I met eighteen-year-old Fanjakely late last year as I was photographing potential patients at a screening day in Toamasina, Madagascar. I knew immediately that she was one of the first Obstetric Fistula patients that had come in. How did I know? The state of her clothes, the look of despair and rejection on her face, the smell. If body language was any key, because I couldn’t speak her language, she told me with her eyes “don’t look at me, don’t ask me questions, I came here reluctantly but I have my appointment card and now I just want to get out of here.”
It had always been her dream to be a mother. When she was fifteen, her captivating features and grace caught the eye of a handsome farmer, and they were wed. Not a day went by without him telling her that she was beautiful.
She discovered that she was going to have a child. As the miracle inside her grew, she had no idea that her months of excitement were, in fact, a prelude to sorrow and suffering.
Her suffering began when her labor became four days of excruciating pain. On the third day, the midwife tried to help, but all her knowledge and experience brought no relief. To find help, they would have to leave the village. At 7 a.m. on the fourth morning, Fanjakely, her husband, brother and mother-in-law set out in a pirogue (a small boat much like a canoe) for a four-hour ride on the river to another village. Then they crammed into a packed taxi-brousse (Malagasy bus). Fanjakely passed out two hours before they finally reached the hospital at 7 p.m. There she finally delivered a baby boy named Antonio.
Her heartache was just beginning. She described what happened the next day: “After I stood up to go to the toilet, the urine flowed out. It was flowing plenty, it would not stop.” With absolutely no idea of what was happening, or why, she was terrified, confused, unhappy and angry, “I didn’t know who to be angry with,” she said.
Sadly, Fanjakely had just become another victim of inadequate healthcare systems in developing countries. Her problems could have been easily prevented by having a caesarean section. Every day, 10 women in Madagascar die from complications related to pregnancy and childbirth. Many more survive but, like Fanjakely, suffer from a debilitating injury called obstetric fistula that is caused by obstructed labor that creates an opening between the bladder and the birth canal.
The doctor explained that the fistula could be surgically repaired, but Fanjakely knew that she would never be able to afford it. She said, “I was so sad, because I thought I would never get health, because I have no money for surgery.”
Life became very difficult. In spite of her efforts to stay dry, the smell of the constant flow of urine caused people to reject her. Her young heart was broken.
In the midst of all the horror, Fanjakely was grateful for two miracles. Often women who suffer an obstetric fistula give birth to a stillborn child and in most cases their husbands abandon them. But Fanjakely was blessed with her beautiful, healthy baby boy and her husband never stopped loving her. He was the epitome of unconditional love. Everyday her that she was beautiful and would encourage her by saying, “Maybe one day you will get surgery.”
Little did they know how prophetic his words were. A radio announced Fanjakely’s third miracle: a hospital ship that treated obstetric fistula for free was coming to Madagascar! With what little money they had, Fanjakely bought adult diapers and made the four-hour journey to Toamasina.
Franjakely arrived at the ship scared and alone – soon she would meet many other women with stories just like hers and realise that she was in fact not alone!
Currently it is estimated that there are 2 million other women world wide and another 500,000 cases are added to that list each year! Unfortunately they are just the ones that the World Health Organisation knows about. Most of these women live in remote villages and suffer silently.
80% of obstetric fistulas can be fixed quite easily with a 30 minute surgery and cost around $200-$400. During our field service in Madagascar during 2015-2016 100 women had surgeries here on the ship. This year we have established an Obstetric Fistula clinic which is now up and running with a team of Mercy Ships nurses and 17 local Malagasy nurses who will be trained and mentored by Mercy Ships nurses to continue to the work with the help of Freedom From Fistula when we leave. Already 34 women have had surgeries in the last three weeks and our wards continue to fill with women each week. These 34 women are either recovering or have already gone home with renewed spirits, hope and restored bodies. It is exciting to celebrate with them at their “dress ceremonies” before we send them home. That’s where I have been today 🙂
It is exciting work and I feel incredibly privileged to see these transformations and be part of sharing their stories.