Coping with a Disruptive Life Caused by Obstetric Fistula: Perspectives from Malawian Women
Abstract
:1. Introduction
2. Methods
2.1. Data Analysis
2.2. Ethical Consideration
3. Results
3.1. Participants’ Characteristics
3.2. Advent of A ‘New Normal’
3.2.1. Managing Urine/Fecal Leakage Throughout All Facets of Life
3.2.2. Containing and Concealing Urine and/or Fecal Leakage
“I found a plastic paper, made holes on it, one on each side. Then, I took the paper and put some strings on each side, so I would put on a cloth pad and then put on that paper under it. So if the paper does not leak, I would stay well. And some people did not even know that I get wet.”(Nabiyeni, 57 years, para 2, 21 years with urinary incontinence)
“Urine just comes on its own, and sometimes when I want to defecate, feces come out through my vagina, and sometimes through my anus. But I see that it has recently changed, it is not as heavy as before. So I just put on a cloth pad on my underwear, wear a half petticoat, a skirt, and on top of that a Chitenje (wrapper). So I could walk freely without people noticing that I get wet.”(Nanyoni, 20 years old, para 1, 4 months living with urinary and fecal incontinence)
While Traveling
“When I am travelling long distances, I carry spare cloth pads in my handbag.”(Namaisa, 36 years old, para 2, 15 years living with fistula)
While Having Sex
“So where I sleep I spread a plastic sheet first and then a mat, and on top of the mat a cloth to lie on. … we can have sex without any problem, but when he withdraws, that is the moment I make sure that the pieces of cloths are under my buttocks to collect the urine, so that urine does not soak through to the mat.”(Nasiketi 33, para 3, 12 years with urinary incontinence)
“The time we used to have sex it was a problem, I had to dry myself with a cloth every now and then for it to happen. The cloth I used to dry myself would be so wet, but we would do it anyway, really.”(Nachanza, 41 years old, para 8, 19 years with urinary incontinence)
“… he could just do it outside, did not enter me, but he did not complain about anything. I guess the only difference was when he was with his other wife that he would compare the satisfaction, but he never expressed dissatisfaction.”(Nabiyeni, 57 years old, para 2, 21 years with urinary incontinence)
“When I developed this problem, and was divorced, my plan was to stay alone for a while without a man. Because I was thinking that, maybe the problem is worsening because of being with a man (having sex), really.”(Nasikelo, 32 years old, para 1, 12 years with urinary incontinence)
While Sleeping
“My mother would spread out sand on the floor, and then she would put the mat on top of the sand. Then I would sleep on top of that mat. She did this to control the flow of the urine, to prevent it from spreading out to a great area. She would even run out of ideas and reach the extent of digging a small hole in my room, and I would put my buttocks on that hole, so that the water drains in the hole.”(Nasawa, 52 years old, 27 years with urinary incontinence)
“When the urine was so profuse, my aunt would make a cloth wreathe for me to place my bottom on. She would wreathe the cloth and have me sit on it and I’d sit on it and sleep. When that one is soaked, she would take it the following day and go wash it, and make another one for me.”(Nabiyeni, 57 years, para 2, 21 years with urinary incontinence). See Figure 3 below, for example.
While Farming
“When I go to the field to clear and till my field, I did not bother about it (leakage). I could do my hoeing; “let it leak, I don’t care, as long as I do my work.”(Nadzimbiri 37, para 5, 12 years with urinary incontinence)
3.3. Restricting the Flow
“If I want to go to church the following morning, I avoid all the eating and drinking even when l feel hungry; I control myself. So when I do not eat or drink, the leaking is minimal, it just drips little by little. But the problem is that the urine is so hot and painful, but all the same, I manage to travel a long distance and come back without any problem.”(Nadzimbiri, 37 years old, para 5, 12 years with urinary incontinence)
“(laughing)... I would sit like this, [crisscrossing her legs] then after sometime I would get up and go somewhere, where I would just spread my legs and let go.”(Namoyo, 16 years old, para 1, 1 year with urinary incontinence)
3.4. Managing the Odor
“I always sit following the direction of wind, so that the smell blows away from the rest of the people.”(Nalike, age unknown, para 6, 4 years with urinary incontinence)
3.5. Managing Sores Caused by Urine Leakage
“… I would apply body lotion on the sores, lock the door, and lie on my back, with my legs flexed and spread like this [lying on her back and flexing and spreading her legs in demonstration] I would spend the whole day, sometimes two or three days, indoors, naked. If people asked about me, my sister would just tell them that ‘Don’t worry she is around, but is busy’.”(Nadzimbiri, 37 years, para 5, 12 years with urinary incontinence)
“…There are times when I pass out hot water [urine] and sometimes cold water [urine]. When I pass out hot water, I don’t feel well, and that means I have to bath frequently in cold water to ease the discomfort.”(Nasibeko, 32 years, para 6, 16 years with urinary incontinence)
“When they [sores] start itching, I would take water and pour on them, but when water is not available, then I would just continue scratching, but in the end it will be fire of sores. Ii! It was very pathetic, my friend, it was such suffering, especially the itching, ii! You had to scratch and scratch, until blood came out, and that meant sores. Now when I came here [Bwaila hospital], they give us skin protection cream. I wish they gave me that protection cream back at our health center, I wouldn’t have had those sores.”(Nabiyeni, 57 years, para 2, 21 years with urinary incontinence)
“To manage them (sores) I would buy the yellow and red capsule and put the powder contents on the sores; so painful! I would also use some herbs found in our area they call it chamasala, also very painful. You get better two, three days, and they reappear again, iii! No peace at all, no peace. It is slavery.”(Nasawa, 52 years, para 2, 27 years with urinary incontinence)
“When I develop sores, I would apply white maize flour on the sores. And I will just be staying in the house, not going out. I would not put on any pads or underwear. I will just let the urine flow freely. Because cloth pads also cut on your skin and worsen the sores…”(Nasiketi, 33 years old, para 3, 12 years with incontinence)
3.6. Emotional-Focused Coping
3.6.1. Spouse and Family Support as Source of Encouragement
“My relatives loved me. For example, among my relatives, there was no one who spoke ill of my condition. People from my husband’s side would say, “This is just a disease. After all, when she was coming here, we did not know that she would end up like this.”(Namaisa, 36 years, para 2, 15 years with urinary incontinence)
3.6.2. Child Rearing as a Source of Motivation
“…When I think about my condition, and again, when I look at my children…I say, “What of my children? And that encourages me.”(Nasiketi, 33 years, para 3, 12 years with urinary incontinence)
3.6.3. Having Faith in God as a source of Encouragement
“At first, I was broken hearted, because it was my first pregnancy. I was worried and wondering what my future would be like. But God has a way of consoling people’s hearts and giving them strength, and so he strengthened me. As time went by I accepted my condition, that ‘What has happened, has happened, let it be.’ So, I was just staying like that.”(Namaisa, 36 years old, para 2, 15 years living with fistula)
“I told my friends at our catholic women organization’s gatherings about my condition, and they told me that they would be praying for me, and they were indeed praying for me, and that encouraged me.”(Nabanda, 55 years, para 4, 21 years with urinary incontinence)
4. Discussion
4.1. Problem-Focused Coping
4.1.1. Containing and Concealing Urine and/or Fecal Leakage
4.1.2. Concealing Leakage
4.1.3. Restricting Urine and or Fecal Leakage
4.1.4. Preventing and Treating Sores from Urine and or Fecal Leakage
4.2. Emotional-Focused Coping
4.2.1. Spouse and Family Support
4.2.2. Having Faith in God as a Source of Encouragement
4.2.3. Children Rearing as a Source of Motivation
4.3. Study Strength and Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Share and Cite
Changole, J.; Thorsen, V.; Trovik, J.; Kafulafula, U.; Sundby, J. Coping with a Disruptive Life Caused by Obstetric Fistula: Perspectives from Malawian Women. Int. J. Environ. Res. Public Health 2019, 16, 3092. https://doi.org/10.3390/ijerph16173092
Changole J, Thorsen V, Trovik J, Kafulafula U, Sundby J. Coping with a Disruptive Life Caused by Obstetric Fistula: Perspectives from Malawian Women. International Journal of Environmental Research and Public Health. 2019; 16(17):3092. https://doi.org/10.3390/ijerph16173092
Chicago/Turabian StyleChangole, Josephine, Viva Thorsen, Jone Trovik, Ursula Kafulafula, and Johanne Sundby. 2019. "Coping with a Disruptive Life Caused by Obstetric Fistula: Perspectives from Malawian Women" International Journal of Environmental Research and Public Health 16, no. 17: 3092. https://doi.org/10.3390/ijerph16173092