"Hoping for a normal life again": reintegration after fistula repair in rural Tanzania.
OBJECTIVE
To explore women's expectations, worries, and hopes related to returning to their family and community after fistula repair.


METHODS
We used a concurrent mixed methods design with a hospital survey and qualitative interviews. One hundred fifty-one women completed a questionnaire, eight were interviewed in hospital after fistula repair, and one woman was followed up at home for six months during the reintegration phase.


RESULTS
Women were concerned about where they could live and about not being accepted by their husbands and in-laws. While 51% feared that their husbands would not accept them despite full recovery, 53% said their parents would accept them. In the qualitative study women wished to live with their parents, whereas almost one half (49.7%) of the women in the quantitative study, who had lived with fistula for a shorter time, wished to live with their husbands. All women hoped to have children in the future, although many women, especially those with no children, were worried about whether they could bear children in the future. Despite fears related to economic survival and social acceptance, women were optimistic about regaining a normal social life.


CONCLUSIONS
Women's expectations of going home after fistula repair are linked to their history of living with obstetric fistula. For women who have lived with a fistula for many years, reintegration involves re-establishing an identity that is clean and respected. To facilitate this transition, fistula repair needs to be accompanied by psychological and social rehabilitation and assistance in returning to reproductive capabilities.
School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Lilian
L
Teddy Mselle
Centre for International Health, Bergen, Norway; Department of Obstetrics and Gynaecology, Sørlandet Hospital, Kristiansand, Norway.
Bjørg
B
Evjen-Olsen
School of Nursing, Bergen University College, Bergen, Norway.
Karen
K
Marie Moland
Department of Sociology and Anthropology, University of Dar es Salaam, Dar es Salaam, Tanzania.
Abu
A
Mvungi
School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Thecla
T
Wankuru Kohi
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D017533:Marital Status; D007744:Obstetric Labor Complications; D017060:Patient Satisfaction; D011247:Pregnancy; D012929:Psychological Distance; D011788:Quality of Life; D012006:Rectovaginal Fistula / Q000209:etiology / Q000523:psychology / Q000601:surgery*; D012424:Rural Population; D011795:Surveys and Questionnaires; D013636:Tanzania; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000209:etiology / Q000523:psychology / Q000601:surgery*