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How Trócaire nurses are helping change lives of women with obstetric fistula in Somalia with the support of UNICEF and the FCDO (Foreign, Commonwealth and Development Office)

At 16 years’ old Shimey Abdi was left cradling her stillborn baby son, whom she laboured with at home for five days.

Shimey after surgery at Luuq District Hospital Shimey after surgery at Luuq District Hospital

Due to a lack of healthcare and a long, complicated birth, Shimey developed a tear known as an obstetric fistula. On top of grieving for her son, she was left leaking urine and was shunned by her husband and community.

Now aged 18, Shimey, from Elbo in Luuq district, 70 km from Luuq town, said her experience was “horrific” and she was left feeling “depressed and dejected”.

Shimey married at the tender age of 15, a norm among the Somali community. She conceived her first pregnancy a year later, successfully carrying it to term.

Due to the distance to a health facility, Shimey didn’t have any antenatal check-ups during her pregnancy. She laboured at home for five days and went through a difficult delivery supported by traditional birth attendants. Shimey survived, but her son was stillborn, and the ordeal left her traumatized and in pain.

Two days after giving birth Shimey experienced leakage of urine through her birth canal. She was taken to traditional healers to cure her condition, but in vain. She suffered chronic pain and incontinence and the ability to walk properly.

“My husband was unable to cope with the new reality, and he deserted me, leaving me under the complete care of my parents. I had urine leakage for two years. I couldn’t leave the house, and many community members avoided and even ridiculed me. I couldn’t go near anyone due to the foul urine smell, and it was embarrassing,” Shimey said.

Obstetric fistula is almost entirely preventable, yet it continues to devastate the lives of the world’s most marginalised, impoverished women and girls left leaking urine or faeces. This condition can lead to physical disability and chronic urinary tract infections.

Moreover, those with this condition are often shunned and considered a societal curse and burden. They cannot fend for themselves and are unable to access education. This leads to poverty, compounded with indignity and embarrassment.

Shimey did not seek any medical help for her fistula due to a lack of awareness of existing services for her condition in Somalia. However, in October 2021, a relative heard an advertisement on radio about screening, surgical treatment, and follow-up care for women suffering from a fistula at the Trócaire-run Luuq District Hospital, supported by UNICEF through funding from the Foreign, Commonwealth and Development Office.

At the hospital, Shimey was diagnosed with a vesicovaginal fistulae (VVF), a hole between the bladder and vagina caused by prolonged and obstructed labour. She was scheduled for surgery in November.

Shimey was the first patient to be offered this surgery for fistula repair at Luug hospital and it was a success. She was monitored closely by the doctors and nurses and given a dignity kit to aid her recovery.

She had some difficulty walking post-surgery but physiotherapy helped her recovery. Shimey was nursed in Luuq surgical ward for 14 days.

Now, Shimey has regained her confidence and place in society and is living her life to the fullest.

“We are poor, we have no money to spend on the surgery, so I stayed at home, ashamed of my condition. Today I still can’t believe I no longer have to suffer in shame. My husband left me when I needed him the most. Still, my parents stood by me, and Trócaire came in and restored my dignity without my family facing any financial constraint. I am forever thankful for this life-changing opportunity, not only for me but also for other women,” Shimey said.

The surgeon who worked at the hospital said he is “delighted to be able to reach women most in need”.

“It made a difference in Shimey’s life, and the satisfaction of seeing how happy and content she was certainly made this project and the work that this team carries out truly worthwhile,” the surgeon said.

A total of 52 mothers have benefited from Trocaire’s fistula camp over the last two years. Trócaire uses radio announcements, mobile messaging, and social media platforms to raise awareness around the support available .

Trócaire Somalia Nurse Midwife Coordinator, Habiba Ali Maalim, said
obstetric fistula is almost entirely preventable. And the support of nurses in helping patients recovery is immense.

“Without our dedicated nursing team in Somalia we could not reach and support all of the patients that we do. Today, International Day of Nurses, is a day to celebrate the dedication and impact of our nursing team.” she said.

Trócaire runs all of the health services in south Somalia – an area slightly bigger than the size of Ireland. Key to delivering the services are the committed nurses who work in the five Trócaire health services in the region.

Said Habiba: “Obstetric fistuala dehumanises women and girls who are left leaking urine or faeces. The women and girls who suffer from this condition are often shunned and considered a societal curse and burden.

“With the support of dedicated Trócaire nurses and doctors we are reaching these beautiful women, even if it’s one woman at a time. It has made a difference in Shimey’s life, and seeing how happy and content she is now has was made this project and the work that this team carries out truly worthwhile.”

Obstertic fistulae surgeries are performed at Luuq District Hospital, one of the health facilities supported by UNICEF through funding from the Foreign, Commonwealth and Development Office.

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