Rebuilding life: A journey through the lives of women who have endured and been treated for obstetric fistula in Tanzania
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Introduction Obstetric fistula is a birthing injury which leaves a woman leaking urine and/or faeces from her vagina. This occurs when there is prolonged obstructed labour, and emergency obstetric care is unavailable. It disproportionately affects poor, uneducated women from rural areas and makes them even more marginalized after they have suffered the injury. The constant smell from leaking subjects them to rejection from society, they are unable to work, and are ashamed of their condition. Obstetric fistula can be prevented by early intervention of obstetric care, and can be cured usually through surgery. Currently there is little or no follow-up of fistula patients after being treated, in Tanzania. Aim This study aims at exploring the experiences of fistula patients after repair in Tanzania. Methodology A qualitative approach was adopted in this study using in-depth interviews, a focus group discussion and observations. With local collaborators, this study was primarily conducted in four regions of Tanzania; Dodoma, Mbeya, Mwanza and Singida. Findings The women who had endured obstetric fistula and received treatment also faced some challenges after repair. Out of 30 women with whom we conducted in-depth interviews, 10 remained with some incontinence and the problems attached to leakage continued. How they experienced and coped with the challenges after repair was closely connected to their experiences before treatment. How the women made sense of fistula also influenced their perception and feelings about their situation and their future. Oftentimes, their experiences before treatment involved struggles with their personal identities as women, their roles as wives and their acceptance as daughters-in-law, which affected their experiences after repair. They commonly experienced loss of womanhood, sexuality, family life and self-esteem and many returned to financial debt and dependency on family or community members. The duration spent with fistula before repair and the success of repair greatly influenced their experiences after repair as well. Almost all who received treatment quickly and were completely dry regained their social lives, however most were financially strained. Discussion The discussion draws upon concepts in medical anthropology and existing research to make sense of the findings. Conclusion Obstetric fistula is an inequity issue and most of the challenges can be prevented with increased awareness, better referral between hospitals and quality care. Treatment of fistula must go beyond the closing of a physical hole, but address physical, psycho-social and economic challenges to completely rehabilitate the individual affected after repair.