Obstetric fistula is a serious disease that affects more than 2 millions of girls and women in the African Continent. Known as well as vaginal fistula, is a medical condition in which a fistula (hole) develops between either the rectum and vagina (rectovaginal fistula) or between the bladder and vagina (vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available. It is considered a disease of poverty because of its tendency to occur in women in countries with insufficient health resources. Fistulas can also develop in victims of raping.
The most direct consequence of an obstetric fistula is the constant leaking of urine, feces, and blood. This leaking has both physical and societal penalties. The acid in the urine, feces, and blood causes severe burn wounds on the legs from the continuous dripping. Nerve damage that can result from the leaking can cause women to struggle with walking and eventually lose mobility. In an attempt to avoid the dripping, women limit their intake of water and liquid which can ultimately lead to dangerous cases of dehydration. Ulceration and infections can persist as well as kidney disease and kidney failure which can each lead to death. In 2005, more than 500,000 women died as a result of complications from pregnancy and childbirth.
Social and psychological consequences
Physical consequences of obstetric fistula lead to severe socio-cultural stigmatization for various reasons, from religious or cultural related beliefs to economic reasons, since in many cases the woman is not able to give birth to new family members or can´t work or develop tasks as wife or mother. There are many misconceptions about obstetric fistula, such as that it is caused by venereal diseases or that it is divine punishment for sexual misconduct.
As a result, many girls are divorced or abandoned by their husbands and partners, disowned by family or ridiculed by friends. Divorce rates for women who suffer from obstetric fistula range from 50% to as high as 89%.
Because such consequences highly stigmatize and marginalize the woman, the intense loneliness and shame can lead to clinical depression and suicidal thoughts. Although there are few sources of empirical data, studies show that some common psychological consequences that fistula patients face are the despair from losing their child, the humiliation from their stench and inability to perform their family roles, and the fear of developing another fistula in future pregnancies.
Only 7.5% of women with fistula are able to access treatment. The vast majority of women are forced to suffer the consequences of obstructed and prolonged labor simply because options and access to help is so incredibly limited.
Treatment is available through reconstructive surgery, although before surgery, treatment and evaluation are needed for conditions including anemia, malnutrition and malaria, and the nature of the injury, which depends on the size and location of the fistula, so a surgeon with experience is vital, being surgeries done by inadequatedly trained doctors usually ineffective.
Challenges with regards to treatment include the very high number of women needing reconstructive surgery, access to facilities and trained surgeons, and the cost of treatment. For many women, 300 USD is an impossible price and they cannot afford the surgery. Access and availability of treatment also vary widely across different Sub-Saharan countries. Certain regions also do not have enough maternal care clinics that are equipped, willing to treat fistula patients, and adequately staffed. An increase in financial support and higher number of doctors, midwives and nurses trained are needed.
The Stop Fistula Project
The Stop Fistula Project aims at the prevention and treatment of obstetric fistula in Liberia. The Republic of Liberia has been particularly sensitive to this problem and has worked persistently towards the eradication of obstetric fistula in the country, having developed a national action plan since 2007.
“Mujeres por África” (“Women for Africa”) is a Foundation based in Spain, which aims to contribute to the economic, social and political development of Africa, through concrete projects geared to empower women and their role in society. Through this Project, “Mujeres por África” offers its collaboration to the Republic of Liberia to reinforce its efforts to eradicate obstetric fistula in Liberia by implementing a project in Monrovia in collaboration with the Saint Joseph´s Catholic Hospital, as a center integrated in the National Health System.
This project is designed to contribute to end obstetric fistula by improving maternal health, strengthening public health systems and reducing health inequities, as well as the reintegration of fistula survivors. This Project will be carried out, in a first stage, in and around Monrovia and in the future could be extended to rural areas.
The most important part of the project lies in the opening, in April 2013, of a Fistula Unit in the Saint Joseph´s Catholic Hospital, aimed exclusively at the treatment of this condition. Aditionally, our center attends to the first deliveries for young women under 18, the ones with a higher risk of developing fistulae. All the treatments are given for free.
The Stop Fistula Project includes measures of prevention and mother-baby health reinforcement, as well as training for health professionals such as doctors, nurses and midwifes.
The Government of Liberia will offer its support to raise public awareness, to identify women that could benefit from the program, to facilitate the entry in the country of surgical missions, and to facilitate the mobility of local public health workers abroad for their continuing training.