The social consequences of fistula are often severe: girls and women are unable to work, become isolated, publicly shamed and even driven from their homes
By Inna Lazareva
BATOURI, Cameroon, July 10 (Thomson Reuters Foundation) - A fter giving birth at the age of 13, whenever Amina Mba wanted to attend prayers in her local mosque, sheer terror would stop her from crossing the threshold.
"I would go and hide behind the mosque in order to pray," she told the Thomson Reuters Foundation, as she lay under a flowery cover in a ward of the Catholic Hospital Complex of Batouri in eastern Cameroon.
The reason, she explained, was that no one could tolerate the terrible smell and leakages of urine and faeces caused by obstetric fistula, an agonising childbirth injury which Amina, now aged 20, developed when she had her baby in her early teens.
But not going to the mosque was the least of her problems.
A refugee from Central African Republic who fled marauding gangs and highway henchmen as a 10-year-old with her nomad parents, Amina was married off by her family aged just 13.
"It was a forced marriage. They wanted me to marry quickly, though I didn't want to," she said quietly.
After her fistula developed, her husband told her to go and live with her aunt, as her parents were on the move.
"He did not visit me even once," she said.
After a few months, her aunt also kicked Amina out of her home, leaving her to fend for herself in the refugee camp.
SUICIDE BY STARVING
Obstetric fistula is a hole that develops between the birth canal and bladder or rectum, caused by prolonged, obstructed labour, leaving women leaking urine, faeces or both.
Girls who fall pregnant at a young age are particularly susceptible, as their bodies may not be mature enough to cope with the physical strain of bearing a child.
The social consequences are often severe. Girls and women are unable to work, becoming isolated and abandoned by their husbands, relatives and children, publicly shamed and even driven from their homes.
Instead of getting support and medical help - which is often too far away, too expensive or simply unavailable - many are dubbed witches and shunned.
Some commit suicide. Others do it slowly, starving themselves to death in a desperate bid to stop the leaking.
In Cameroon, every year around 2,000 women develop fistula, an average rate of more than 5 new cases each day, said Jean Pierre Tsafack, a health expert with the United Nations Population Fund (UNFPA).
But a new programme launched this week in eastern Cameroon, funded by the UNFPA and Fondation Orange, the philanthropic arm of the telecoms firm Orange, is offering free surgery to heal fistula victims and help them rebuild their lives.
The programme in Batouri is the second such initiative in the country's East Region, and aims to provide operations for 120 women over two years.
In addition, more than 600 women have been successfully treated at the fistula repair centre in Ngaoundéré, the capital of Cameroon's Adamawa region, set up in 2013 with UNFPA support.
"After the operation, the women are completely transformed," said Joseph Réné Boum, head of the UNFPA office in Bertoua in east Cameroon. "They become beautiful, smiling - they start their lives again."
BUSINESS TRAINING
Yet the fistula surgery is only the first step to recovery.
The UNFPA also runs reintegration programmes for survivors, said Angelique Dikoume, a gender specialist with the agency.
First a series of conversations is held with the woman's family and heath workers who explain exactly what fistula is, how it happened - and how it may be prevented from reoccurring.
"We can advise families on contraceptive methods, and we also explain to the husband that after the operation, the woman shouldn't have sex for six months, in order to allow the healing to take place," said Dikoume.
On Tuesday, policymakers, donors and advocates will gather in London for a family planning summit that will discuss ways to reach an international goal to provide 120 million more women and girls with access to modern contraception by 2020.
The second part of the Cameroon programme is economic support for women and girls to identify business opportunities and provide vocational training.
"Re-integration is very difficult as it often means starting again from zero," said community health worker Marie Sebo. "Many women start by doing some farming, to keep malnutrition at bay."
Fifty-year-old widow Sophie Makoro suffered with fistula for a decade - which not only isolated her socially, but also cut off her only source of income selling vegetables at the market.
"People refused to buy anything off me. They were scared of me because of the smell," she said.
To make ends meet, she would sell her crops to neighbours. "That was the only way people would buy my goods," she said.
Now, after surgery, she plans to expand her farm. But she is also anxious about the challenges ahead as she gets older.
"I don't have anyone to support me - no husband, no children. I rely only on myself," she said.
HOSPITAL SHIP
More free fistula operations are planned for Cameroon.
In September, the world's largest civilian floating hospital, run by international faith-based group Mercy Ships, is due to arrive in the port city of Douala to carry out thousands of critical treatments, including 500 fistula operations.
But UNFPA Cameroon head Barbara Sow is also seeking longer-term solutions, such as establishing a foundation for the treatment of obstetric fistula nationwide.
"It's so easy to do - to change the life of a woman."
After Amina was abandoned by her husband and her aunt, Aya, a woman in her 60s and a fellow refugee from Central African Republic, met the teenager wandering alone in a camp and took her in to live with her and her daughter.
"Why? Because I'm a mother," she shrugged, holding Amina's hand.
Until now, Amina has been home-bound, cooking, while Aya's daughter sells water in plastic bottles collected by her mother. "That's how we get by," Aya explained, clutching a bag of empty bottles she had just gathered at the hospital.
Now that she is recovering, Amina hopes to start her own business. "I want to sell clothes," she said.
Asked if she would go back to her husband, Amina laughed, shaking her finger. "No way," she exclaimed. "Never! Never!"
"I will make new friends and start again," she said. (Reporting by Inna Lazareva; editing by Megan Rowling and Kieran Guilbert. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, climate change, resilience, women's rights, trafficking and property rights. Visit http://news.trust.org/)
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