Helping fistula survivors to become self-reliant in Malawi

NTCHISI, Malawi - Marita Vula was in pain, but she tried to ignore it. The 28-year-old was experiencing her first labour pains and couldn’t wait to a be a mother.

“When I got married, I stayed for three years without a child,” says Ms. Vula from Kambola village in Ntchisi. “In our culture, one is expected to have a child as soon as they get married.”

However, try as they could, Ms. Vula couldn’t get pregnant. This displeased her in-laws who took every opportunity to remind her that they wanted grandchildren. On this particular day, Ms. Vula’s husband was tending their maize field. When he heard that her wife was in labour, he hurried back home.  Since the hospital was far away, he decided to take Ms. Vula to a traditional birth attendant to help her deliver. 

“That was the only option we had that time,” recalls Ms. Vula. “I didn’t see the labour coming that soon and hadn’t planned to travel to the hospital.”

"The look on my husband face told me that something terrible had happened." - Marita Vula, fistula ambassador

Access to maternal services still a challenge

For hours, the traditional birth attendant tried to help Ms. Vula to deliver but without luck.  In desperation, the traditional birth attendant prepared some herbs, which she said would help ‘push the baby out’. Instead of helping her give birth, the herbs made Ms. Vula lose a lot of blood.

“My husband became worried and he rushed to the nearby village to hire a car,” she said. “When he came back, I had passed out. The next thing I remember, [I] was in a hospital. The look on my husband face told me that something terrible had happened."

Ms. Vula arrived at the hospital semi-conscious. Medical staff had to perform a caesarian section to save both mother and child. Unfortunately, the child didn’t make it. Her husband had to break the sad news to her.

“This was devastating news. I was looking forward to holding my child in my hands,” says Ms. Vula. 

Although Ms. Vula recovered well, she could no longer control her urine and she kept wetting herself. The prolonged labour caused her to develop a hole between the birth canal and the bladder. As a result, she developed obstetric fistula. Ms. Vula became one of nearly half a million women and girls who are estimated to be living with fistula.

“When I returned home, my husband’s attitude towards me changed,” she says. “He started sleeping in his own bed.”

A ray of hope for women with fistula 
For eight months, nothing changed. Eventually, her husband disappeared only for Ms. Vula to learn that he had married someone in another village. 

“I was okay with him sleeping on another bed,” she says. “But running away from me was the last thing I expected from him. He was responsible for the pregnancy and I couldn’t have developed fistula if it wasn’t for him.”

With time, Ms. Vula soon learnt to accept her condition. One day, as she was listening to the radio, she heard a testimony of a woman who'd had her fistula treated. She listened with interest and learnt that the operation was done at Bwaila Fistula Centre in Lilongwe. Ms. Vula saved money for transport and treatment at the centre. The waitlist was long. She stayed at the centre for a month and finally got treatment.

“The support I received from the fistula centre transformed my life. I have moved from being a social outcast to become one of the community's respected tailors.” - Ms. Vula, fistula ambassador

Helping fistula survivors reintegrate
“The support I received from the fistula centre transformed my life,” says Ms. Vula, who is now a fistula ambassador in her community. “I have moved from being a social outcast to become one of the community's respected tailors.”

To help her reintegrate in her community, the Bwaila Fistula Centre used Spotlight Initiative support to train Ms. Vula and other 48 fistula ambassadors in tailoring. The ambassadors were each given a sewing machine to help them establish tailoring shops to earn an income. Today, Marita is a well-known tailor in her community. She sews dresses, suits and uniforms. In a good month, Marita makes about US$80. During wedding season, her earnings go up to more than US$100 per month, she says.

“I am saving money to buy iron sheets for my house,” she says. “I have lived a difficult life and now just want to make the best of what I have.” 

In 2021, UNFPA successfully lobbied for the re-opening of the Bwaila Fistula Centre after it was converted into a Covid-19 isolation centre. The closing of the Centre prevented hundreds of women suffering from fistula from getting treatment. Since re-opening, the Centre with support from the Spotlight Initiative, has successfully repaired 90 women suffering from fistula.

By Joseph Scott

Originally published by UNFPA