This month, we bring you the third and final story written by Dr. Yoni Barnhard during his time at our programs in Tanzania. This story that captures the immense hope of second chances: after receiving corrective surgery for an obstetric fistula, AK is able to deliver a healthy baby boy. It also demonstrates why it is so critical to go beyond treatments such as fistula surgeries to prevention through improved maternal health care.
Final Day: Forgiveness
AK is 23 years old. Aged and experienced in ways a young woman should not understand. It is not her story as such that is most deeply painful. Rather an avoidable suffering that degrades too many.
Happy to be pregnant, AK regularly attended her prenatal appointments with the encouragement of her husband. Unlike many women in sub-Saharan Africa she had access to healthcare. She understood the symptoms of labor. And the warning signs of potential complications.
After nearly two full days of regular, searing contractions and two attempts at being admitted to a hospital, AK returned to the hospital in pain, sure that something was wrong. No fetal heart tones could be heard. Another doctor was called. He could only confirm an intrauterine fetal death. Stillbirth.
Labor was induced. 14 hours of agony. No medication to relieve the pain. She never saw her child. Four hours later she was sent home.
AK was unable to leave her home for weeks. Fearful that others would mark her as the cause of a tragedy she had done everything in her power to avoid.
Over the next several weeks, AK noticed a constant sense of wetness between her legs. The death of her child sprouting uncontrollable nightmares. She was never given any explanation. AK assumed she had done something wrong. An older neighbor told her she was drinking too much water. AK stopped drinking water. The leaking continued. Another neighbor convinced her this happens to women who are promiscuous. She had never known any man except her husband. Yet accepted responsibility for her fate.
About a month later AK noticed an advertisement for women with vesico-vaginal fistula. She mustered the courage to inquire. After an initial appointment with a health worker, AK was referred to CCBRT, an amazing rehabilitation hospital in Dar that does miraculous work including treatment for women with fistula. After seeing a doctor at CCBRT, AK was properly evaluated and her underlying condition clearly explained. It had nothing to do with water. And certainly was not the result of some imagined past sin.
A compassionate team guided AK and her supportive husband through the process of healing and repair.
The fistula was likely caused by prolonged labor. AK had a hole in her bladder leaking urine into her vagina repaired early one Tuesday morning. After a week of recovery in the hospital she returned home. Whole in a certain way for the first time in many months.
AK even took a new job. Her afternoons were spent counseling other women with fistula at CCBRT. She spoke with conviction about the possibilities of healing. From the inside out. Physically. Psychologically. She worked with women in the hope that their husbands’ would not abandon them as is too often the custom for women with fistula. Outcasts. Placed in an eternal isolation. She gave these other women hope that life could be different. She praised their initiative. She honored their taking control of their own lives. She dignified their every effort.
Seven months later AK missed her first period. She immediately saw a doctor. An early pregnancy was confirmed. An uneventful pregnancy unfolded until late one night around 28 weeks’ gestation. A little blood. Some abdominal pain. Rhythmic tightening just above her pelvic bone.
AK contacted an amazing doctor at CCBRT. Doctor Brenda met her late one night at the national hospital, Muhimbili. She was admitted. Worked-up. Medications given to stop her contractions. Every doctor at Muhimbili knew her history. A story of loss. A story of repair.
Days passed. The contractions waned. The bleeding subsided. AK went home to rest. She lay in bed. Reduced her activity. Kept her prenatal appointments. And time passed.
At about 35 weeks, AK felt a gush of fluid one morning. The floor below her feet wet. She contacted Dr. Brenda. Plans were made. Admission to Muhimbili arranged.
On an airless, January morning, AK was brought to the operating theater. She knew well in advance that delivery would be by Cesarean section. Every effort made to avoid any trauma to the bladder. To the vaginal tissue. To the suffering buried deep inside her.
A live male infant was delivered. Healthy. Shortly after the surgery, Her newborn son was placed on her chest. He instinctively found a nipple. His lips moving like the paws of a cat clawing at play. AK smiled. Tears on her cheeks.
Before AK left the hospital Dr Brenda asked her about the past year and a half. She looked up from a chair. Looked beyond the doctor, beyond her pain and she said something I will always remember. “I will never forget [what happened]. But I have forgiven. My husband did not leave me despite the fistula. I now have a beautiful child. I am a mother. My life begins now.”