Monday, May 23, 2011

The Stench of Ignorance & Neglect.

Her name is Biyana, and she’s 18. Her first child was born naturally, but succumbed to the dreaded ‘one-day-diarrhea’ and died at a year and a half old.

Her second pregnancy brought on four days of excruciating labor pains which ended in a cesarean.     -- The baby didn’t make it.

The scar of that day, marked her body with a keloid an inch and a half wide -- from pelvis to umbilicus. She had a classical incision; and when I asked her why she had to have surgery, she couldn’t answer me.

-- “Didn’t you ask the doctors what happened?” I prodded. 
-- “No.”
-- “Didn’t they explain?”
-- “No,” she repeated with the twisted sucking sound made my Dinkas to indicated a ‘no’. 
-- “I see. So, when did this happen?”
-- “Last July.” 

I continued on with the rest of the prenatal as if such an obstetrical history was normal.
    -- Which, here is.

We discussed LMPs (last menstrual period) and fundal heights (how large her belly was growing for her dates), and I re-assured her that this baby was doing fine. She seemed excited and happy to be pregnant again, but something was off.

Although obviously clean, her clothes smelled strongly of urine. It was overwhelming, and attracting flies.

I waited until the prenatal was almost over before I asked her about it.
-- “Biyana. Did you shower today?”
-- “No. I didn’t.”
-- “Well... Right now, I can smell a lot of urine on your clothes. Do you have urine leaking from your vagina, by any chance?”

Looking at me in muted surprise, she clicked her tongue in response. “Yes.” Click.
-- “Really? Does it come out only when you carry heavy things, or is it all the time?”
-- “All the time,” she said flatly. The lack of emotion in her voice was frightening. 
-- “How long has that been happening?” I enquired.
-- “Since July. It started after my surgery.”

I started counting back months in my head. If it’s May now, that would mean... 10 months!
-- “Really?” I said calmly, trying to keep the desperation out of my voice, “You’ve had urine leaking from your vagina for 10 months?”

She must have thought me stupid for asking such a simple questions over and over again. But she answered me each time I asked.
-- “Yes,” she explained, “In fact, I haven’t urinated since the surgery.”

When my translator gave me this information, I made him repeat himself several times. I couldn’t be hearing what I was hearing. I just couldn’t!
-- “Wh... wha... what do you mean?” I stuttered, “Are you saying you have not urinated at all in 10 months?”
-- “Yes. It just comes out of me all by itself.”

Knowing full well I had some kind of vesico-vaginal fistula on my hands, I called Sarah in to watch and learn. I was fairly confident she hadn’t seen one before.

(For those who don’t know a vesico-vaginal fistula (VVF) is when the wall between the bladder and the vagina is compromised, allowing urine to pass through it unimpeded. If you are interested in learning more about it click here and here.)

Pictures taken from this website.
Then I asked Bisaya if she’d allow me to do a vaginal exam to see if I could identify the size of her hole. She agreed, but seemed a bit confused on the purpose.
    -- Did she think her incontinence was normal? I couldn’t tell.

But in the end, the exam caused more questions than it answered.

Instead of finding a small tear or thinning anterior wall, I encountered a large mass of scar tissue about 6 cm long and 3 cm wide. She writhed in pain as I attempted to feel around it.

Fortunately, I had my trusty translator James by my side and he was able to calm her down and explain what was happening and why. Once she relaxed, I was able to assess it better; but honestly, it had no idea what I was looking for.     --It was a mess in there.

Frankly, from the amount of pain my exam caused her, I’m amazed she even got pregnant. When I asked her if it was just as painful during sex, she clicked her tongue loudly in confirmation.


We talked in depth about going to Wau for a GYN consult, the possibilities of a repair, and whether or not another cesarean might be indicated.

Right now, she is five month pregnant. However, if her pain is that intense during a vaginal exam, how much worse will it be for the birth?      --Lord! How can we help this girl?

She promised to discuss things with her family, but I’m not sure whether or not she’ll go to Wau. She did sound hopeful though. I think, I’m the first person to tell her there might be a solution to this curse. I think she had given up hoping for a way out of the smell of her stigma.

Oh, the stench of ignorance! Imagine not urinating for 10 months!        -- Just imagine.

Imagine not knowing there was a way to fix it.
      --It breaks my heart.

Please pray for Biyana. I will hopefully be seeing her in the coming months. Pray that one day, we’ll get a surgeon out here to repair fistulas in this community. Thanks.