Repairing Injuries, Repairing Lives
Every year, more than half a million women die because of complications of pregnancy and childbirth, which are largely preventable. This tragedy is most significant in the poorest countries where the risk of death is many hundred times greater than it is the developed world. For every woman who dies in labor, many more will suffer serious injury if proper obstetrics care is not available in time. Obstetric fistula is one such injury.
Obstetric fistula is most commonly caused when a woman is in labor for too long—sometimes many days. The prolonged pressure can create a hole in the birth canal, leaving the woman incontinent. To make an incredibly difficult labor even harder, in cases when a fistula develops, the baby is stillborn. For women left with the loss of their babies as well as their urinary or bowel control, physical scars become emotional scars; these women become stigmatized and are shunned by their husbands and families.
Worldwide, more than 2 million women are living with fistula, 80 percent of whom live in sub-Saharan Africa. An estimated 50,000 new cases are reported each year, though the number is likely much higher. Many women who can't access treatment are never counted.
Fistula is preventable. When women have access to good emergency obstetric care, the incidence of maternal death and disability drops significantly. Fistula was essentially eradicated in Western countries by the early 20th century, when cesarean section became widely available. In the developing world, fistula still exists due to poverty, inadequate access to health services, low status of women and girls, and lack of knowledge about maternal health.
One Hour Can Change a Life
Fistula repair surgery is a relatively simple one- or two-hour procedure when undertaken by a trained surgeon and skilled nurses. The success rate of repair on the first attempt can be as high as 90 percent. A successful surgery restores dignity to a woman who has often lived for several years with the discomfort and humiliation of not being able to control her continence and being shunned by her husband or family. As news spreads about this life-changing procedure, women travel long distances to wait their turn.
Direct Relief supports several fistula repair and prevention programs in Africa, from Ethiopia to Liberia.
As the regional referral center and teaching hospital in northwestern Tanzania, Bugando Medical Centre houses a 70-bed ward dedicated to fistula repair and recovery. It treats more than 300 women annually. Patients travel to Bugando from many hundreds of kilometers away, including neighboring Kenya, Uganda, Rwanda, and refugee camps in Burundi and the Democratic Republic of Congo. Bugando's services are announced on the radio, but word of mouth is often the most powerful incentive for fistula patients. All treatment—including the $250 surgery and post-operative care—are provided free of charge. The patient also receives bus fare for the return trip once she has been discharged.
In Somaliland, Edna Adan Maternity and Teaching Hospital is the region’s main referral center for obstetric emergencies. Somaliland suffers from very high maternal mortality and morbidity largely due to the lack of health facilities offering good maternal health services. The traditional practice of female genital mutilation (FGM), common in Somaliland, can lead to complications in childbirth and increase the likelihood of maternal injury or death. Edna Adan Maternity and Teaching Hospital places high priority on training nurses, midwives, and community health workers to prevent maternal death and disability such as fistula. The hospital and is the only facility in the region where fistula repair surgery is performed. To promote good quality obstetric surgery in Somaliland, Direct Relief has equipped Edna Adan Maternity and Teaching Hospital’s operating room with all the necessary components of a fully functional theater.
The JFK Medical Centre in Monrovia, Liberia, has a ward and operating theater dedicated to fistula repair. The multifaceted program in Liberia focuses on prevention, repair, and rehabilitation/reintegration for fistula patients. The project was launched in 2007, and in the first year and a half, more than 330 women received fistula repair surgeries at JFK Medical Center and in seven outreach hospitals in rural areas throughout the country. Nurses and midwives have been trained to provide quality emergency obstetric care, including safe delivery, and doctors have been trained in management of common obstetric emergency techniques, including cesarean section.
In Ethiopia, Direct Relief provides support to the Addis Ababa Fistula Hospital, the only medical center in the world dedicated exclusively to fistula repair. The Addis Ababa Fistula Hospital is the model institution for fistula repair and training in Africa and the leading training center for health care providers around the world. Since it was founded in 1974, it has treated 30,000 women for fistula repair. The hospital provides free repair services for approximately 1,200 women every year and long-term care for 30 women whose fistula cannot be repaired.
In Kenya, Jamaa Mission Hospital, established in 1971 by Sisters of Our Lady of Charity, is a 63-bed hospital whose mission is to assist teenage girls and women by providing affordable solutions to their healthcare needs. The hospital serves a population of 400,000 in the Eastlands area of Nairobi, a low-income area of the city. In 2004, the Nairobi-based hospital launched an obstetric fistula repair program and health care provider training in pre and post operative care and rehabilitation. At the inception of the program, the hospital was able to treat fewer than 10 patients a month. Today the hospital is able to provide fistula repair services to 40 women monthly with a goal to increase that capacity to 60 surgeries a month. Consistent with its mission to provide good quality and affordable heath care, Jamaa Mission Hospital provides all fistula surgeries at no cost to the patient. Recognizing that the majority of women who have fistula are very poor, the hospital provides money for return transportation to their village after their recovery is complete. In Kenya, the estimated annual incidence of fistula is 5,000 women and girls but still only a small percentage is receiving the care they deserve. Jamaa Mission Hospital is dedicated to the continuation and expansion of its fistula repair program to help meet the demand for this life-restoring surgery.