I’ve been following the work of the Fistula Foundation for a number of years now. Let me tell you a bit what they do.
First up, you may be wondering what a fistula is. From the Foundation FAQ page (a trigger warning on this next paragraph:
A fistula is a hole. An obstetric fistula of the kind that occurs in many developing countries is a hole between a woman’s birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder (called a vesicovaginal fistula or VVF) and sometimes between her vagina and rectum (rectovaginal fistula, RVF). This hole results in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their inability to have children and their foul smell.
Obstetric fistulas are presently most common in Asia and sub-Saharan Africa. Regularly they are a direct result of rape, often in conflict zones and as a tool of war. Young women often develop fistulas as their young bodies are sufficiently developed to become pregnant, but not to carry easily. Also:
The root causes of fistula are grinding poverty and the low status of women and girls. In developing countries, the poverty and malnutrition in children contributes to the condition of stunting, where the girl skeleton, and therefore pelvis as well, do not fully mature. This stunted condition can contribute to obstructed labor, and therefore fistula.
Again, it’s poor women in isolated areas with little by way of medical care who are suffering. Stillbirths are more common than not. Only a fraction of the women living with fistulas have undergone repair surgeries – most fistulas can be fixed with surgery – with only a few thousand being performed in a year. Statistics are understandably hard to come by, but WHO puts the number of women living with fistulas at at least two million. And, as the UNFPA says, 50 000 to 100 000 new cases develop each year. These women become further impoverished and cut off from their communities, and can develop psychological issues in addition to their other medical concerns. This is horrific.
Which is why I am so glad for the Fistula Foundation, one of the main organisations working in this area. Some years ago, I was fortunate enough to attend a talk given by Dr Catherine Hamlin, who founded the Addis Ababa Fistula Hospital in Ethiopia in 1974. That one hospital has treated more than 32 000 women so far. The Foundation is now supporting hosptials in D.R. Congo, Angola and Afghanistan as well as in Ethiopia. Their programs are quite comprehensive, working on prevention, treatment and education programs. They’ve done everything from fund medical training for surgeons to education programs to building hospitals to setting up a village in Ethiopia for women who can’t return home. There are now even mini-hospitals for those who can’t make it to the main one in Addis Ababa.
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