OBSTETRIC FISTULAS Lisa Gwaltney

OBSTETRIC FISTULAS Lisa Gwaltney As the hot, dry Ethiopian wind wisps around her, she wonders what will According to the World Health Organization, an estimated 2 mil- become of her future. Sold into slavery at the age of eight, raped by her lion women are living with this condition. Each year, another 100,000 master at twelve, and sent into the bush at thirteen to deliver her Þrst cases are likely to occur. (Obstetric Þstula, 2001). child alone, she asks god if this is what is meant for her. After days of Though a Þstula is, in itself, a physical condition, its causes are labor, a dead child is born, and though her body doesnÕt feel the same, directly social. Poverty, malnutrition (and because of it, smaller body she is lucky to be alive. Suffering crippling internal injuries, including size), no education, child brides and childbearing at too young an age, a Þstula, she crawls back to her village only to be greeted by her mas- female genital mutilation, the general treatment of women (as if they tersÕ disgust. The smell of urine and feces dripping constantly down were disposable), and no medical care all contribute to this horriÞc issue. her legs will have her village condemning her for carrying evil spirits. (Moving beyond, n.d.). In rural areas accounting for 87% of EthiopiaÕs Her master takes her to a faraway hut, conÞning her and removing the population, it is custom for young girls to be married off after their Þrst door so that hyenas, attracted by the odor, will tear her apart at night... menses between the ages of 10 and 15. Traditions of cohabitation with (Kristoff, 2003). postponed sexual relations were once prevalent, but due to moderniza- Her name is Mahabouba Mohammed, and her story is unique in tion and disconnectedness from ancient law, this is no longer practiced. that she did survive. After Þghting off the hyenas and crawling for a day (DeÞning obstetric, n.d.). The result is pregnancy in a child whose pel- to seek the help of an American missionary, she was taken to the Addis vis is physically too small for a babyÕs head to pass through. Ababa Fistula Hospital, founded by Dr. Hamlin, who was able to repair This failed birth attempt is doubly traumatic in that the child is Ms. MohammedÕs Þstula. She now works at the hospital as a nurseÕs often stillborn and the womanÕs body, torn apart by labor, no longer aide, helping other women through their often debilitating experiences. functions properly. This event is accepted by the woman as a personal (Kristoff, 2003). ßaw; one she lives with in silence and shame and considers to be her Obstetric Þstulas, a condition gone largely unnoticed in the modern fault. Dr. Ann Ward, an obstetrician and gynecologist in southeast Ni- world, occurs when a tear develops between a womanÕs vagina and blad- geria notes her greatest work to be convincing these young women that der, or vagina and rectum, due to prolonged and obstructed labor, some- this has happened to them because they are poor and have no access to times lasting for days. This condition often results in various forms of medical services or emergency procedures such as Caesarian sections, extensive nerve damage and permanent incontinence. The woman is not because they are bad people. (UNFPA objectives, n.d.). then forced to live in humiliation while feces and urine constantly drip There are programs currently being implemented to serve this is- down her legs. She is completely cast out of society. Her husband will sue. Dr. Hamlin has been Þxing Þstulas in Ethiopia for 44 years. Her leave her and her family and friends will want nothing to do with her. hospital has served over 20 thousand women. Surgical repair can have She will be left alone, ashamed, and destitute, with no money or educa- a success rate as high as 90 percent, and women can usually have more tion. She may turn to begging and prostitution to survive. (DeÞning children. The cost of surgery range from $100 to $400, an amount no obstetric, n.d.). This disease, partly inßicted upon those most unheard Ethiopian woman can come up with on her own. (Moving beyond, n.d.). of women by their own societyÕs treatment, is indescribably horrendous A rural village has been constructed allowing those women whose Þs- for millions of sufferers, and could be avoidable through reform of cur- tulas are irreparable to function in an understanding environment and rent social norms. live out their lives with purpose and dignity. (Fistula hospitals, n.d.). Fistulas are virtually unheard of in developed countries. The Outreach is instrumental in increasing awareness among rural Þstula Þrst Þstula hospital was established in 1850 in New York. Its doors sufferers that a cure does exist. Western medicine and facilities once were closed in 1895 when this condition ceased to be a problem due superstitiously regarded as a desperate last resort, taboo and not to be to improved obstetric care and modern technology. (Fistula hospital, trusted are beginning to gain recognition and appreciation. A movement n.d.). When a Þstula is encountered in the west, it is often the result of among young people in Ethiopia, Nigeria, and Afghanistan against the a hysterectomy for benign diseases such as uterine Þbroids, menstrual practice of child brides is gaining momentum. Education on womenÕs dysfunction, and uterine prolapse. It may also occur after a cesarean rights, midwifery, and childbearing are key. Core indoctrinated beliefs procedure, or as a result of pelvic radiation. (Vesicovaginal and ure- of a womenÕs role; that she is alive merely to please her husband sexu- terovaginal, n.d.). It can be repaired by cutting out all scar tissue, ob- ally, produce children, and work in the Þelds (Fistula hospital, n.d.) need taining fresh margins and closing the tract without overlapping suture to be changed. For those lucky enough to hear about Dr. HamlinÕs Þs- lines (Harris, 1950). Great strides are taken to show western medical tula hospital, a new, much more empowered sense of life awaits. For practitioners how to repair a Þstula, for it is now considered to be a rare those suffering silently, a prayer goes out, that they or their daughters condition in developed countries. may be reached. Exact numbers of Þstula sufferers in developing countries are un- known since rural living and shame keep these women isolated and un- EDITORÕS NOTE: This is an informational essay that was written for aware of the possibility of cure. English 100, Expository Writing. 89 References DeÞning obstetric Þstula. In Saving womenÕs lives. Retrieved October, 2003, from http://www.unfpa.org/issues/factsheets/Þstula_deÞning.htm Excerpt from vasicovaginal and ureterovaginal Þstula. In emedicine. Retrieved October, 2003, from http://www.emedicine.com/med/byname/vesicovaginal-and-ureterovaginal-Þstula.htm Fistula hospital. In The women. Retrieved October, 2003, from http:// www.Þstulahospital.org/women.htm Harris. (1950). Excerpt from vasicovaginal and ureterovaginal Þstula. In emedicine. Retrieved October, 2003, from http://www.emedicine. com/med/byname/vesicovaginal-and-ureterovaginal-Þstula.htm Kristof, N.D. (2003). Alone and ashamed. In The new york times. Retrieved October, 2003, from http://www.ethiopia-nid.org/downloads/ NY_Times_OpEd_Fistula_Hospital.pdf Obstetric Þstula: moving beyond the silence in Africa. In Engender health. Retrieved October, 2003, from http://www.unfpa.org/Þstula/ docs/Þstula-needs-assesment.pdf 90 .

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