Man Crying

A 47 year old who is a furniture dealer at Nairobi’s Gikomba market suffers from Rectocutaneous fistula.

His is an abnormal communication between the rectum and the peri-rectal skin, may be as a result of trauma, pelvic fracture, rectal foreign body, para-rectal abscess or surgery. Faecal material may be discharged through the skin or wound.

He was set to see a doctor on July 6 as the last time he was treated at Mama Lucy Kibaki hospital, the same did not heal causing further complications.

His report from the doctor read that “there is an approximately 3 cm long fistula with an opening at the anal mucosa opening onto the right perineal skin”

James says even though his wife has been supportive all through, the condition has seriously affected his livelihood. His mobility he says is constrained and most of the nights he lacks sleep and lays awake till the crack of dawn.

“As we speak right now, my inner pants are already soiled with pus. I can feel the wetness and it makes me feel very uncomfortable. i cannot place a bandage to ease the pus from coming out because i will have worse difficulties in moving around. There is nothing I can do for now except wait for treatment and pray to God that I be healed of this disease,” he says

According to Doctor Ondede, Fistula is simply a connection or tract, an opening between a hollow organ and the outside, that is the skin. Take for instance the hollow organ in this case to be the rectum and the anal canal distally and the skin on the outside.

“Whenever a patient develops a complication that will lead to an abnormal communication between the rectum and the surrounding skin so that you end up with two openings the normal anal opening and the abnormal opening of the skin that is known as a fistula,”he said.

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James further informs me that whenever he feels like farting but decides to hold it, the same air comes out through the 3 cm opening.

“That really scares me. I am agonized. I have never seen such a condition I always ask myself what is this I am suffering from,” he says.

Dr. Ondede points out that the sphincter is the one that helps in holding the urge to pass gas/wind in public settings. It also acts as a Sensor. When a sphincter is damaged, a patient can loose the ability to control stool.

“Between the outside and the inside of the rectum there is what is called a sphincter which is like a valve which controls stool and gas. One can sense if what is going to be passed out is either solid stool or diarrhea with solid stool you can wait but with diarrhea you can’t. When these openings open on the inside not the outside below the sphincter they are known as simple cutaneous fistulas,” said the doctor.

Fistulas he added are divided into different categories which helps in the management of patients. They can be simple if made up of only one route of communication between in the inside of the rectum and the skin. However when there are multiple openings unto the surface of the skin this is known as a complex fistula. More often than not complex fistulas are as a result of other issues other than simple infection such as diseases surrounding the anal canal it can lead to opening both inside and outside of the anal opening with multiple tracks coming down.

Another cause for complex fistulas is abscess which is a collection of pus. One can have an abscess adjacent to the rectum and when it opens out to the outside you might find it has opened several channels outside which are also connected to the interior. Foreign bodies are also causative factors in complex fistulas. Injuries from grenades, gunshots,metals or even a stick as a result of a fall more often than not one is likely to have a complex fistula. A Complex Fistula becomes hard to manage because now you are dealing with multiple openings.

Dr. Ondede observed that there is no clear cut that certain types of fistulas are more common in men than women. The simple and complex types of fistulas are in both sexes leave alone birth fistulas which are in women.

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He added that although the men tend to have a larger share reason being men get infection around the anal region, diarrhea, hemorrhoids, fissures and the fact that men sit on their problems much longer than women so they complicate and end up in such situation.

Ondede who began practicing as a surgeon back in 2009 has handled at-least 200 cases of fistulas in male patients. He opined the reason as to why the cases of men with fistulas not being highlighted is that the girl child has been given much more attention and also a number of men are not willing to speak up about the problem they are facing. He urged the men to not be afraid and come out and seek treatment before the situation worsens.

Kenyatta Hospital has in the past three weeks been conducting a free fistula camp mainly for women. The free fistula camp is part of a three year Kshs. 114 million Safaricom Foundation, Flying Doctors Society of Africa and Freedom from Fistula Foundation-Kenya grant towards various interventions for women living with obstetric fistula.

As the camp came to a close, over 400 women were attended to with 91 surgeries performed in an ongoing two-week free fistula camp at the Kenyatta National Hospital.

Joseph Ogutu Chairman Safaricom Foundation said part of the funding will also go towards training 20 specialists, 20 anaesthetists and 40 nurses on fistula management while enhancing their capacity to handle the condition in seven hospitals. The free fistula camps will also be replicated across various counties as 119 are admitted in KNH awaiting surgeries.

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James was among the men who rushed to Kenyatta National Hospital on June 16 when he heard there will be a shs 12 million Fistula campaign. To his surprise, he was informed that the campaign had been set aside for women and some 200 women living with Obstetric Fistula would benefit from the free fistula surgeries.

“I was saddened as I had already set in my mind that I would benefit from the free fistula camp. I simply urge the government and hospital institutions to also provide the same for men suffering from this condition. Some of us are not afraid of coming out,” he said.

The World Health Organization has termed fistula “the single most dramatic aftermath of neglected childbirth” estimating that more than 2 million women live with fistula worldwide.

Fistula he said is not a woman only condition but it is in both men and women only that the common Vesicovagina fistulas (VVF) are fistulas in women which are birth related.

A 47-year-old refugee woman from Burundi was among the patients who received treatment and underwent re-constructive surgery at KNH. The mother of six was dragged, raped and foreign objects inserted inside her vagina in her war-torn country back in 2014.

Hope (not her real name) is one of the many Burundian refugees who have sought refuge in Kenya, when protests against President Pierre Nkurunziza’s bid for a third term were violently repressed by pro-government forces. The Burundian civil war was an armed conflict lasting from 1993 to 2006.

When she was dragged, she was with her husband, who was stabbed in the stomach but managed to survive.

This is the second time the woman will be undergoing surgery after the first one failed.

Hope appears devastated and bitter with what happened to her. She has been wearing pampers for the past three years.

“I am constantly leaking urine as my organs down there have raptured. I have to wear pampers every day, which costs me a lot of money. I’m pained by what I have to go through as it has changed my lifestyle completely. There are bad people out there. But I chose to forgive them,” she said.

Hope uses five pampers daily. Her children, she says, have also been affected by what she has to endure daily.