Background
Methods
Study setting
Study design and sampling
Data collection
Data analysis
Results
Respondents’profile
Age in range | Current Marital Status | No of children | Fetal outcome | Years with Fistula | |||||
---|---|---|---|---|---|---|---|---|---|
Married | Divorced/separated | ≥1 | 0 | alive | stillbirth | < 1 yr | 1 yr–5 yr | > 5 yr | |
18–25 | 3 | 1 | 3 | 1 | 1 | 3 | 2 | 2 | 0 |
26–30 | 0 | 4 | 2 | 2 | 1 | 3 | 0 | 4 | 0 |
31–35 | 0 | 2 | 1 | 1 | 0 | 2 | 0 | 0 | 2 |
> 35 | 0 | 1 | 2 | 0 | 0 | 1 | 0 | 0 | 1 |
I. Social experiences
Onset and perceived cause
“Before I went to my mother’s house for delivery,one day morning I felt pushing down and back pain (may be labor). I had that symptom from morning to the following day evening waiting until his [husbands] grandmother comes. She was known in her village for her “skill” in helping laboring woman. When she arrived I was tired and unable to push more. She started to push my abdomen down to help baby come out. She did for several times in between she introduced her hands in but nothing was changed”. (Age 26-30 years, divorced, has no living child).
“As the baby was not delivered and I was getting weaker, she talked something, they discussed among themselves. After a while people came and took me to health center.”(Age 18–25 years,married, has one living child).
“It happened in my first pregnancy, after Ihad labored for two days they took me to health institution, there they (health professionals) inserted an object in to my body to assist birthing and dead baby was born. After some days I had periodic spills that I thought it will improve through time. But it was getting worse from day today.”(Age 19-25 years, married, has alive child).
“…Initially I was feeling that I am the only cursed woman with such problem; therefore I have not told to any one, I always cry, hated myself, and the day I was born. I was broken. But when I see other women with similar problem here (in hospital) I got friends and am slightly consoled.” Another woman responded that “You cannot be against to what has been intended for you at birth; it is all about my fate” (Age 31–35 years, divorced, has no child).
Experience in role and relation ship
“At the beginning my family and neighbors were sympathetic, were advising and helping me. Through time when the problem persisted they started to be distant from me. They do not want to touch thing that I used, my seat and place became separate I am not allowed to sit other than my seat I think that they lost hope at me no one cares about me, I was just living in my mom’s house striving to hide my condition, soaked and washing all the time” (Age 31–35 years, divorced, has one child, lived with fistula for six years).
“…There he (spouse) heard that the baby was not alive then he was not interested to take me back home and I returned to my mother’s house until I recover. On his visit my mother told him my condition and asked him to take me to health center, afterwards he never came back to visit me again…”(Age 26-30 years, separated, lived with fistula for two years and eleven months).
“Four months after he recognized my problem he divorced me. I left my home there and went to my sister’s house found in small town Tselemt. I told her all what happened to me and we planned to work together sharing role, me to make tella and work in house activities and she will sell it (serve) to the customers. In this way we were leading life, later after a year I found difficulty to manage the pain and leak which goes by itself, my body has peeled off then I tend to reduce the activities and becoming dependent on her. It was unpleasant for her to continue with me in such condition since the income is very small. From day to day she complained and insults me that I smell and defaced her house, I detested my fate and left her house and moved to my grandmother’s house in another village…. She (her grandmother) was happy for my going there because she had no child living with her. When she knew my illness she felt miserable and gave me her old cloth. She shared me all what she had and also encouraged me to search for solution.”(Age 26–30, divorced, lived with fistula for three years).
“Since the problem I became disabled I cannot assist him in farm work and unable to make household chores independently as I did before. They (husband’s family) started discussing on me…that their son lacks care and I am no more purposeful as a wife.” (Age 26-30 years, Divorced woman, has no child, lived with the condition for four years).
“…He married me at my young age (17 years). We have one baby, the problem happened on my first delivery I did not knowsuch problem before. I suffered a lot from labor. Thanks to the doctor he saved my baby while I was left with another ‘disease’…..Now he(husband)brought me here to get treatment. He is caring for the baby at home with my mother.”(Age 18–25 years, Married woman, has one child, lived with the condition for five months).
“You cannot sleep comfortably until morning, all the bedding become soaked I have to wake up two to three times in the night to change especially when I was with my husband I worry much to make him unaware of heavy leak”(Age 18–25 years,Married woman, lived with the condition for one year and 9 months).
“I was incapable to do heavy work which requires vigor. This problem made me weak. I spend a lot of my time washing my clothes and self. I used to cook food and clean the house with all the difficulties to save my marriage, but lately I become unable to do so and he become offended and divorced me”(Age 26–30 years,divorced,lived with the condition forthree years and two months).
Experience with income source
"As I left my home I was working on (AbaTesfhager’s’ 1 ) (a neighbor of her natal family) farm for weeding. He gives me cereal (barley) and sometimes I used to sell that to get money (birr) for my expenses”.(Age 19–25 years, divorced, lived with condition for five years).
“Before the problem I was selling ‘tella’ [local drink], also continued after my illness but when my condition became recognized….no one was coming to my house….now I stopped it. Whenhe (husband) left me….I went to my mother’shometo live with….”(Age 26–30 years, divorced, lived with condition for four years).
"I was roasting maize/barley for a woman who prepares “tella” for sell every week. She will give me on the day I complete the work, I will use that for soap, underwear and sometimes for salt and coffee.(Age 26–30 years, separated,lived with condition for two years and11 months).
Coping with the incontinence
“It is miserable, distressing life and I prefer dying rather than living in such painful life…. Ehh (breaths deeply) my condition is the worst. I was repaired for the first fistula which happened during my first delivery. The problem recurred after two years. I have no good time since this problem. Just crying, hating my being. I came on appointment, for this relapse I was repaired twice and the urine flow became worsen I lost hope and was tried to kill myself (commit suicide).”(Age 31–35 years, Divorced, lived with for seven years).
“I do not want to stand around or sit aside any body. You see I would have to kept all my suffering inside, other than my family if someone in my village had known my condition;It was very shameful for meand it was better to die rather than being in that condition.” (Age 18–25 years, divorced, has no child, lived with condition for five years).
“Iwore ugly ‘dirty’ clothes that does not expose the sign of urine and mystify my condition” (Age 26–30 years, divorced, lived with condition for three years).
“…mostly I won’t go out, if I should, I wear a black dress or wrap my waist with another sheet….” (Age 18–25 years, married, lived with condition for three months).
“The urine pours without stopping, I use piece of clothes as a pad to protect my cloth from getting wet easily. I have to wash and change it repeatedly unless the smell is so humiliating, I will soak all the pieces at day time and wash when they sleep, the problem is you could not get private place to dry all the pieces mainly in rainy season it will not dry easily. So I will hang up it over“Tunjit”(a kind of herb with good smell) smoke.”(Age 26–30 years, divorced, lived with condition three years and two months).
“At home, when the piece of cloth in my pants irritates me I will remove and let the urine flow, but this also cause itching and sores on my thigh.” (Age18–25 years,lived with condition for five months).
“Since this ‘disease’,I go to church too early and return before people come together……..the smell is so humiliating, thus I do not want to sit with people in a closed area (where there is no free air movement). Because though I feel clean, those who know my condition pretend to cover their nose ….”(Age 18–25 years,lived with condition for one year and 9 months).
“It is disgraceful disease which turns a clean woman to insanitary. When I go for invitations like ‘mahiber’ [a kind of religious social gathering, ceremony], I putpieces of old cloth in my pants for adequate protection until I return.”(Age 26–30 years, divorced, lived with condition for four years).
“In funerals, where absence leads to family exclusion I will put on another cloth to cover the stain”(Age 26–30 years, lived with condition for two years and eleven months).
“After two years of the problem I decided not to take fluid as I should. Especially I avoided hot drinks like coffee to minimize the flow but I the change was minimal. Rather the urine burned my thighs again I started to take more water….I reduce water intake when I have outdoor activities”(Age 43 years,divorced, lived with the problem for more than nine years).
Awareness and use of service
“I have never seen or heard of such disease before, and did not think it could be treatable so I take care not to be identified in the community, after years I am bored of my condition and went to health center to know the case in order to decide on my life. However they assured me that the problem is treatable and gave me a letter to go to Gondar [the place where the Fistula Treatment Center is found].” (Age 26–30 years, divorced, lived with condition for three years).
“I was applying green paste on my thigh, that local healer has given me to relief pain and heal the sores. It was very helpful……I met my old friend coming from town (Gondar)….I discussed all my problem with her thinking that if incase she can help me in money to pay for….she told me that government is treating women of similar problem and gave me few birrand her contact to call her when I go there… therefore I am encouraged and decided to come herefor getting relief”(Age 31–35 years, divorced,lived with the condition for six years).
“Though I have heard of service availability I could not go as soon as I then my baby was only seven months. What will be fed to such baby? To whom do I could leave my child to care for at home? I do not have mother or sister. So I had to stay until he (the baby) able to feed other than breast milk…” (Age 18–25 years, married, lived with the condition for one year and nine months.
“…the woman (our neighbor working in kebele) has taken me to Woreda(district) women’s affairs office; we heard that the Ambulance service is free for people like me. She sent me to health center. Again they sent me here [treatment center]. If I had not got theses service how would I reach here? I may remain there until I get sufficient money or would have dead. Here, they helped me a lot, offered me a bed and food. No problem of water for bathing and washing.I saw the doctors [most people coming to hospitalcall every health professional ‘doctor’] arevery caring”.(Age 26–30 years, divorced,lived with condition for 4 years).
“In my attempt to commit suicide my uncle who was living in Addis has heard of my condition and took me to hospital there,I found women with similar problem. I was stayed there for two months, got treatment and becameable to control the feces (bowel symptom) but not the urine flow. They advised me to return to Bahir Dar or Addis Ababa another time for the urine leak. In between I heard that Gondar has been giving the service and I came here” (Age 31–35 years, divorced, 7 years with condition).