Abstract:
Background: Obstetric fistula is a reproductive health problem causing immense suffering to 1% of women in
Kenya that is formed as sequelae of prolonged obstructed labour. It is a chronic illness that disrupts women lives,
causing stigma and isolation. Fistula illness often introduces a crisis in women’s life begetting feelings of shame and
serious disruption to their social, psychological, physical and economic lives, in addition to dealing with moral and
hygiene challenges. Currently, women undergo free of charge surgery at vesicovaginal fistula (VVF) camps held in
national referral hospitals and dedicated fistula centres generating a significant pool of women who have
undergone surgery and are ready to regain normal lives.
Objective: The purpose of this study was to explore experiences of women immersing back into communities and
their return to normalcy after surgery in three VVF repair centres in Kenya. We set out to answer the question: what
strategies improve obstetric fistula patients’ reintegration process?
Methods: We used grounded theory methodology to capture the reintegration and regaining normalcy
experiences of women after surgery. Narrative interviews were held with 60 women during community follow-up
visits in their homes after 6–19 months postoperatively. Grounded theory processes of theoretical sampling,
repeated measurement; constant comparative coding in three stage open, axial and selective coding; memoing,
reflexivity and positionality were applied. Emergent themes helped generate a grounded theory of reintegration
and regaining normalcy for fistula patients.
Results: To regain normal healthy lives, women respond to fistula illness by seeking surgery.. After surgery, four
possible outcomes of the reintegration process present; reintegration fully or partially back into their previous
communities, not reintegrated or newly integrating away from previous social and family settings. The reintegration
statuses point to the diversity outcomes of care for fistula patients and the necessity of tailoring treatment
programs to cater for individual patient needs.
Conclusion: The emerging substantive theory on the process of reintegration and regaining normalcy for fistula
patients is presented. The study findings have implications for fistula care, training and policy regarding women’s
health, suggesting a model of care that encompasses physical, social, economic and psychological aspects of care
after surgery and discharge.
