF, and Pat Ryan and Family.  In April 2007, the hospital received its first Support from Safaricom Foundation to facilitate fistula awareness creation among the rural poor and also carry out fistula repairs.

This was a 2 year grant.  The outcomes were very encouraging.  We were able to help break the silence about fistula.  We realized that discussing fistula openly helped reduce the stigma associated with it and learning that the condition is treatable transformed the lives of those who had lost hope.  Radio has been and still remains our most powerful tool for this.

A successful awareness creation was funded by Manos Unidas in 2007-2008.  Other donors who have supported the project include Freedom from Fistula Foundation, Direct Relief International, World Fistula Foundation, Fraternidad sin Fonteras NGO, Tena Products, General Motors (K) Ltd and NIC Bank.

The number of women seeking fistula repair have been on the rise by the day.  Most of these patients are identified by community health workers, social workers, healed patients, churches and medical personnel and directed to the hospital.

In August 2009, the hospital received another grant from Safaricom Foundation to cope with the rising numbers.  Over the years, with the support from the Safaricom Foundation and others, we have been able to help over 2000 women suffering from obstetric fistula and about 30 men with urine control problems. In January 2011, Safaricom Foundation seconded a staff member (Florence Ojwang) to help in enhancing our capacity in awareness creation and fundraising under the World of a Difference Initiative.  She did us proud.

The Problem and Magnitude:

A fistula is a hole.  An obstetric fistula is a hole between a woman’s birth passage and one or more of her internal organs.  This hole develops over many days of obstructed labour, when pressure of the baby’s head against the mother’s pelvis cuts off blood supply to delicate tissues in the region.

The dead tissue falls away and the woman is left with a hole; which can be between the vagina and the bladder (Vesico-vaginal fistula-VVF) or between the vagina and the rectum (Recto-vaginal fistula-RVF).

According to World Health Organization, approximately 2 million women have untreated fistula and approximately 100,000 women develop fistula each year.  In Kenya, the figure is about 100,000 women with an annual incidence of about 3000 new cases.

A fistula results from an obstructed labour. It is estimated that 5% of all pregnant women worldwide experience obstructed labour.

In many developing countries including Kenya, where there are few hospitals, few doctors, and poor transportation systems, obstructed labour often results in death of the mother.  When she survives, there is a great likelihood her child will die and she will develop a fistula.

The three main delays that contribute to the development of a fistula: delay in seeking medical attention; delay in reaching a medical facility; and delay in receiving medical attention upon arrival at a health care facility.

Women most at risk include:-

  • Very young women (in communities where early marriages is practiced)
  • Women delivering their first child
  • Women whose growth is stunted because of poor nutrition or childhood illness
  • Women living in remote/rural areas
  • Women who use traditional maternity care and deliver at home without treatment, their prospects for work and family life are greatly compromised, and most often left to rely on charity.

Key strategies adopted by Jamaa Mission Hospital to address fistula

The key to ending fistula is to prevent it from happening in the first place.  Prevention, rather than treatment, is the key to ending fistula.

We do this through:-

  • Providing information on the need for women to seek reproductive health services and skilled attendance at all births and emergency obstetric care for women who develop birth complications.
  • Addressing social issues that contribute to the problem such as early pregnancies, girl’s education, poverty and need to empower women economically.
  • Sharing Information on the need to delay, space and limit pregnancies.
  • Advocating for infrastructure improvement-roads, hospitals, health centres through stakeholders forums.  There are still some parts of the country where distance is measured out in hours or days rather than miles or kilometres.

Impact of the project

  • Over 2000 women have undergone corrective fistula surgery since inception and are now actively involved in economic activities within the communities; which they could not do before surgery due to foul smell. There is a general increase in awareness about fistula in all the endemic regions and most mothers in these regions are now embracing antenatal clinics so that they can deliver safely.
  • Hospital deliveries have also increased in the said regions and TBA’s have been sensitized not to let a woman labour for more than 12 hours.
  • Over 30 nurses have been trained in pre, intra and post operative care of fistula patients
  • Over 20 community health workers have been trained on how to identify fistula patients and where to refer them.
  • Awareness creation through both print and electronic media especially radio has helped reach more communities especially in the regions affected by Fistula.  This has helped the communities address the risk factors.
  • There is change of attitude towards fistula patients among the communities they come from.  Initially it was considered a curse but now it is appreciated as a medical condition which is treatable.
  • International recognition of fistula as a problem affecting many third world countries hence concerted efforts to help eradicate it.

Cost of Surgery

It costs Kshs 65,000 (USD 680, Euro 590 or Sterling Pounds 500) to successfully repair a fistula patient.  If you want to support a patient kindly get in touch with the Hospital Administrator on the address or email provided on this website.