Restoring Health to Women with Obstetric Fistula

Aberdeen Women’s Center, Freetown, April 21 

We hope that Act Three never arrives. We work hard in Acts One and Two – training and equipping midwives and improving emergency obstetric care – so that mothers can experience a safe pregnancy and the health of their newborn. But at present time, we cannot draw the curtain after only two acts, and must also care for women who have endured serious injury during childbirth.

In Freetown, I meet Dr. Alyona Lewis and her dedicated staff at Aberdeen Women’s Center. The Center provides treatment and support for women who have developed a debilitating obstetric fistula as a result of prolonged and obstructed labor. Obstetric fistula is almost entirely preventable with improved obstetric services. In places like Sierra Leone and other countries in sub-Saharan Africa where access to and quality of care is inadequate, obstetric fistula still occurs at alarming rates.

In 2010, Aberdeen Women’s Center provided fistula repair for 189 women who came from all parts of the country and even neighboring Guinea and Liberia. The center includes a maternity ward (which was completely full during my visit) and an outpatient clinic for children. All services are provided free of charge.

The joyful rhythm of African drumming and singing rose up over the compound during my visit, happily interrupting my conversation with the procurement manager as we were discussing how Direct Relief could provide surgical supplies and medical materials to the center. I witnessed the Glady-Glady ceremony, a weekly celebration when the whole center breaks into song and dance to bid farewell and good luck to the women who are leaving to return to their villages. After staying about two weeks to heal following their fistula surgical repair, the women don a new dress and get ready to return home to their families and their community as a whole new person. The hope and positive energy of these brief weekly celebrations underscore the significant value of a center like Aberdeen.

The Center focuses on holistically healing women with obstetric fistula—repairing the debilitating physical condition and treating the emotional and psychological distress attached to the stigma of fistula. A three-month follow-up visit is required for every woman, to ensure the integrity of the surgical repair as well as providing an opportunity to share information on family planning and reproductive health. Dr. Alyona told me that when a woman returns, she often wants to learn about how to plan her family and is curious about her ability to have another child. (Women with a repaired obstetric fistula can have children but are counseled on the importance of having a cesarean section.)

The good news: The long waiting lists for fistula surgery in Sierra Leone have all but disappeared. While there are likely to be women that are harder to reach, or are tentative to come for treatment–many women from remote areas have never been to the Capital and are afraid to leave their village for an unfamiliar place–it is also possible that the incidence of fistula has decreased due to recent interventions to improve access to and quality of obstetric services. Aberdeen is planning an expanded outreach program in the coming months to areas not yet reached to offer help to women who still need treatment. Meanwhile, continued attention remains on improving obstetric care to prevent fistula and maternal death.

Someday, the fistula ward at Aberdeen Women’s Center will become obsolete, like the Fistula Hospital in New York City that was torn down 150 years ago and later became the famous Waldorf Astoria Hotel. Until then, Aberdeen Women’s Center will continue to play a critical role in restoring the health of women living with obstetric fistula and Direct Relief will remain committed to bolstering such important efforts.

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