Visiting Borama and the Fistula hospital in Somaliland

Fatumo Osman, Sweden

PhD Nurse

It is Friday morning on the 11th of January 2019. It has been a week since I came to Hargeisa, working with our PhD students in Somalia and Somaliland. However, this morning I am so excited to revisit the Fistula hospital in Borama. I woke early to prepare myself and the workshop on mental health I will give to nurses, doctors and female community health workers who work with mental health in Borama. At 2.00 pm. Dr Yakoub picked me up from my hotel, and we travelled to Borama. For the 2 hours drive to Borama, I was thinking about the two days in Borama, and all the fantastic people I will meet who have dedicated their lives to stand up for people who are mentally ill and for women who suffer from fistula.

The fistula hospital in Borama was established by two Somali doctors; Dr Qaws and Dr Walhad who were horrified by the prevalence of obstetric fistula in the country. An obstetric fistula is a hole between the vagina and rectum or bladder. An obstetric fistula can be caused by prolonged obstructed labour, operations or born with it (congenital fistula) that leaves a woman incontinent of urine or faeces or both. Majority of obstetric fistula occurs woman who lives in low-income countries who do not have access to skilled birth attendance. More than 75% of women with obstetric fistula have endured labour that lasted three days or more (www.fistulafoundation.org). Women who have fistulas are often stigmatised by their family and society, and they often live in the most miserable conditions.

The hospital was opened in 2008 and is supported by the Fistula Foundation. The hospital offers free surgery and support to women with fistulas. The patients often travel great distances to get there from regions in Somalia and Somaliland including Banadir, Lower Juba, Middle Juba, Bakool, Hiiraan, Gedo, Galgadud, Bari, Sanag and Togdher.

The first time I came to the fistula hospital was in 2011, and I remember it like it was yesterday. I saw both suffering and hope at the same time. Women who suffered from fistulas for several years but now had hope to go back to their families and live normal lives. I remember when Dr Qaws and Dr Walhad said that they are two Robin Hoods, they work as doctors at the public hospital in the morning, and in the evening they work at their private clinic to support the fistula hospital. The Fistula Foundation supports patients who travel from across the countries to come to the fistula hospital, they assist with medical supplies and provide counselling and livelihood support to the patients.

This time when I come, I met almost 20 women who came from the regions Sanag, Togdher, lower and middle Juba and Bakool. Some of them had undergone surgery three weeks ago, and others were waiting for the operation. Outside the ward, there is a traditional Somali house in which the women go inside and share their stories and worries. The women told me that sharing their stories gave them healing. They also realised that they are not alone with their problems. The traditional house also symbolises a place to leave their worries, each time they finish their story sharing, they go and leave the worries and anxiety there.

In January 2019, when I again visited the fistula hospital the one person I wanted to see was Hoodo. I met Hoodo when I visited the fistula hospital in Borama for the first time. She was around 15 years old, and I was told that she underwent the fistula surgery, but the doctors did not succeed with the operation. Instead, the two doctors who established the fistula hospital decided that she should not go back to her family because of the stigma from the society. I wanted to hear what has happened since last time. When I went to the fistula hospital in 2015, I was told that Hoodo was studying to become a nurse.

It was great to see the beautiful lady Hoodo has become. We greeted each other and went to the traditional house to tell me all about her story. Hoodo told me that she was born with congenital fistula and her family was a nomad family who did not know that she had this problem when she was a baby. But as she grew older they realised that there was a problem as she couldn't control her urine. When Hoodo was seven years old, her family took her to a doctor in the city. The doctor diagnosed her with congenital fistula and told them that it would have been better if they would have brought her in a long time ago. He advised the family to come back when she got older. Her family brought her back to the doctor after a couple of years, and this time the fistula hospital was established. Since then, Hoodo told me that she underwent several surgeries without success. The doctors decided that she could stay in the city to go to school and to learn how to live with her fistula problem. Hoodo said: I am so thankful for the supporting doctor Qaws gave me, he treated me like one of his children and used to comfort me whenever I felt sad whenever I witnessed other patients getting healed and returning to their homes. All the children of the doctors treated me like their sister and used to talk to me. I am thankful for all the support they gave me. Later I went through another surgery, and again the procedure failed, and they said that my problem could only be done abroad.

Hoodo has studied to become a nurse and a midwife at Amoud University. She told me that none of her classmates knew that she had a fistula problem. She did not want to be treated differently. It was a tough time, mainly when she had her internship at the hospital. She needed to go to the bathroom several times, and many of her classmates and colleagues wondered why she was always in the toilet. However, she felt that everybody treated her well. Today she helps the women during the process of surgery until they go back to their families. She knows what these women had gone through and can give them the support they need physically and emotionally.

Hoodo dreams and hopes to be treated and healed. She said: I want to continue with my education, and meanwhile I will try to get help with my fistula problem. I have great hope, and I am thankful for everything I have now.

Hoodo has approved to share her story (Hoodo is called something else).

We at Noora wellbeing Association would love to contribute our knowledge and support the women who suffer from fistulas with rehabilitation and to teach them skills which hopefully will help them cope with difficulties and prepare for possible future problems. You can support us as we work towards this by buying our book Crossing borders – Learning and living together in a colourful world.