“I couldn’t control a fart,” a woman’s crusade to end the stigma of fistula

Nampaiyo Koriata is a human rights defender, fistula ambassador and female genital mutilation (FGM) advocate. She is the founder of Nampaiyo Koriata Fistula Trust, an organization based in Ololunga, Narok County, which advocates for the rights of girls not to be subjected to female genital mutilation and raises awareness for young women suffering from fistula to seek treatment.

According to the World Health Organization, female genital mutilation refers to the removal or injury of all or part of the external female genital organs for non-medical reasons. Although the practice provides no health benefits for girls and women, it remains widely adopted. An estimated 200 million girls and women alive today have undergone female genital mutilation, and 3 million girls are at risk of undergoing this procedure each year.

Like Nampaiyo, most girls are mutilated before the age of 15. On November 22, 1999, Nampaiyo, then 12 years old and in class eight, faced the wrath of female genital cutters and her life, as she says, “took a different turn.” fold’. After the cut, she was seen as a “mature woman.”

“For any shepherd girl, regardless of age, FGM automatically initiates her into womanhood. She even puts you ‘on par’ with your mother,” she says.

“Throughout my childhood I had focused on my studies, but now I was considered ‘mature enough’ to have a boyfriend and become a girlfriend. “Then I became pregnant at a young age in 2002.”

“If a man pesters you to be his girlfriend and you reject his sexual advances, other men threaten you with that. ‘Kama hautatobolewa kuna come tutakutoboa’ (If you do not agree to lose your virginity, we will take it from you). “Female genital mutilation plays a role in many cases of teenage pregnancies and early motherhood.”

In 2003, she gave birth to her first daughter and suffered a fistula.

“I didn’t understand what it was, but I was determined to continue my studies, so I returned to school in 2004. Even on the day of my re-entry, I soaked my sanitary pads with feces and urine.”

Psychological well-being

Because Nampaiyo could not control the loss of feces and urine, he suffered from low self-esteem.

“I couldn’t even control a fart. She would push the desks to make some noise so she wouldn’t feel the shame of letting out a smelly one.”

The condition had affected his physical, emotional and psychological well-being. She “she was very thin. Other people had assumed she had another illness. But because of her fistula, she couldn’t eat enough to avoid a long call. She also couldn’t drink enough water to avoid getting wet.”

There was a lot of stigma and also self-stigma, since he couldn’t bear that condition, he says.

Frustrated by these challenges at school, the teenager decided to have a second pregnancy. “I was hoping to get married and end the fighting at school. But I continued to fight the fistula even when I was at home,” she recalls.

Years later she met a suitor and married. “We had three more children while I still had the fistula.”

In July 2015, he underwent corrective fistula surgery at Kenyatta National Hospital (KNH) Clinic 66.

“Due to the fistula, I frequently suffered from bacterial infections. This had made my life miserable as I was always seeking treatment. After the fistula repair, I told myself I would not stay silent,” she says.

An obstetric fistula is an abnormal opening between the vagina and rectal bladder that causes continuous urinary or fecal incontinence.

Photo author: Photo | Pool

When she informed her husband, with whom she ran a non-governmental organization, that they should talk about the fistula in their programming, he was not so receptive, she alleges.

“He told me, ‘No, I don’t want other people to know that I married a woman who had fistula.’ This is where my marriage began to decline and as the days went by it ended.”

“I chose to talk about fistula to raise awareness among women and girls,” she adds.

“In 2018, when former first lady Margaret Kenyatta visited Narok, I shared a platform with her as she spoke about fistula.”

A few days later, a friend advised me to form an organization to help women with fistula seek medical care. This is how the Nampaiyo Koriata Fistula Trust was born, she says.

To date, Nampaiyo has linked over 300 fistula survivors from Narok, Bomet, Kisii, Kuria and Migori for corrective surgeries in partnership with the Fistula Foundation, Kenyatta National Hospital Clinic 66, Moi Teaching and Referral Hospital and others that offer free surgeries.

Her organization is among those that received a Global Fund grant last year to promote the health of women and girls through corrective fistula surgery.

“I am also approaching the Narok County Government to partner with me to raise awareness and reach out to women so that they can seek medical help.

“Fistula takes a woman’s life. You can’t go to church, attend ceremonies or even be around people. It’s as if you were excommunicated from community life. You can’t even have friends,” Nampaiyo explains.

“After they undergo corrective fistula surgery at KNH Clinic 66, I have to guide them back to the community; being able to integrate into the social life of the community and mix well.”

Marked as a witch

Women with fistula face stigma, she says, and as a result withdraw from any social life. “I know of a case in which the woman locked herself in her house and her neighbors branded her a witch because she rarely attended community meetings or associated with the neighborhood. She had no friends.”

Some are expelled by their husbands. “I know someone who lived alone in her hut and her husband enjoyed life with his co-wives. Due to his condition, he was assigned the task of herding cattle. At least cows and goats cannot detect feces or urine. It’s sad.”

For these women, the options are hard and miserable. “In Maasai culture, such a woman cannot return to her parents’ house nor can she return to her husband.”

Nampaiyo says partnerships are needed to help grassroots women talk about their fistula experience and seek medical help.

For some, their children intervene and reunite them with their husbands. However, this is sometimes dangerous, as Nampaiyo narrates. “I have seen the case of a woman whose fistula was successfully repaired and her children took her back to her husband. She had been absent for over 15 years but she had not been completely cured. That same night, her husband insisted on intimacy and the repair broke down. I had to take her back to the hospital.”

Others, when discharged from the hospital after fistula repair, have to ride a motorcycle to get home. “When they get home, the stitches have come loose due to the friction, the pushing of the motorcycle.”

Nampaiyo plans to establish a center that can address childbirth complications, fistula repair and fistula-related complications in Narok.

“It will be important to have a facility that serves women in the remote villages of Narok and at the other end of Isebania, and our neighbours, Kajiado and Samburu counties.”

The FGM survivor criticizes recent data from the 2022 Kenya Demographic and Health Survey (KDHS), which indicated that the national prevalence of FGM is 15 percent.

“In Narok I think it is more than 90 percent. I’m an advocate, but a girl comes to me and asks, ‘How am I going to stay in this community where every girl except me has been subjected to FGM?’ Girls are joining together and seeking FGM services because of the stigma that comes with not getting mutilations. A woman who has not undergone female genital mutilation is considered “immature.”

Discrimination and stigma are so pronounced that even men getting married loudly announce that no “uncut” woman should attend their wedding or dowry ceremony.

“This has taken some of their mothers by surprise. The mother must undergo FGM to attend her child’s dowry or wedding ceremony. I am talking about well-educated children, some are professionals with university degrees,” she comments.

SIDEBAR

Female genital fistula, also known as vesicovaginal fistula (VVF), is a birth injury caused by prolonged and obstructed labor without access to timely and quality medical treatment.

The nature of the condition varies and manifests as an abnormal hole or opening between the woman’s birth canal and the urinary tract or rectum, causing the woman to be unable to control urine and/or stool. An obstetric fistula is an abnormal opening between the vagina and rectal bladder that causes continuous urinary or fecal incontinence, says Dr Khisa Wakasiaka, obstetrician-gynecologist and senior fistula surgeon at KNH.

Harmful cultural practices such as female genital mutilation and teenage pregnancies also increase susceptibility to fistula. This is because teenage mothers are at higher risk of obstructed labor as their bodies are not developed enough to handle childbirth safely.

Statistics from the World Health Organization (WHO) indicate that two women suffer from female genital fistula for every 100 births, generating approximately 3,000 new cases per year. Of the new cases, only 7.5 percent of patients have access to medical and surgical treatment.

The condition is usually caused by prolonged labor when women do not have access to quality emergency obstetric care services. If left untreated, it causes isolation, skin infections, kidney disorders and even death.

Despite great advances in Kenya’s health systems, it is expensive for women to seek surgical fistula repair. Women learn to live with the condition and resort to suffering in silence. Those who suffer from obstetric fistula are often rejected by their families, religious organizations, friends, and their husbands or partners, says Dr. Khisa. This causes them to lose self-esteem and self-worth. They end up depressed and stigmatized, he adds.

“To eliminate obstetric fistula as a global health problem, it is necessary to expand the capacity of countries to provide access to emergency obstetric care and treatment of fistula cases.”

KNH, in partnership with M-Pesa Foundation, Amref Health Africa, Flying Doctors Society of Africa and Royal Media Services, has been conducting free fistula corrective surgeries. A total of 45 cases were corrected by surgery at KNH in May 2021, while in November 2022, 46 cases underwent surgical treatment at the national referral hospital.