Before being involved with MPA’s new fistula program I had no clue what it was. There is not much coverage on it, especially in USA. Driving out into the rural areas, we visited many women’s houses who had Fistula or who needed surgery. The conditions, stories, and situations most of these women live in were hard to take in.

I want to break this article up into three parts. First describing what Fistula is and the background information about it; Second tell the women’s stories; Third describing what MPA is doing with the pig project.

What is fistula?

Rectovaginal fistulas form as a result of injuries during childbirth, which cause a tissue breakdown that creates a connection between the rectum and the vagina. When a woman experiences these issues during childbirth in developing countries, she often loses the baby. Fistulas are occurring in the developing world for two main reasons. Either the woman is too young or the woman is not receiving proper medical care. When a young woman that is not fully developed attempts to give birth, the baby’s head is often bigger than the women’s pelvis and therefore the woman experiences obstructed labor. The majority of women end up losing their baby during obstructed labor. When a woman has not received proper prenatal care before having her baby, she could need a C-section but she doesn’t get one, due to being in a rural area with no immediate access to health care. A lot of the times (from the women we talked to) they give birth in their home with an TBA (traditional birthing attendant) who does not have sufficient medical knowledge to know when the women needs a C-section. If they realize they need to go to the hospital, it is usually too late. The woman will be taken on the back of a bike or motorcycle to the nearest clinic, but she will have already lost her baby.

You might ask why they just don’t go to the hospital. I think it boils down to simply a lack of education. The rural areas are not well educated and are often the areas of the worst poverty. Their belief is that their mothers and grandmothers used a TBA to give birth, so they can as well. The transportation cost to get to the hospital, and the possibility of paying for a C-section (not sure if all government hospitals cover that cost) is also another cost they sometimes can not afford. The other cause of fistula when the woman is too young just has to do with poverty. Women are married off to older men when they are quite young. The woman might come from a poor family and therefore is happy to be taken care of or does not have a choice. The man wants babies and wants to have a big family which is seen as the most important quality in society. He does not think about providing for the children, he just trys to have the most children to tell others he has a big family. It is even common for the man to get the woman pregnant before getting married to make sure she can bear children. If not, then the man might search for another woman. When the woman is too young her pelvis is not developed enough to give birth, which leads to the fistula forming when they give birth.

Women who then have this condition after birth are usually cast out of their homes. They can not control the fecal matter or urine leaking from their body since the connection of the two passageways is present. Men often tell them to leave the house, marry another, keep them around and have another woman, or stay with them. From the percentage that we talked to, I would say 25% stay with their wife. The majority kick them out in one way or the other. These women are left to find shelter somewhere else, and to find income some other way. They don’t have anything, and are very very timid, and think they can not reproduce again. Each night they sleep in a “wet” bed. From what I saw there was no bed they slept in, instead it was a mat on a dirt floor, but the point is every night they wet themselves or pass fecal matter while sleeping. The leakage also happens during the day, as there is no control over it. The only way to get rid of this condition is through surgery, but surgery costs more money than they have.

That is where the good news starts though. Surgury by Dr. Maura and her team in Kitovu Hospital is free for all women who come. They provide the cost of the surgery, food, and care at no cost to these women, thanks to Engender Health. I think Engender Health funds the surguries along with a little money from the king.

Stories of the women

We visited a women who was 23 years old that had a fistula. She said her husband, who is 47, is now with another woman as well as providing a little for her. She hasn’t had her menstrual cycle since surgery. She was very anxious about it because she wants to have a child to prove her worth to her husband. After surgery she went to the doctor because she wasn’t having her period. The doctor wrote her a prescription, but she never went to get it because she couldn’t afford the cost of medication. She pet her pig while talking to us, never looking us in the eye. She was happy to recieve her pig as a source of income, but we could see in her eyes, that she was broken by the effects of what fistula had done to her.

The second women we went to visit, had surgery two times. After having it once, she continued to have some leakage and went for a second surgery. She had a few children with no problems, and I think with the third child she developed fistula. I am not sure if it was because she needed a C-section and was too far away, but that seems the most likely. After discovering she had developed fistula, her husband left her and took all the children. She was kicked out of her house and had to find another place to stay. She built a hut on her brothers land. She is still having a few problems after the surgery, but was very excited to have the pig, and told us she has big plans for the pig. She wants to save up to get a cell phone and be profitable with the pig, then buy a house.

The third women we went to visit had the baby successfully, but during the process of giving birth developed fistula. Upon coming back from surgery she found out her husband married someone else. Her husband told her that she could stay near the house but would not feed her. She was eventually kicked out of the house and had to go rent a room from someone that her mother knew about. MADDO then gave her some supplies so she could sell some products in town and make some money. She was coming back from another town on the boda boda and her husband saw the taxi driver waiting for her to give him money. The husband thought the driver was trying to take her away from him and got in a fight with the driver. After getting in a fight with the driver he proceeded to tell her that this behavior was unacceptable and then destroyed all her supplies at her store. She can’t have anymore kids due to the complications of her surgery and now the husband wants to take her one child. Even though the police are now involved it is quite a hard situation for her currently. She is now living with her dad who was drunk at 2 pm when we visited.

We went to visit one woman who had been referred to us by an employee at MADDO. Her story was the toughest for me. As you can see she is on wooden crutches. She was born with both physical disabilities and a fistula. Her whole life she has lived with this condition. She was the most timid of all the women we visited. She told us about a bad experience that happened a few years ago. She was knitting sweaters near a school as means for income, when a man approached her and took advantage of her. She ended up getting pregnant. She won’t report the incident or describe who the man was to anyone. She happened to give birth to her baby, and now is trying to support her child. She has not had the surgery yet, but MADDO is making sure she will attend the next fistula repair camp, so that she gets proper care. We tried to buy about everything we could from the shop she was looking after, but her confidence was so low that she didn’t want to sell anything to us that she didn’t have permission to.

How MPA is helping

MPA is funding the Piglet Project to help these women gain social acceptance, gain an income, and be self sustainable. A few people from MADDO go out to each one of their homes after the surgery. They tell the women to form a group of three. After the women get out of surgery they are given a pig that they keep in a wooden pen. Once the pig is pregnant the women will give a piglet to the other two women in their group. They then give two of the piglets back to MPA and MPA continues to give pigs out to other fistula patients in need. Once the pig produces the piglets the women can decide to sell them or keep some of them to continue to get more pigs. I believe each piglet goes for around $25, with the price going up as the pig gets bigger. With this income they can buy more plants to grow, to further gain more money to eventually send their children to school and be self sustainable. The surrounding people were surprised to see the trucks going up the road to most of these houses we delivered the pigs at. It is not common to see cars or trucks on these tiny clay roads since most people in these communities usually don’t have much means for transportation. Upon seeing our two trucks, we had many people follow us to the woman’s house. With this increased attention, it made the women feel important which is a good first step. The rest of the people in the village will quickly know what house those trucks went to. Most all women were so thankful to the whole team, often times giving us gifts back from their land.

Each time we delivered the pigs, we could see how it impacted them socially, and how it will help economically. MPA and MADDO seek out the people who are most vulnerable and those who are living in extreme poverty. The ones who can not control the passing of fecal matter and urine all day and night, with no income, and usually a husband who has left them. Through MPA we give them an important means of income so they can start a new life, be independent, and feel important once again. When we see the chance to help these people, there are no other thoughts in our heads, but how do we help them have a better life.

How does the pig project makes an impact? Uganda struggles to find a dominate industry throughout the country. The main source of income for everyone is through their own land, whether that is through farming or agriculture. The project works, because it is something for the women to do, and it is relatively easy for them to feed the pig every day. It does not require a degree and does not require much from the fistula patients. This can also be a path for them to gain more and more means of income. They can then be selected to be part of the cow program through MPA. This program can give them a cow which will then produce milk to sell to MADDO or their neighbors, as well as fertilizer to have a successful set of plants to feed their family and sell in the market.

What are the issues here…women’s rights, poverty, poor health care and so on. They can all be aided by helping with this project. The best thing for us to do is find the truth. Making these field visits to some of the people living in poverty in Uganda was a big learning experience. Instead of taking someone else’s word for it, we experienced it first hand. With this knowledge, we can act on it now and feel confident that this is a good project. When we get a chance to find out who lives in poverty and what they need, we have been given a great gift. We can act on that gift and help these women become self sustainable, feel self worth, and live a better life with improved health care.

How to help – If this inspires you to give to the program, click the link to the Piglet Project through MPA and scroll down to where it says piglet program. Each pig and their food costs $200.