Story of Sufia: the quiet suffering of a village woman in Bangladesh

Bangladesh – Thirteen-year-old Tania, who is pregnant, carries a small jar outside her home, in the south-western district of Barguna in B… | Bride, Pregnant, Photo

Let me not pray to be sheltered from dangers but to be fearless in facing them.

Let me not beg for the stilling of my pain but for the heart to conquer it.

Let me not look for allies in life’s battlefield but to my own strength.

Rabindranath Tagore


by Ajmal Sobhan   7 June 2021

She lay down close to the end of the bed, clutching the sheet near her neck. If she moved any further, she would fall off. She was tense, anxious, and feverish. She could not relax. She was embarrassed beyond words. It was hot and clammy. The ceiling fan made a  whirring noise as it spun. The fan regulator did not work. The wobbly movement of the fan blades as they spun, made hardly a difference to the perspiration that had drenched her saree. Jainul, her husband, was fidgety and distraught. They had been married only six months and had experienced little marital intimacy during that time. The few times that they did try, Jainul wasted no time in foreplay. Sufia would shriek in pain and would immediately crouch into a fetal position. Jainul could not understand. He did not want to hurt her and was befuddled by her pain. But he was losing patience. His mother, though often an observant woman, failed to decipher the situation from words and sounds she heard coming from the bedroom. She knew something was not right.  She finally approached Sufia and whispered to her, “What is the matter?” In response, all Sufia could do was to weep silently. She asked again “If you don’t tell me what the problem is, I cannot help you. Do you realize that?” After many such questions, Sufia softly told her mother-in-law “It is too painful”. The mother-in-law was in her forty’s and was aware of such problems as she had faced similar ones herself, early in her marriage. But, the woes of her daughter-in-law appeared to be worse still. So, she said to her “Don’t worry, I will take you to a doctor”. Sufia was very shy and chose to keep quiet initially. At last, she blurted “It’s my fault. There is something wrong with me”. Her mother-in-law said “Whatever the problem is, let’s see if it can be fixed”. Jainul was less sympathetic – it had already been 6 months past the wedding, and he was getting frustrated at not being able to consummate their marriage, yet. “I want to have a child. We can’t have a child if you act like this. If the mother wants to take you to the doctor, then go, but I am not going with you. It’s your problem, not mine”, he said to Sufia agitatedly. “My friends are already making jokes about our marriage. I should have never married you” Dismayed by the insensitivity and lack of understanding on the part of her husband, and saddened and bewildered by her own physical pain, Sufia was slowly descending into a time of depression. She had no one to confide to. Her parents would not understand either. On the contrary, they would blame it on her. She had confided in her mother. Her  advice:” Learn to please your husband”

Sufia’s,  husband,  Jainul, owned a shop in a rural area. His parents owned a plot of land, which they farmed. They were self-sufficient, and in no way could anyone describe their financial means as being one of dearth , want, or wealth . The conjugal relationship between the newlyweds appeared to have strained from the outset due to their inability to consummate their marriage. Jainul’s mother, noticing unhappiness, made the arrangement for Sufia to see a specialist. It was not easy. There were no female doctors in proximity – forget about wanting to consult a specialist. Jainul’s mother was able to find a good doctor, but it would not be cheap.   They travelled 100 km to an adjacent city, where she was lucky to find the female GYN doctor who dealt with Dyspareunia (Sufia’s malady), they made an appointment with her. When the day came, Sufia and the mother-in-law took the long bus ride to see the doctor. Jainul was nowhere in the picture. He refused to go with them. At the doctor’s office, Sufia was nervous beyond comprehension. The Doctor examined her thoroughly. After the exam, she sat down with Sufia and her mother-in-law. “There are several problems that can be the cause”, said the doctor. “I am not sure which one of these, is the main one – there could be more than one. The first is dryness, the second is infection, and the third might be related to her husband’s performance”. The mother was rather taken aback by the doctor seemingly pointing a finger at her son. “What do you mean, there is something wrong with my son?” said the mom. The doctor replied, “Madam, it is always not the fault of the wife, and it may not be a fault at all – your son may be trying too hard, too fast”. Sufia’s mother-in-law was shocked and a bit embarrassed at the doctor’s openness and assertion. The doctor prescribed medicine for Sufia and asked the mother-in-law to send her son in for a talk at a later date. When they reached home, Jainul said excitedly,“So, did the doctor fix the problem?” Sufia kept quiet until nudged again by Jainul. She said, “The doctor gave me some medicine, but she wants to talk with you”. Jainul was taken aback. He said “Why does she want to talk with me? There is nothing wrong with me!” And angrily walked out. Jainul’s mother overheard the conversation and told her son, “Don’t be stupid, go see the doctor and see what she has to say”. After many entreaties, Jainul finally went to see the doctor. The doctor looked at Jainul straight in the eyes and said “Do you want a happy marriage? If so, don’t assume it’s all Sufia’s fault. You need to do a better job. You need to take it easy, show her affection; caress her, and make her feel loved. You don’t rush into her, she is not a baby-making machine. Do you understand”? He was amazed by her words. He had never heard a woman speak that forcefully. He was angry and yet he managed to control himself. For once he felt intimidated by a woman.

Sufia took her medicine and Jainul did what he was instructed to do. They seemed to have crossed the bridge and both appeared to be happier. Jainul’s mother was also happy. Sufia spoke with her parents and told them that things were better and that they ought not to be worrying about her. About 4 months later, Sufia was in the family way. Though both of them were happy, Jainul prayed that the baby would turn out to be a boy. He wanted a son. Sufia’s anxiety came rushing back. “I just want a healthy baby, how can I ask God for a boy?” she said to herself. Nonetheless, for the sake of peace and harmony, she prayed to God that she would be blessed with a son. Jainul was impatient. He could not wait anymore. As soon as an ultrasound sex verification was possible, he wanted Sufia to go to the city to have one done on the fetus. Sufia objected. “Do we at all need to know the sex of the baby right now? Can’t it be a surprise?” But Jainul would not relent. On the fateful Saturday afternoon, he took his wife to a lab in the city where they did an ultrasound on pregnant mothers. At the end of the procedure, even the technician who performed the test was quiet. Jainul knew by her countenance, it was not good news for him. He was furious. He barked at Sufia “I knew it, I knew it, you can’t do anything right. First, you gave all the trouble after we got married, and now you are going to have a daughter. I don’t need a daughter, I want a boy!”  Sufia looked at Jainul pleadingly. “I can’t give you what you want, I can give only what God gives me. It’s going to be a healthy girl. What else can we hope for?” Jainul left her there and angrily walked away. Sufia, with the help of the people at the ultrasound facility, found her way back home. It was a long lonely ride and she only saw gloom.

Though Jainul’s mother was not very happy either, she said to him “Stop acting silly, if she gives us a granddaughter, we have to accept that with Grace, we can’t be ungrateful”. Sufia was relieved by her mother-in-law’s rectitude. It momentarily took the pressure off her. Jainul who had a bad temper continued to remain irritated at Sufia despite her effort to make him happy.

Over the next months as Sufia advanced in her pregnancy, there was little effort made by the family to have prenatal checks to see if everything was going alright, or whether the fetus was ok, and the  heart beats were normal.. Sufia had a few spottings (passage of some blood) but they were of very small amounts, and due to them she did not suffer much pain. As she got closer to the delivery, a midwife was brought in to assess her condition. The midwife raised no alarm other than to advise Sufia to take an iron pill each day as she “looked” anemic.  Some vitamins were also prescribed for her. There were no other ultrasounds done on Sufia as both Jainul and his mother were already sensitized to the knowledge that it was going to be a girl after all.  The Midwife said “ everything seems alright, call me if anything bad happens”

On the day she started having labor pain, it was raining cats and dogs. The weather was stormy with wind blasts close to 60 km per hour in ferocity. The midwife was called, but she arrived late by many hours. Sufia was writhing in pain and her water had burst. When the midwife finally came and examined her she said “Something is wrong, the baby’s head is not advancing the way it should”. She gave Sufia some medicine and examined her again, and said “The baby’s head is stuck( obstructed labor due to cephalo/pelvic disproportion)). The mother’s pelvis is too narrow for the head of the fetus, and we need to move her to the hospital immediately”. Outside, the rain was pouring in torrents with vengeful gusts of wind mercilessly felling trees and blowing away tin shed roofs. The mother-in-law said, “We cannot take her to the hospital in this weather, there are no buses or CNG’s (a three-wheeler running on compressed natural gas),  you have to deliver her here”. The midwife in response said “I cannot! I just told you, the babies head is stuck, it won’t budge, she will need a C-section. Sufia was moaning in pain while the mother-in-law was yelling at the midwife, “ why didn’t you warn us before, you are good for nothing midwife!”. Jainul screamed out in agony. “She has only brought us misery! What are we going to do now?” There was nothing to be done. As Sufia suffered from the unborn baby, they waited for the weather to improve. By the time the weather relented, twelve hours had already passed. Sufia had lost a lot of blood and was hardly conscious.

Finally, Sufia, the midwife, and the mother-in-law arrived at the hospital. Sufia could not talk but be still moaning away. She was immediately taken to the delivery room. After several hours, the doctor came out to say “The baby is stillborn. We had to make a few cuts( episiotomy) to get the baby out. A C-section would not have saved the baby. The mother is safe”. Sufia remained in the hospital for a few days. She could hardly walk due to the pain but gradually regained strength. When she finally started walking she was alarmed to notice that her saree remained soaked in urine most of the time. The doctor came back and told her and the mother-in-law that Sufia had developed a fistula( Vesico-Vaginal). The baby’s head while stuck in the pelvis had eroded the region between the vagina and the urine bladder. As a result, there was a gaping hole between these two organs. In sheer distress, the mother-in-law addressing the doctor asked “So, what can be done about it? Can’t it be fixed?” The doctor said, “The operation is complicated. It requires a specialist to perform it. We do not have one with us, you will need to take her to a  hospital that is equipped to so such surgeries”. It may be too early to think about that operation for now. First, she needs to recover and regain her strength. She is weak and has gone through the mental agony of losing a baby. You need to take her home”.

It appeared that there was no end to Sufia’s miseries but her nightmare was only beginning. When she reached home, she was not allowed to stay in her room with her husband. She was told to stay in a smaller room and sleep on a blanket on the floor. The fistula had made her urination involuntary, and she was always wet. Her inability to keep herself dry, the stench of urine, the constant changing of sarees and blankets, and the overall lack of hygiene not only made her increasingly miserable, but the whole family now started shunning her as though she was a pariah.

After being in the house less than a month, the mother-in-law said to Sufia “We can’t have you stay in the house, there is too much smell and nothing can be kept dry with you around. It’s impossible to pray in the midst of such malodor and contamination.  You will need to live in the cowshed. We have made a small bed for you there, we will bring your food for you”.

In agony and in shame, Sufia took some of her belongings and made her living quarters next to the cows, the goats, and the chicken. The mother-in-law brought some diapers for her so that she was not wet 24/7 but the diapers also required frequent changing, and there was never enough. Diapers were too expensive. The mother-in-law stopped buying them. There was a maid that worked for the family who felt sorry for Sufia. She took it upon herself to help Sufia bathe and clean. She also made sure that Sufia had food. In essence, despite living in the same compound, Sufia was virtually abandoned and isolated by the family. She spent lonely nights in utter squalor, all by herself.   Sufia’s father-in-law, a staunchly religious person, mostly ignored her plight. The only advice he had for Sufia was prayers. He said “God is punishing you for your sins, but if you pray hard enough, He may forgive you and heal you. But you need to pray constantly, that is the only way. You have brought us a lot of misery. It was a mistake bringing you in as Jainul’s wife”

One may wonder why or how Jainul’s family had such a stranglehold on the life of Sufia. What makes a family of modest means (owning merely a small parcel of land, and a small shop to boot) have such bloated importance in the society, while the daughter-in-law is essentially voiceless and powerless? To understand all of this, one needs to delve a bit into the social and religious fabric of the societal setup Sufia happened to live in. While Jainul’s family-owned land, no matter how small or meager, Sufia’s family was landless. Jainul’s family owned a shop, in truth Sufia’s family-owned nothing. Though not often worse off compared to the indentured labor, these landless people nevertheless tend to generally work for a pittance, either by grazing the land owned by the gentry or simply eking out a measly existence. Furthermore, to be born into a kind of feudal society such as this, for a woman such as Sufia, enjoyment of true freedom or personal liberties appeared elusive. Such a society is typically chauvinistic and male-dominated, which means women – especially those in the lower rungs of the society, get to enjoy little independence, either in the ways, they wish to think or do things for themselves. Sadly, then, a female end up obeying her husband and in-laws, or acquiescing to their constantly harsh demands, till her last days of servile life on the earth. Wealth, power, education, and class, all play a pivotal role in keeping this harsh societal structure intact, and thus fostering its imperviousness to any real alteration despite the extant laws of the land. One who is wealthier, or more educated, tends to wield enormous power over those who have less wealth and are illiterate. The upper class gets to exercise the rules of the game. The apparent invincibility and power of Jainul’s family over Sufia, so evident in the present story, were an unfortunate byproduct of this hideous class distinction so commonly witnessed in her society.

“In addition to this, it is common, that many fistula sufferers are abandoned by their husbands, forced out of their homes, ostracized by family and friends, and even disdained by health care workers, who consider them “unclean”. They end up begging for a living, and they are mostly unaware that there is a treatment available.”( “Situation analysis of obstetric fistulas in Bangladesh”, carried out by Engender Health, an International Organization)

Exhortations to Sufia from Jainul’s father regarding prayers were at best a perversion of what prayers should truly be all about. Such exhortations are merely ritualistic sermons for absolution. Basically, he was blaming Sufia for the misfortune that had befallen her, thereby unjustly imputing that it was she who had brought it upon herself. In being merely a doctrinaire, he had lost all sense of compassion for the hapless Sufia. The cruel and nefarious powers of religion and class distinctions inflicted on women, especially those living in rural areas, are accentuated further by the power of male domination thrust upon these women. Male domination is so pervasive that even an educated female is likely to remain by force, a simple housewife. She may even be forbidden to seek employment if such employment meant endangering the pride and ego of the male counterpart or his family. Spousal abuse is common, especially when a female dares to challenge the male. Criminal cases of spousal battery are rarely brought up in a court of law, unless something diabolical has taken place – a murder, or an acid-burn, or a rape, for example.

At the behest of her father-in-law, Sufia spent long hours praying. She asked God the reason for her punishment, why she was chosen to be treated so harshly, why she was being humiliated in such a fashion. She did not get any answer from the Almighty. There were no revelations of His intent, either. She felt the strong urge to end it all – a pointless life, a burden for herself and for others. She did not see any way out of the dark tunnel she had entered. Being at the end of the rope, and with little prospects of her daily torture vanishing away, Sufia decided she would poison herself. She found out that farmers used pesticides, and that could be used to poison oneself. She finally got some and kept it at her side in the shed to take it in the middle of the night. But before nightfall, the maid who cared for her came running excitedly to her and exclaimed “They are miking( public address system)  in the streets that some foreign doctors have come to do fistula operations! They want females with fistulas to come immediately to the hospital to be tested. You must go, please!” The foreign surgical team was US-based, but there also was a separate Fistula Ward sponsored by an International Organization set up at the hospital of late. Suspicious, and at the same time hopeful, Sufia decided that she would try her luck.

Sufia took a CNG (three-wheeler, running on compressed natural gas)) to the outpatient clinic at the  Hospital. She was frail and fragile; looked pale, and weighed hardly 70 pounds. She underwent screening for patient selection for the Surgical Mission that had taken residency at the hospital. Examining her, the medical team found that Sufia had a vesicovaginal fistula (an abnormal connection between the vagina and the urinary bladder) brought about by protracted labor; and the subsequent necrosis of the tissue separating the vaginal wall from the urinary bladder. This abnormality led to a continuous flow of urine into the vaginal cavity. It turned out that Sufia was a good candidate for repair. But, she would require replenishment as she was not a healthy candidate yet for a major operation unless she was fortified. She was admitted to the hospital, hydrated, and transfused; antibiotics were administered to control infection, and a bowel prep( cleansing) was done. After ten days of extensive pre-op workup, Sufia was at last operated upon. The fistula was repaired after a five-hour operation. She stayed in the hospital for ten days. By the third post-op day, she had stopped leaking urine; and by the time she was to leave the hospital, she was completely dry. Sufia finally could wear a saree without being soaked in her own urine. It seemed she had received a new lease on life.

Sufia was allowed to stay in the hospital for two more weeks to get back her strength. The hospital staff knew she was traumatized by the whole experience of having a fistula. After she was discharged, following a month’s stay at the hospital, she reluctantly headed for her in-law’s house. Before she got there, her mind was already made up as to what she would do next. Neither her husband nor her mother-in-law came to visit her at the hospital. Her husband and mother-in-law were there to greet her. Sufia was least impressed by the lukewarm welcome she received. She kept her gaze on the floor. “I will not live here. I am going back to my father’s house”, she announced forcefully. “These past two years, you left me in the cowshed to languish for myself, never ever bothering to take care of me while I suffered endlessly. You left me in filth and just pitied me. You asked me to offer prayers to God for his forgiveness for something that I had nothing to do with. You kicked me out of the house because I was too unclean for you. Now, you want to wipe that chapter clean and accept me as though nothing ever happened. No, I will not live here. You have the least bit of love for me. Where were you during my worst time? I would rather live alone than live with you, here” said Sufia pensively, addressing her husband and the mother-in-law. Where she got the courage or the strength to say what she said, only she and her God knew. Jainul was now livid. “You are still my wife. You cannot leave without my permission. You have given us a lot of headaches, already. No, you are not leaving this house until I say so”. Jainul’s mother interceded “Let her go my son, don’t stop her, she has only brought us grief. Let her go”. “No,” said the son. Sufia hastily packed her meager belongings into a small suitcase and started walking out the door. She did not care to look back, and she kept walking straight ahead. She had no fear, no remorse.  Jainul screamed at her several times for her to get back, but Sufia would not stop. In a fit of rage at his wife’s apparently insolent behavior, Jainul took a kitchen knife and pierced it deep into her chest. Jainul’s mother, horrified at what she had just witnessed, screamed aloud “Oh God! What have you done? What has happened?” As her, profusely bleeding body wilted and fell down on the ground with a thud but without a wince, Sufia in the faintest of whispers whispered “God, please take me away. I am ready to go!” Jainul, now aghast at what he had just done to his wife, sobbingly wailed “Sufia, I didn’t mean to kill you, please don’t die!” Sufia’s listless body did not move anymore. She had left behind her mortal body to be with her Creator at last – so it seemed. The world was too cruel for her. Ironically, it appeared as though death had been inflicted on her without her wanting, just so that her life of pain and suffering could cease to exist at last.

PS: More than 1000 VVF’s have been repaired over the last 10 years in major institutions with grants from the UN and other International Organizations in Bangladesh. But fistula cases have not stopped in rural areas due to poverty and lack of urgent obstetric care. An early C-Section can prevent such a deadly complication. Where doctors in the urban area are keen to do C-sections as the reimbursement is high, it is the opposite in the rural areas as the poor are unable to pay.

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