New Hospital Ward: Ammunition Against Shame

Story by John Schenk: Global Centre Communications, Manager Communications Academy

Hodan’s confidence, experiences and personality make her a fiery spokesperson for suffering women two and three times her age.  She mesmerized an audience of dignitaries - including the minister of health - World Vision staff and media with her personal story of shame, isolation and triumph at the opening of a new ward funded by World Vision for the National Borama Fistula Hospital in Somaliland last week (Thursday, 6 November 2014).

“I want girls and women not to hide themselves, but to know fistula (a tear in the bladder causing incontinence) is as treatable as any other disease,” she said in an interview after her speech. “Now, I have gained back my lost dignity. I am normal again. It is not untreatable.” She moved many to tears with this message that was fuelled by great passion.

Obstetric fistula, nearly unknown in developed nations - less than 10 deaths per 100,000 births - is prevalent in Africa and Asia. It causes at least 1,000 deaths per 100,000 births in those regions that once constituted Somalia. It happens during prolonged birth labour due to obstruction, mostly caused by female genital mutilation (FGM) and early childhood marriage, in which girls have not achieved full adult pelvic growth. (Source: WHO)

The result is the humiliating inability to control the flow of one’s urine and, in some cases, feces. The Somali phrase “isku furan”, used both as a medical term and an insult, means “both open.” 

Hodan married at 13 and had her son within a year. She was small and her hips narrow. Difficult labour left her with a fistula. Her husband divorced her as soon as he realized her condition. Her mother and sisters cared for her, as opposed to some families who shun their own, but her community shunned and mocked her. 

“It is awful when people tell you that you smell and you believe your condition is incurable. I was not just pushed away from my community. I put myself away from them. I was depressed and I stigmatized myself,’ she said.

Two years ago she learned about a fistula hospital from staff at the refugee camp where she lives. She applied and World Vision paid for Hodan’s travel and $540 surgery. When she healed they gave her five goats as a means of income. She has bred them into a herd of 14. She also received health training to protect against future problems.

Forty other women were also helped with travel, surgery and goats in Phase 1 of the World Vision Fistula Victims Support Project. It concluded in June 2013 but Phase 2 has started with the aim of helping 80 women with surgeries and to help them through management training and $500 gifts to reintegrate into their communities with a practical livelihood. Forty have been helped so far.

Phase 2 also funded the new ward. It expands the Borama facility run for free by two Somali doctors, Dr. Ibrahim Said Osman and Dr. Said Ahmed Walhad. They have performed more than 2,000 fistula procedures since 2008. The ward will house patients whose first surgery failed. It can take as many as four surgeries to correct the condition. The final success rate is more than 90 percent.

Dr. Osman received his training in the fistula procedure from Dr. Catherine Hamlin, an Australian gynecologist, in Addis Ababa, Ethiopia. She and her husband, Reginald, founded a hospital there in 1974, which has received support from World Vision over the years.

Dr. Osman at the Borama Facilty 

Dr. Walhad was moved to do this work by the plight of an older sister with a fistula. “I was young at the time but I could see that her suffering was enormous,” he said.

He said women come to their facility from Somali communities across the Horn of Africa. “They have been so terribly stigmatized that it impossible to describe the relief and healing that comes from being able to speak and tell your troubles and shame in your own tongue to someone who cares and understands,” he said.

Hodan recalled that pain and those who helped her: “People used to call me isku furan. It was very bad then but it is nothing for me now. I am normal now. I have the hope to be like other girls and reach a higher position in life. I have enrolled in school. I have never before been to school. Without knowledge I can do nothing.

“I will never forget those who helped me,” she said. Since Hodan’s surgery she has become an outspoken “ambassador” for the hospital, spreading the word among women who are often much older than her. Women frequently find the hospital after 20 to 25 years of living with a fistula.

Somaliland is mostly sparsely populated and arid. More than 80 percent of women have undergone FGM. Fifty percent marry as children in the rural areas that make up most of the country and 90 percent of births take place at home in communities with no health services. Traditional birth attendants typically have no training and do not use sanitary procedures.

A donation of medical supplies, including 28 ward beds, 23 patient beds and 47 mattresses, was donated by Australian Doctors for Africa to Taakulo Somali Community (TASCO), a local NGO. World Vision paid the shipping of the supplies valued at $10,000. The beds will be split between the new ward and the rest of the National Borama Fistula Hospital.

Through our advocacy programs and the Fistula hospital, World Vision has been able to reach over 13,000 women, educating them on harmful effects of FGM and empowering them to adopt alternative rites of passage practices and nursing them back to health. We hope to continue empowering women to speak out against this practice.