Effects of Obstetric Fistula

In America, from birth every child is given an equal chance of survival. Our hospitals are equipped with the latest in medical technology and medical doctors that are educated to handle most any type of situation. It is hard to even conceive the notion that millions of women are not given the opportunity to give birth in hospitals. Often times these women end up with a condition known as obstetric fistula. This condition “appears to be most common in sub-Saharan Africa and South Asia” and “rare in the developed world because emergency obstetric is readily available” (“Fistula Most”). Dr.Catherine Hamlin said, “These are the most to be pitied in the world. They’re alone in the world, ashamed of their injuries. For lepers or AIDS victims, there are organizations that help. But nobody knows about these women or helps them” (qtd. In Kristof). The effects of obstetric fistula, can be detrimental to women that suffer with it, but through awareness fistula can be prevented.

Obstetric fistula is caused by a number of unfortunate and inexcusable circumstances. This domino effect “begins with the low socioeconomic status of women in the Third World, compounded by malnutrion, limited social roles, illiteracy, and lack of formal education” (Wall 863). This is due to the poverty of Third World countries. “This in turn leads to early marriage and childbearing before pelvic growth has been completed, virtually always in parts of the world where there is little if any, access to emergency obstetric services”(Wall 863). “When cephalopelvic disproportion occurs, the lack of obstetric care means that women may be trapped in obstructed labour for days on end—sometimes for as long as a week—without relief”(Wall 863).Although caesarean sections could reduce the number of fistulas that occur, many women do not have enough “money to pay for transport to reach medical help” (Donnay and Weil 71). Sharon LaFraniere writes in an article in the “New York Times” about a girl named Gide that had arrived at the hospital in September, after she was in labor for two days. Finally it took five hours for two cows to pull her family’s wooden cart to the nearest hospital, 10 miles away. There Gide labored for two more days before managing to expel a dead baby boy. Perhaps if the hospitals were better equipped and staffed, she could have been helped. Dr.Waaldijk said, “You go to a hospital and they have no working facilities. ‘You say you need this, this, and this.’ You go back. No water! No water in the whole hospital! You go back again, no lights! (qtd. in LaFraniere) Some hospitals have a lack of doctors, causing patients to wait days before a caesarean section can even be performed. (LaFraniere) Not all women receive fistulas from labor; some receive them from “the result of sexual violence—rape so brutal (often using gun barrels, beer bottles or sticks) that a tear develops between a woman’s vagina and her bladder or rectum or both” (“Hidden”). Whether they received their condition from child birth or rape, their misery has just begun.

Women in America are fortunate to not have to fear getting a fistula when having a child, but women in developing countries are not so lucky. Once these women go into “prolonged obstructed labour the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal), or both, that leaves her with urinary or faecal incontinence, or both” (Donnay and Weil 71). As horrific as this is “in nearly every case the baby is stillborn” (Donnay and Weil 71). Instead of a child to follow in their footsteps, they have a constant flow of urine and faeces that trails behind them.

The stigma that follows this condition is even more devastating than the injury itself. The lack of awareness and information about fistula often leaves society blaming “the women for her condition and some women blame themselves” (“Fistula Most”). Women often blame themselves after a loss of a child due to the stress of losing a child and looking anywhere for answers. These women have the added stress of the stigma that is associated with the disease. Zainabu Ado, 19 said, “People ran from me, even members of my own family. My husband abandoned me. Nobody talked to me. Nobody visited me. For that whole year I stayed indoors” (LaFraniere). Nicholas D. Kristof tells a story in the “New York Times” about Mahabouba Mohammed:

She had been sold into virtual slavery at age 8, raped by her master at 12, and then sent out into the bush at 13 to deliver the baby on her own. After a long labour she delivered the dead baby, but suffered from a fistula. The baby’s father was horrified by her smell. He confined her in a faraway hut and removed the door, so that hyenas, attracted by the odor, would tear her apart at night. This girl fought off the hyenas and crawled for a day to reach an American missionary, who eventually brought her to Addias Fistula Hospital that Dr. Hamlin heads. Dr. Hamlin was able to repair her fistula and now, Ms. Mohammed is a confident young nurse’s aide at that hospital.

These women most overcome the most horrific and unspeakable acts against humanity, before they can regain their dignity. Since half the women with fistula are divorced in result of this condition they face a life of shame and isolation (Browning 023). “Research shows that girls and women with fistula often eat alone, sleep alone, and pray alone” (Bangser 535). They are referred by professional working in the field as “poor little girls,” “the wretched of the earth,” and “women who can not even be successful prostitutes” (Bangser 535). Even though a stigma is placed on them from everyone that they seem to come in contact with, “they typically show remarkable resilience and strength” (Bangser 535).

Perhaps the most damaging of all the effects is the depression these women and the people that still remain to care for them go through. A woman whose daughter sufferered from obstetric fistula says, “It’s her misfortune that she’s alive. Those who die are luckier” (qtd. in Ebrahim). “As she wipes the tears from her daughter she adds, ‘She tells me to kill her. You tell me, can a mother do that?’” (qtd. in Ebrahim) Yet another fistula sufferer tells her story in an article by Zofeen Efrahim in “Pakistan: Fistula Camp Treat Afficted Women for Free” that is just as heartbreaking. Farida says:

“I gave birth to twins, one of who died, and I developed this problem. I was completely on my own as my husband had to go for work. I not only had to take care of the newborn, but the older two. My 11 year old helped me as much as she could, but after a few days I had to take them from school, as I just couldn’t manage. I had to continuously wash my soiled cloths and I smelled so much, I could barely keep myself sane. I remember crying all the time. So in between taking care of the home, the chores and nursing the young one, tell me, did I get time to miss my dead baby?”

These women will do anything to end their suffering. “Syed recalled that one patient sold her two young daughters to come up with money for the surgery, only to learn that she did not need any money” (Ebrahim). These women spend years searching for anyone to help. They are “spurned by their families and communities, they lie at the very bottom of the social pyramid: reeking of urine and stool, outcast, illiterate, improvished, sexually unattractive, powerless women, often under 20, sometimes as young as 11 or12 years of age”(Wall 865). These women are so desperate for help they “may consent to procedures they do not really understand, placing their faith blindly in the skills of the strange white doctors who have turned to help them” (Wall 865). Ruth Kennedy states, “We need to provide an alternative for those so ripped and hopeless they can no longer think for themselves” (qtd. in “Hidden”). “Facing familial and social rejection and unable to make a living by themselves, many women with fistula live for years without any financial or social support” (“Fistula Most”). Many women with fistula fall into extreme poverty (“Fistula Most”). At the Addis Ababa Fistula Hospital, one woman in every five reported begging for food to survive (“Fistula Most”). “Some cannot cope with the pain and suffering and resort to suicide” (“Fistula Most”). Even when obstetric fistula is treated the women are still scarred for life, with the loss of their child and the treatment they faced. “Dr.Waaldijk remembers one patient well.

’She managed to push out only her baby’s head before collapsing from exhaustion in her hut. Her brother carried her, balanced on a donkey to a road, where a bus driver demanded ten times the usual fare to take her to a hospital. She half stood, half sat for the trip, her dead baby’s head between her legs, her urethra ripped open’” (qtd in LaFraniere).

Dr. Waaldijk also states, “To be a Woman in Africa is a truly terrible thing” (qtd. in LaFraniere). American people should spend a day with these women before they are prescribed any medication for depression.

While the rich just seem to be just getting richer, the poor seem to be just forgotten about. “Until this decade, outside nations that might be able to help effectively ignored the problem” (LaFraniere). The last global study, in which the World Health Organization estimated that two million women were living with obstetric fistulas, was conducted 16 years ago (LaFraniere). As long as our nations keep turning a blind eye to what they don’t want to see, we will never have a hold on all the diseases that can affect us. AIDS was not our concern in Africa, but it has since become our problem. Although its effects can be heartbreaking to hear, it is time to stand as a nation to give these women back the dignity that obstetric fistula has taken from them. Hearing the stories from victims of this senseless condition, should be a reminder of how truly fortunate we are.