2002, December 13, In a winter morning in Bangladesh.
I was a recently graduated doctor fresh off my internship and ready to embark on the road to become a surgeon, wearing a brand new white coat and a proud stethoscope hanging in my shoulder. As I had not done gynaecology in my internship rotation I decided to work with renowned gynecologist professor Anowara Begum to get a working knowledge about obstetrics and gynaecology. Shortly after starting to work under her supervision, I was asked to meet a young fistula patient named Josna in the fistula ward at Muttalib Community Hospital. I was to provide pre-op counseling to her. I had read about obstetric fistula before but it was my first time meeting a patient suffering from it. I had no idea about what to expect. What I found out shocked me to my core, to discover the picture of child brides of rural Bangladesh.
Josna was a 14 years old girl from Jamalpur district. She sat in silence with her young face covered in dark clouds. When she looked up, her eyes looked distant and vacant. She spoke in an empty voice as she detailed her situation to me. She was a child who was also a bride; she was the mother of a dead baby.
Josna was born in a poor farmer family with eight siblings. At the age of 11, while studying in grade five, she was forced to marry Abul Mia, a 26-year-old van puller. Within 3 months of marriage, she became pregnant with her first child. Her pregnancy was not a pleasant experience for her as even during the pregnancy, she was bound to do all the household works. Most of the days, she ate “panta bhat” and “bhorta”. Once in a while, she had fish gravy with small fish. She felt weak and tired. Her conservative husband and in-laws refused to allow her to be seen by a doctor during her whole pregnancy even though the hospital was nearby. She did not receive any tetanus injection even though it was free of cost.
Things took a turn for the worse as Josna’s labor pain started. Tradition dictated that an untrained dai (midwife) attend her. After 17 hours of intense labor pain, Josna became unconscious. Against her husband and in-laws’ permission, her father brought her to the Jamalpur Sadar Hospital after 2 days of labor pain. A dead male baby was delivered through c-section. Josna returned home with broken dreams but Josna’s ordeal did not end there. After 2 weeks, suddenly she realized that she was leaking urine and feces. At first, she could not understand what was happening. But as the dribbling and leakage continued, she started to get frustrated. She thought that it will all be fine the next morning. However, the same thing continued the next day. She was devastated and completely broke down. She lost all interest in life and could not concentrate in her family. All day long, she would cry and curse her fate. The loss of her child and on top of that her constant dripping problem ate her up from inside. She kept thinking that she will never be normal again. Within 3 months, Abul Mia left her.
Abandoned by her husband, Josna was brought to her parents’ home. She was forced to sleep on the floor due to bedwetting. She used pieces of old cloth as pad and reused the old cloth after washing with water only as she could not afford to buy soap. Gradually, her family and other village members started to avoid her due to foul smell of urine and feces.
She was seen by several village doctor without any improvement. Finally, she went to the BRAC hospital and came to know that she had obstetric fistula. It is a condition caused due to prolonged and obstructed labour in young girls; a hole is created between vagina and bladder and/or rectum leading to continuous leakage of urine and feces. This condition is not curable through medicine. Josna was told that she would have to undergo surgery to treat it. BRAC Hospital referred her to undergo surgery in Mymensingh Medical College Hospital after 14 months of suffering from fistula. Unfortunately, the surgery was unsuccessful due to the complicated nature of fistula having leakage of both urine and feces. Then, she was referred to The National Fistula Centre in Dhaka Medical College Hospital. Due to lack of available seat in Dhaka Medical College Hospital, she got admitted to Muttalib Community Hospital.
The surgery was very complicated and took about 3 hours to perform. Three weeks after her surgery, her catheter was removed. With the grace of Allah (SWT), she was completely cured. My initial visit with her had left a scar on my mind and I felt compelled to participate in her rehabilitation. During this period of waiting and healing, I visited her daily and took care of her food and other daily expenses provided by professor Anowara. Teenage Josna expressed her gratefulness as she had never had a whole egg to eat by herself.
I can still remember the day Josna was discharged. It was a sunny winter afternoon and the girl with the stone eyes and haunting voice had come alive. There stood a teenage girl with eyes full of dreams. Josna wanted to go back to school again and continue her studies. On the day of her discharge, Professor Anowara asked me to give her Taka 500 as transport cost to go back to her village. Josna was taken aback at first as she had never even seen 500 taka in her life. She was amazed and grateful that her condition was cured through a surgery and her family did not need to spend any money given their financial difficulties.I saw tears in her eyes but this time I loved her tears. I decided to leave surgery and to become a gynaecologist to see tears of pearls in the eyes of the girls like Josna.
This was the story of my first fistula patient Josna. I had never imagined how meeting that young girl Josna would change my entire perspective on life. That afternoon, I felt determined to embrace obstetrics and gynaecology as my field of medical practice. During my eight years of practice, I was able to attend to 400 fistula patients. It has been a blessing to be able to improve health access for these vulnerable child brides whose lives are crushed by the condition known as obstetric fistula. Watching these girls find their voices, their dreams after living through unspeakable suffering and humiliation has been an inspiration.