September is National Suicide Prevention Month and a time to remember those living with depression.
 
September 2024 marks six years since Kathi Gutierrez and I conducted our first recorded interviews with fistula survivors. I had been involved with Dignity:Liberia since 2012, and had spent time with survivors: singing with them, learning some of the trade skills they were taught, helping them with a reading class, and doing crafts. I also watched as they danced joyously and showed them pictures of my family and pets. I understood on an intellectual level that an obstetric fistula causes constant leaking of urine or feces (sometimes both), but I had never asked how their injury made them feel.
 
By asking probing questions such as “how did this [fistula] happen?” and “what makes it hard,” I finally felt in my heart, the pain caused by the peepee poopoo disease. I did not realize that most survivors had delivered stillborn babies and that they had had hysterectomies due to tissue damage. Their responses, some delivered with downcast eyes, helped me understand that some were smiling to mask their pain, while others were smiling because they had found joy at knowing they weren’t alone. We spoke with 12 survivors who opened up about the injury that had caused them so much pain and shame.
 
Their stories were very similar. Constantly leaking urine, Beatrice cried all the time and washed frequently. Only her mother knew about her fistula because she was ashamed. Another survivor told us that before having her fistula repaired, she had to change her clothes 9 or 10 times a day. Yet another told us that even with in a supporting environment, there was a temptation to commit suicide.
 
Fanta told us that during her labor, a traditional tribal midwife tried unsuccessfully to force the birthing process. When they finally took her to the hospital, her baby had already died. Helena told us she would encourage friends to go to the hospital to give birth. Similarly, Hawa would advise her pregnant friends to have their baby in a hospital or clinic.
 
Dignity:Liberia’s maternity waiting home, House of Hope and Dignity will allow Helena and Hawa’s friends to do that. The home is on the cusp of becoming operational. However, we are raising funds for an ambulance, which we are required to have before we can open. Per Dr. John Mulbah, a world-renowned OB/Gyn in the area of obstetric fistula, the injury is preventable with such a home and medical care. It will be a game changer!
 
We are so grateful to all of you who have stayed with us on this journey. It has been longer than hoped and your companionship means a lot. It helps to know that you are supporting our efforts to fight depression and end suicidal thoughts brought on by this avoidable injury!
 
Click on this link if you would like to hear the fistula survivors’ stories. 

For several months I have written about the progress of the maternity waiting home project, House of Hope and Dignity, and about those involved in its design and construction.  This month’s blog introduces you to two young ladies whose hopes were put on hold as they dealt with hardships caused by obstetric fistula.  In October 2021, Mercy Benson and Jumah Fahnbulleh candidly spoke to Dignity:Liberia about their experiences with obstetric fistula.  Both still had their fistulas at that time.  Jumah has since improved and Mercy is now dry.  
 
Mercy Benson is from Bomi County, Liberia.  A high school graduate, she works as a Lab Assistant at a construction lab.  At the Phebe Rehab Center, she learned how to make soap and to bake.  She has two girls ages eleven, and nine-months at the time of the interview.  She got her fistula when her younger daughter was born.   
Jumah Fahnbulleh is 25 years old and comes from Grand Cape Mount County.  She also learned how to bake and make soap at the Phebe Rehab Center.  She wants to be a nurse.  She has two children.  Her sister is caring for them, while she goes through her fistula repair surgeries and rehabilitation.  When interviewed, her children were six and seven years of age.  Her baby did not live.  She had lived with her fistula for a year and three months.  She had two surgeries to repair the “toileting” (leaking feces) and was scheduled to have another in November to repair the “pee pee” problem (leaking urine).   
 
In this four-minute video, you will hear these young ladies’ stories in their own words.  Please consider making a donation toward Dignity:Liberia’s efforts to prevent other Liberians from experiencing fistula.  Thank you.   

Fistula Survivor’s Name:  Albertha Zerinsaye       
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Twenty-year-old Albertha Zerinsaye is from Nimba County.  She has 5 sisters and 1 brother (some of her siblings have different mothers).  She speaks Mano.  She wants to tell God thank you for the help you’ve been giving to us. 
 
Albertha was in labor for one day, but the child was too large to be born vaginally.  She went to E&J Hospital in Ganta where she had a C-Section.  The baby did not live.  The next day, she started pee-peeing on herself.  She has no other children. 
 
She has had her fistula for four years.  She has had 4 fistula-repair surgeries but she is not dry.  Her most recent surgery was during the second fistula campaign in January 2020. 
 
She learned cosmetology at the Phebe Rehab Center.  She also learned soap making, tie-dye, and bread-making.  When she gets her materials, she can go into business.  She plans to return to Nimba, where will live with her parents.
 
When she came down with fistula, she and her boyfriend were together, but he left her when he found out about her fistula.  She felt bad and thought she was the only one who had this sickness.  She cried every day and stayed at the house.  She went to Ganta Methodist Hospital where a doctor told her they had a training center in Gbarnga.  When she came here (the Rehab Center), she made friends and is happy now.   
 
She would tell a pregnant friend that when she is in pain (in labor), she should not go to a midwife (tribal birth attendant) but should go to a hospital to give birth because the midwife will cause the problem (fistula). 
 
When she goes home, she will not be dependent on anyone because she has learned plenty of things at Rehab and she is able to take care of herself. 
 
Albertha Zerinsaye is a fistula survivor.  Hear her story in her own words.

Fistula Survivor’s Name:  Rebecca Garyozon        
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Rebecca Garyozon was born in Grand Bassa County.  Now 23, she recalls playing football (soccer) and kickball as a child.  She has one brother and six sisters.  They help their mom around the house.  Rebecca helps with cooking and cleaning. 
 
She speaks only English – no dialect.  She’s been through the 8th grade and would like to go back to school.  Her favorite topic was Social Studies.   
 
Rebecca got her fistula through childbirth.  She was in pain (labor) for one week.  Her mother took her to a country midwife (no medical training).  They “try, try,” but "the baby never came outside" (the baby was stuck). Then she took her to JFK [Hospital], where they performed a C-Section (“did the operation”).  When she went home, she started experiencing the pee pee coming down on her.
 
Having a fistula made her feel bad.  It made her to not go around her friends and made her stay in her house.  Her mom supported her, helping her stay clean.  Her friends didn’t stay with her. They avoided her.  Rebecca told me, “she go far away from me.”  She’s had one fistula repair surgery and is dry. 
 
She learned baking and soap making at the Phebe Rehab Center.  She prefers making soap, which she plans to sell.  She will go back to Red Light and sell things in the market.
 
She would advise someone in labor to go to straight to the hospital.  If she had a friend with fistula, she would support her.  The friends at Rehab are good friends.
 
Rebecca is a fistula survivor.  Hear her story in her own voice: 

Fistula Survivor’s Name:  Linda Kumah
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Linda Kumah and I had a bit of trouble understanding each other, but with laughter and repetition, we were successful in communicating.  Linda is from Sinoe County.  She has six sisters and five brothers by the same ma and same pa.  Linda’s favorite color is blue.  I asked her to say something in her dialect, Krahn.  Afterward, she translated that she is grateful to God for making her well.  She said she wants to go back to her people and to be happy.  
 
She got her fistula on March 15, 2019, after being in labor for three days, the baby died in her womb and was surgically removed at the Greenville Hospital (F.J. Grant Memorial Hospital, in Greenville).  She has no other children.   
 
The doctor advised her to go to Bong County so she could get well.  Her grandma and her pa took her.  She learned how to bake at the Rehab Center.  She wants to go back to her people in Sinoe County, where she will open a shop and bake bread to earn a living. 
 
When she had her fistula, she had to clean her clothes a lot, but she is dry now, after only one fistula repair surgery.  She would tell her friends to go to the hospital when they’re in pain (labor). 
 
When I asked her what she could tell me about herself, she replied that she can’t give birth by herself, and thanked God for her health.
 
Linda Kumah is a fistula survivor.  Hear her story in her own voice: 

Fistula Survivor’s Name:  Susan Dwanah
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Susan Dwanah is from Bopolu.  Her favorite color is pink.  She is the oldest child (the first) in her family.  She is 22.  She doesn’t know the ages of her 2 brothers and 1 sister.  Susan has no children. 
 
I sensed a lot of pain and reluctance to talk about her experience.  At one point during the interview, I felt compelled to tell her she should not be ashamed.  She has a sickness.  She has a lovely smile and laughed when we joked about her doing my hair and when I showed off my limited Kpelle. 
 
Susan was in pain (in labor) for 3 days.  Then “they were on her” and she got the pee pee problem (fistula).  She had a C-section to remove the baby who was stillborn. 
 
Emma Katakpah explained that Susan was assessed for surgery in December 2019, during the fistula campaign.  Her fistula is all the way to the bone, so it will require a special surgery.  It’s a very difficult surgery.  So, she is still on a waiting list to have her fistula repaired and she is still leaking.  She has been leaking since 2018.
 
Susan had been at Rehab for a month at the time of the interview.  Unfortunately, she hasn’t learned a trade because there is no material available.  The Rehab Center has run out of material.  Susan is hoping that they will be able to get things so she will be able to practice.  She wants to learn cosmetology and plait hair.  She can do some now.  The other girls who are at Rehab, had completed their courses and were only awaiting graduation.  When Susan goes back home, she wants to fix a place to do her business.
 
The fistula makes her feel bad.  Her grandmother is at Rehab with her.  Her former friends have abandoned her, but she has made new friends at Rehab.  They play ball together.     
 
Susan would tell pregnant women to go to the doctor so they would not get fistula.  They shouldn’t stay in the village.  They shouldn’t go behind the house 
 
Although not yet healed, Susan is a fistula survivor.  Hear her story in her own voice: 

Fistula Survivor’s Name:  Wilhelmina Davis
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Wilhelmina Davis is from Grand Gedeh County.  She told me “thank you, God will bless you,” in Krahn, her dialect.  She has five brothers and three sisters.  She has four children of her own.  Her oldest is 18.  Her next child is 12.  The third one is 10.  Her fourth child is 7.  They are all four boys.  Her youngest had been living in Grand Gedeh County, but she sent for him to join her at the Rehab Center.  Wilhelmina is 35 and has not been to school.  Her favorite color is blue
 
She got her fistula from going to the bush to give birth (giving birth at home).  The pain grabbed her (she was in labor), but those assisting with her delivery did not want to wait. They asked her how many hours she had been in labor.  They did not want to listen to her.  They were trying to force delivery by hauling the child (pulling on the baby).  The people said that something was coming from underneath her so they took her to Redemption [Hospital].  They gave her some medicine and sent her home.  She went to Dr. Mulbah’s clinic and he said she had a fistula. 
 
Dr. Mulbah repaired her fistula.  Dr. Mabry did a follow-up examination for some residual incontinence, but she said Wilhelmina no longer has a fistula.  She said she would be okay.  Wilhemina still leaks small small (a little bit).
 
She was feeling bad when she had her fistula.  Her big sister didn’t want her to feel bad.  She didn’t want her to be worrying.  She would hold her and talk to her.  She assured her that God would be with her and that God would help her. 
 
But her boyfriend didn’t have time for her since she had her fistula.  Since she was in Monrovia, he wouldn’t even call her.  Her sister was the one that took care of her.  She didn’t do anything to make her feel bad.  Whatever she wanted; her sister would do for her.  She gave her support.  She told her to come to the Rehab Center to learn a trade.
 
Her friends wouldn’t come around.  She couldn’t tell them her secret.  Because when you tell your secret, they’ll be “carrying your name around” (gossiping) so she’s got no friends.  She just kept quiet about it.  She said “My stomach is feeling all right.”  No one besides her sister knew of her problem (fistula), because if you explain your problem they’ll be “carrying your name all around.” 
 
She learned tailoring, soap making, and bread making.  But there hasn’t been any material for a year now.  She’s been at Rehab for one year.  She wants to go home.  She wants to fix soap and bread to sell for money so she can send her son to school.  She would be supporting her children. 
 
She would tell a pregnant friend to go to Phebe Hospital to wait until your time is reached [you’re ready to deliver].  If you’re pregnant go to the hospital to deliver safely to avoid getting a fistula.
 
Wilhelmina is a fistula survivor.  Hear her story in her own voice.

Fistula Survivor’s Name:  Mammie Davids
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Mammie Davids is from Nimba County.  She is 26 years old and is not married.  The second child born to her parents, she has one brother and five sisters.  When she was a little girl, they played kickball. 
 
She got her fistula in 2006.  After two years of leaking, she had a fistula repair operation.  She has had three operations to repair the fistula because of a recurrence, but she is dry now.  She was in pain (labor) for two days.  She was in Monrovia on GSA road.  The child (baby) was big, so she couldn’t deliver on her own.  They took her to the James Davis Hospital.  She had a C-section (the child operation) and came down with a fistula.  The baby died.  She has five girls.  Her first child was born in 2003 and the last in 2010.  Currently they live in Monrovia with her brother, who is taking care of them while she is at the Rehab Center.  Their father lives in Nimba. 
 
She and her boyfriend are not together now and her family doesn’t want to see him.  Her brothers and sisters have stuck by her.  When I asked what was hard about having a fistula, Mammie said that her boyfriend abandoning her made her sad.  When she went into labor, he cut himself off from her.  He would not come to the house, so her people got vexed (angry) and her family told her not to be with him.   
 
When she had the sickness (her fistula), she had to spend the whole day washing her clothes by herself.  She is dry now.  She is not experiencing anything anymore so she tells God thank you.
 
She said having a fistula “opened her brain,” (opened her eyes) because her boyfriend was bossing her around in Monrovia so she tells God thank you for opening her brain.  Fistula taught her tailoring, fistula taught her tie-dying, fistula taught her [could not understand], fistula taught her soap-making.  She can do everything now.  Her favorite is tailoring.   
 
She sees tailoring as her future.  When she leaves the Rehab Center, she and her children will survive on it.  She is building her own house.  At the time of the interview, it had reached roof-level.  When her house is finished, she will have her shop attached to it.  She will be able to conduct business from the house.  Her children can be home while she does tailoring and sells her clothes.
 
She likes to sing and dance.  She composed the words to a song that she sang for us in her beautiful voice.  Some of the lyrics are:
 
No money can buy your salvation
No man can do it for you
Your family member can’t do it for you beside God
You must be baptized and be born again
I fear no man by the grace of God
 
Mammie is a fistula survivor.  Hear her story in her own voice:

Fistula Survivor’s Name:  Fatu Moore
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 

Fatu Moore grew up in Chebiah with three brothers and three sisters.  She stopped attending school in the 8th grade.  I asked her to say something in Gola, her dialect.  She told me: “Hello.  How are you coming on? I tell God thank you.”  She is 20 years old
.
Fatu was in pain (in labor) for one week.  They took her to Tubmanville Hospital where she was told she was having “slow pain,” (pressure, not true labor) so she returned home.  When she started progressing, the TTM (Traditional Tribal Midwife) thought she had it under control but didn’t recognize when the baby got stuck.  By the time Fatu got back to the hospital, the baby had already died and they had to cut her open.  Her stomach started getting big so they took her back to the hospital where she was told her womb was damaged.  Following a second surgery, she came down with fistula. 
 
She had fistula since January 2019 until December when she had her fistula repair surgery.  She is not dry but is just leaking at night.  She will need another operation. * 

Fatu had both RVF (rectovaginal fistula), which was repaired in December, and VVF (vesicovaginal fistula) which will be repaired next.  She still experiences leakage in the night but she has panties (Depends) to stop the leakage.

Fistula makes her feel bad and lonely.  And she feels discouraged.  Her friends won’t come around her.  Some of her family are with her but some are embarrassed by her situation. 

She has learned how to make soap and bread, but there are no starter kits.  [Note: a starter kit would include the supplies needed to go into business.  Previously these were provided to Rehab Center graduates.]  So, despite learning a trade, she will stay at the Rehab Center.  When she does leave the Rehab Center, she hopes to keep making bread and soap in order to survive. 
 
She will tell her friends don’t allow any midwife (TTM) to screw you - to give birth by yourself.  If the doctor says you are not able [to give birth by yourself], please go to the hospital.  And the TTM shouldn’t allow you to give birth without assistance (to “born the baby by yourself if don’t able to born it by yourself”).  Fatu said you should go to the hospital and not just assume a doctor will make a mistake.   
 
She was in slow pain (feeling pressure) and was crying for the whole week. The fetus had already died.  She has no other children.
 
When she leaves the Phebe Rehab Center, she wants to be a student.  She likes Social Studies.   

Fatu is a fistula survivor.  Hear her story in her own voice.

*ADDITIONAL INFORMATION:
Because Fatu had both RVF and VVF, she will have to have multiple surgeries.  The rectal fistula is repaired first so as not to cross contaminate with stool, the vaginal surgery.  She also needed a colostomy bag.  Just prior to my leaving for Liberia, a friend donated some stoma bags to Dignity:Liberia.  We left those for Fatu.

Fistula Survivor’s Name:  Evelyn Jagbah
Interview Date:  February 25, 2020
Interview Location:  Phebe Rehabilitation Center, Bong County
Interviewer:  Kathy Beth Stavinoha
Assisted by: Emma K. Katakpah
 
Twenty-eight-year-old Evelyn Jagbah grew up in Sinoe County with her sister and two brothers.  One brother is 25 and the other is 15.  Her sister is 40.  They have the same ma and same pa.  She has had no schooling at all.  She has three children ages 16, 8, and 7; her oldest was born when Evelyn was 14 years old.  She likes the color green. 
 
She was pregnant.  She was going to give birth by C-section.  During the operation, she got a fistula which she had for more than a year.  She first said she is not leaking, but then said she is leaking small small (a little bit).  [Note: we believe her fistula is healed, but that perhaps she suffers from incontinence.]  She has had only one operation and they will not do another. 
 
Evelyn learned how to make soap and bread while at the Rehab Center.  When I asked if she would open a shop, she said there is no material and no graduation.  [Previously, the Rehab Center held graduation ceremonies for the survivors.  At graduation, the survivors received the materials they needed for their trade and some seed money to start their business.  However, there is no longer any funding for this.]  When she leaves the Rehab Center, she has no way to make a shop or to make anything.  She told us that the people who ran the program “don’t have time for you.”  She has the skills, but she has no way to use those skills or to start a business.
 
When I asked her what was hard (difficult) about having a fistula, she replied that when you get fistula, nobody will help you.  People won’t come around you.  They are afraid of you because you have fistula.  You can’t go among people.  You are lonely.  You’re sitting down.  You are crying.  But when you come here to the camp [the Phebe Rehab Center] you can be free and move around.  You’ve got no family.  They can be afraid of you. At the Center, they love you and accept you.  Because you meet other people here and you can associate yourself with them. 
 
Before coming to the Rehab Center, she felt bad.  The baby died.  She had this problem [fistula] and she was feeling bad.  She would advise a girl to marry a good man who would take care of her.  She asks people not to forget about them.  She said that the place they are in now, they “have no friend, no brother, no sister” and that we Dignity:Liberia) are the ones that are helping them and that we have not forgotten them.  We always remember them.  
 
She speaks Krahn.  I asked her to say something in Krahn.  She said: God will be with the people every time they are coming to us.  Because “they get nobody that are dependable for us now” and that we were the only ones coming.  “We say thank you.”
 
Evelyn is a fistula survivor.  Hear her story in her own voice.