Introduction
Obstetric Fistula (OF) is a condition most commonly developed by women who have experienced a difficult or failed childbirth without adequate medical care. In an obstetric fistula, a hole develops between either the rectum and vagina or bladder and vagina, causing severe incontinence. Once common throughout the world, OF today is still prevalent in the developing world, especially in parts of Africa and South Asia. Sufferers of OF are often severely stigmatized by their husbands, families, and communities. Fortunately, reconstructive surgery exists. This page provides a brief introduction; for a wealth of information please browse the references listed at the end.
Causes
OF is most commonly caused by prolonged labors in which the pressure of the unborn child in the birth canal cuts off blood flow to the surrounding tissues, causing the tissues to become necrotic. Many of the affected are very young women with small stature, often malnourished, and unable to get proper medical care that would prevent these problems. Whereas in the developed world labors of this sort are handled by C-section, this option typically is unavailable in the poverty-stricken and remote areas in which these patients live. These women often give birth at home without the assistance of a skilled birth attendant. It is estimated that least 2 to 3 million women worldwide suffer from this condition although actual numbers are difficult to determine and the prevalence may be even greater.
Symptoms
Women suffering from obstetric fistula leak urine and/or feces, and are at risk of even more severe complications such as ulcerations, infections, nerve damage, and sometimes kidney disease and death. In an effort to prevent leaking some women restrict fluid intake and become dangerously dehydrated. The psychological ramifications, however, may be even worse than the physical. Severely stigmatized for their odor, and frequently also mourning the loss of the child they tried to deliver, OF sufferers very often become isolated, depressed, and suicidal.
Prevention and Treatment
Efforts to prevent OF consist of promoting family planning and access to skilled birth assistance at deliveries. Efforts to educate girls and delay the age at which girls are married also help, albeit in a less direct and more long-term way. Treatment for OF consists of reconstructive surgeries, followed by careful post-operative care. Although these surgeries have a very high success rate, sufferers usually cannot afford to pay the $300 - $450 cost for the surgery and follow-up care. As a result, the primary providers of these surgeries are charitable medical organizations that provide the surgeries and the post-operative care without cost to the patient.
OF Organizations
Several organizations provide reconstructive surgeries and other services to OF sufferers. Their web sites provide a wealth of information and accept donations to assist in their efforts.
The Fistula Foundation (www.fistulafoundation.org) funds one of the oldest and largest efforts, which serves the women of Ethiopia. The Fistula Foundation supports the Addis Ababa Fistula Hospital in Ethiopia, as well as a clinician training facility, programs for prevention and education, and mini-hospitals in more rural areas. A moving new film entitled A Walk to Beautiful (http://www.walktobeautiful.com) chronicles the lives of five women treated in these hospitals and will help raise funds for the Fistula Foundation.
In Sierra Leone, the West Africa Fistula Foundation (http://www.westafricafistulafoundation.org/) is working to build a free standing Obstetric Fistula Centre in Freetown, Sierra Leone, which will not only perform the surgeries but also provide training, and may be the first of its kind in West Africa. The group also performs several hundred surgeries a year, and is working to provide services on the borders of Sierra Leone in order to bring help to women in surrounding countries. In 2008, personalmed.com is contributing 3% of all revenues to the West Africa Fistula Foundation.
The World Health Organization and United Nations Population Fund Campaign To End Fistula provide education, advocacy and some funding for prevention and treatment efforts.
References and Links
United Nations Population Fund Campaign to End Fistula (http://www.endfistula.org/index.htm)
Wikipedia: http://en.wikipedia.org/wiki/Obstetric_fistula
Recent New York Times Article by Nicholas Kristof:
http://query.nytimes.com/gst/fullpage.html?res=9C06E4D7163EF935A25756C0A9659C8B63
http://www.westafricafistulafoundation.org/
Fistula Foundation: www.fistulafoundation.org
