Obtaining Fistula Repair ………………………………………………………………...... Future Ambitions ………………………………………….……………………………..... Comparison of the different types of services …………………………………………… Mobile Clinic ……………………………………………………………………………. Fixed Approach ………………………………………………………………………….. DISCUSSION ……………………………...………………………………………………….. RECOMMENDATIONS ……………………………………………………………………... Fistula Curative Services ………………………………………………………………….. Preventive Approaches ……………………………………………………………………. Proposed Topics for Further Research …………………………………………………... REFERENCES……………………………………………………………………………...…. 30 31 32 32 33 35 39 30 41 43 44
Data Collection and Management Quantitative Close-ended questionnaires were administered by clinicians to women with fistula seeking fistula repair. Interviews were carried out in the hospital environment in a private setting and lasted about 15 minutes. Subsequent to the interview, a physician carried out a physical examination to understand the type of fistula the woman experienced and its size and location. Qualitative Two researchers with backgrounds in anthropology and vast experience carrying out qualitative studies led the field work. Both researchers have received extensive training on qualitative data collection, including approaches used when interacting with respondents, conducting open-ended questioning with an emphasis on probing, note-taking, and writing up and expanding upon field notes and ethical issues related to carrying out research. In Lodja and Kabongo women were recruited to translate questions from French into the local language and responses from the local language into French. The researchers were responsible for training the female translators. Criteria for selection of these women included the ability to speak French and the predominant local languages of the area, a minimum of a high school education, and good interpersonal skills, with a preference for women who had already carried out research. Interviews and group discussions were only carried out in a private setting; if privacy could not be adequately maintained, the researchers changed the location of the interview or rescheduled the interview for a later time. In-depth interviews took anywhere from 1 to 1 1/2 hours; if additional time was needed to complete the interviews, more than one session was held. For the interviews, the researchers took detailed notes during the interview and expanded upon their notes shortly after the interview was completed. Researchers paired up to lead group discussions, with one acting as a moderator and a second taking notes; discussions were tape recorded and transcribed subsequent to their completion. Data Analysis Analysis of the quantitative data was carried out on SPSS. As qualitative data was collected, a coding system based on the initial research questions and objectives, theoretical concepts, as well as emergent themes generated though the data, was developed by the investigators for the qualitative data analyses. Content analysis was used to identify and compare trends of key concepts in the coded data. Data triangulation was employed to identify only those concepts that could be validated through a combination of data sources, such as multiple interviews and group discussions. Ethical Review
In the other sites, those women still involved in relationships were obligated to have sexual relations, with some having to endure many consequences in order to satisfy their husbands. This woman from Lodja stated, This condition causes sores around the vagina and thighs, sometimes when I have intercourse I am in pain, but I sacrifice myself to satisfy my husband. A woman from Kabongo said, Despite the sores, I accept what my husband wants in order not to be forced out of the household. This would be another subject for mockery. Another woman from Lodja explained, I do not have the same sexual desire as before, but if my husband expresses a sexual need, I cannot refuse. It is the man who is the head of the household and it is he who can say that he does want to have sexual intercourse with me. If he finds no fault in having sex with me, I cannot refuse. Some women described the inconvenience of getting wet, with some avoiding liquid intake before having sex to accommodate and satisfy their husbands. Others suggested that it was not a problem for their partners to get wet during intercourse. Fewer women indicated that they still had the same sexual desire as before the onset of the condition. One married woman from Kabongo explained, I was always available when my husband wanted to have intercourse. I always had the desire and as soon as my husband wanted to have sex, I had no objection. I also wanted us to have sex regularly. Those who were not in relationships expressed disinterest in engaging in new sexual relations and responding to the multitude of questions the condition inevitably provoked. Violence One woman from Kinshasa and four from Lodja indicated that they were victims of physical violence after they developed the fistula and before they separated from their partners. This Kinshasa respondent explained, During the five months that we remained together, he treated me with extreme violence. He wanted me to return to my parents, but I could not because I did not develop the condition there. It was in his home that I got pregnant which caused the condition and therefore I could not return to my parent’s home. For this reason he decided to leave the village so that I could no longer stay with him. Family