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Obstetric Fistula

Equipping Surgeons to End Obstetric Fistula

While surgery and surgical tools are essential to ending fistula, they are only part of the equation.

Danja Fistula Center, Niger (Courtesy photo)
Danja Fistula Center, Niger (Courtesy photo)

Obstetric fistula — a birth injury that occurs during prolonged and obstructed labor — is almost entirely preventable and treatable, yet it still devastates the lives of thousands of women each year.

Its prevalence, concentrated in the developing world, signals deep-seated inequities in health systems and little access to timely emergency obstetric services.

And its consequences are tragic.

Take Gajara, a 35-year-old woman living outside of Cox’s Bazar in Bangladesh. After three days of obstructed labor, Gajara gave birth to a stillborn baby. She developed a fistula in the process that left her incontinent.

That was 12 years ago.

Gajara endured her debilitating birth injury for more than a decade before learning that she could access life-restoring surgery, free-of-charge, at the nearby HOPE Hospital.

Doctors at the hospital told Gajara that her case was particularly complex due to the large size of the fistula as well as the fact that she had developed bladder stones. She underwent four operations to fix the extensive damage to her bladder and urinary system. Her treatment was ultimately successful. She got her life back. Every so often, she calls the hospital to express her gratitude.

A patient is prepared for a fistula surgery at HOPE Hospital on January 17, 2018, in Cox’s Bazar, Bangladesh. (Photo by Rajib Dhar for Direct Relief)
A patient is prepared for a fistula surgery at HOPE Hospital on January 17, 2018, in Cox’s Bazar, Bangladesh. (Photo by Rajib Dhar for Direct Relief)

Fistula also occurs where social norms related to child marriage and female genital mutilation exist, as was the case with Siyan.

At 13, Siyan underwent what is referred to locally as “traditional initiation” or female genital mutilation. Before the wound had healed, she was married to a 25-year-old man and became pregnant.

Siyan went into labor at home. Two days passed before a birth attendant arrived to assist. She gave birth to a healthy baby but suffered a vaginal tear that didn’t heal and left her incontinent.

A short time later, her husband left. Siyan moved back with her mother where she lived for more than a year before a local hospital referred her to the Gynocare Fistula Hospital in Eldoret, Kenya. There she underwent successful surgery to repair her rectovaginal fistula. After her recovery, Siyan was able to go back to school. After her surgery, Siyan said she hopes to study medicine in college. She wants to be a fistula surgeon.

The Fistula Repair Module

A Fistula Repair Module from Direct Relief is unloaded at the Gynocare Fistula Center in Kisii, Kenya. (Courtesy photo)
A Fistula Repair Module from Direct Relief is unloaded at the Gynocare Fistula Center in Kisii, Kenya. (Courtesy photo)

These stories are representative of thousands of women in the developing world who are living with obstetric fistula. To help ensure they can access care as Gajara and Siyan were able to, Direct Relief developed the Fistula Repair Module.

The module, endorsed by the Federation of Gynecology and Obstetrics, contains 55 surgical and medical items, including highly specialized sutures generously donated by Ethicon (part of Johnson & Johnson Medical Devices Companies), to perform 50 surgeries.

By the end of this fiscal year, Direct Relief will have shipped 100 Fistula Repair Modules to 17 countries — enough surgical supplies to enable 5,000 surgeries.

Partnering to End Fistula

While surgery and surgical tools are essential to ending fistula, they comprise only part of the equation.

That’s why Direct Relief is privileged to partner with dozens of healthcare facilities and advocacy groups around the world that work tirelessly to not only address obstetric fistula as a physical injury but as psycho-social trauma, helping women overcome the associated stigma and successfully reintegrate into their families and communities.

For a comprehensive list of organizations working to end obstetric fistula, visit the Global Fistula Map below:

Editor’s note: Names were changed to protect patient privacy.

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