[This post was written by Quinn Jenkins, who is an intern with the Freedom from Fistula Foundation Fistula Care Center in Lilongwe, Malawi. The care center is headed by Jeff Wilkinson, associate professor of OB-GYN at UNC and a member of our global women's health team.]
This past month, 85 year-old Magalena January received treatment at the Freedom from Fistula Foundation Fistula Care Center in Lilongwe, Malawi. Unfortunately, she has advanced cervical cancer and cannot be cured. We worked with our palliative care colleagues and arranged for her to go home for end-of-life care. Before she was discharged, we had the good fortune to sit down with her and her husband, Sandram Phiri, and listen to them share their life histories.
Ms. January clearly remembers the day she started leaking. She’d spent the hours in labor alone with no medical help and no family members nearby. After the prolonged labor and ultimately a stillbirth, she realized that urine was leaking down her leg. It was, she said, “the worst day of her life.”
Unfortunately, Ms. January hadn’t had an easy life prior to losing her baby and developing the fistula. She’d never met her father and was abandoned by her mother shortly after being born. Her aunt took in her and her five siblings, and she dropped out of school to work as a for-hire farmhand.
Ms. January doesn’t remember when she was born or how old she was when she married her first cousin. She does remember, though, that soon after becoming pregnant, her husband left her, leaving her alone to give birth and alone to deal with the devastating consequences of a fistula.
Her second husband, Sandram Phiri, also experienced misfortune early in life. Mr. Phiri was born blind in 1937 in the village Madedza. He never knew his father and was separated from his mother at age five. He grew up without a family, living with different village members throughout the years.
In 1961, Mr. Phiri attended a school for the blind and remained there for several years, learning handiwork and other skills. Towards the end of his education, he was employed by the government to work at the school’s agriculture department.
Mr. Phiri met Ms. January when he visited Mponera, her home village. They married soon after meeting, and worked for the majority of their lives farming maize and tobacco. In our interview, Mr. Phiri described how he and his wife have always struggled. He has been discriminated against because of his blindness. She was able to have her first fistula repaired, only to develop a second one years later.
For both of them, life has become harder with age. At the end of our discussion, Mr. Phiri and Ms. January both fervently agreed that their greatest worry at the moment was their house in their village. They dreaded leaving the fistula center and returning home.
Given the frail state of both the patient and her husband, The Fistula Care Center arranged to take them home in our project vehicle. Our driver noted the desperate state of their living conditions and reported back to us. We then took a trip to their village the next day and it was worse than imagined, with one of the walls bowed inward and half of the thatched roof missing and patched with plastic bags. There was no window, and it was cold and damp inside. In one corner were ashes from an old fire and a pail of maize powder—this was where they cooked their food. Next to that was a pile of old clothes and straw—this was where they slept. It was almost uninhabitable.
Along with the project director, Margaret Moyo, we formulated a plan to help build a structure where they could live. Over the next two days, we hired a builder from the same village, bought materials, and met with the chief to ask for his blessing.
By Friday—less than a week after Mr. Phiri and Ms. January returned to their village—there was a brand new house with a tin roof, concrete floor, strong walls and a new mattress and chairs for the couple to use.
The entire village came out to watch the completion of the house, and many individuals expressed thanks to the Freedom from Fistula Foundation for allowing their two oldest community members to live out the rest of their lives in greater comfort and dignity.