Meseret, from the Lalibela district in northern Ethiopia, was only 13 when she became pregnant. Married at 12, her underdeveloped body was not ready for the stress of giving birth. After six days of gruelling labour her child was finally born, but it was dead.
As a result of the long labour, Meseret suffered crippling injuries ‒ including the ripping of internal tissue. This created a hole between her bladder, vagina and rectum, a condition that doctors term an “obstetric fistula”. As a result, Meseret became unable to control normal excretory functions ‒ and urine and faeces started to drip down her legs constantly.
The girl’s husband quickly rejected her. She had given him a dead baby and now she stank badly. He sent her home to her family.
If left untreated, Meseret’s condition would probably have led to infections, kidney failure ‒- and eventually, death.
But fortunately, her mother heard of another girl in the village who had suffered from this ailment ‒- and how she had successfully sought treatment in the capital, Addis Ababa.
The family then sold a cow to pay for the three-day bus journey to the capital and arrived at the gates of the Addis Ababa Fistula Hospital, with Meseret, penniless.
For the hospital’s founder, Dr Catherine Hamlin, this was a common tale. Hamlin is an Australian gynaecologist who has spent the last 44 years in the capital.
Her hospital treats 1 200 women annually. However, as the continent marks African Women’s Health and Rights Day today, health experts acknowledge that this is a fraction of the total number of fistula cases that occur in Ethiopia.
The World Health Organisation believes up to 8 500 women in the East Africa country develop the condition every year.
“In many developing countries, the role of women is limited to providing sexual satisfaction for their husbands, producing children and performing the hard labour associated with agrarian life,” says Hamlin.
“Fistula injuries destroy their ability to fulfil these roles, and with it their sense of self-worth. They become social outcasts from their community through no fault of their own.”
Fortunately, most fistulas can be corrected surgically, even after several years.
The cost of the operation ranges from $100 to $450. While this amount is far beyond what most patients can afford, the Addis Ababa Fistula Hospital offers free surgery ‒- and a free bed for the patient.
“If done properly, surgical repair can have a success rate as high as 90% and women can usually have more children,” said Hamlin.
Reliable data on obstetric fistula are hard to come by for the whole of Africa, although the United Nations Population Fund (UNFPA) estimates that between 50 000 and 100 000 women may be affected.
“If obstetric fistula was something that happened to both men and women there would have been more efforts made to study it,” said Ruth Kennedy, the Addis Ababa hospital’s administrator.
But because of poverty and the stigma associated with their condition, most women living with fistulas remain invisible to policy makers both in their own countries and abroad.
“These are girls are illiterate, so they cannot communicate ‒- they cannot write and say, ‘Look I’ve got this problem can you help me?’,” notes Kennedy.
UNFPA began fistula prevention programmes in 2002. But US President George Bush, alarmed by reports that the agency was supporting forced abortions in China, later withheld $34-million worth of funding for UNFPA. This has had a knock-on effect for the agency’s work in other parts of the world, including Ethiopia. The UNFPA denies the charge of endorsing forced abortions in China.
Postponing the age of marriage and delaying childbirth can significantly reduce the risk of subjecting young women to the arduous labour that induces fistulas. However, educating Ethiopian women about these facts is proving an uphill battle.
At present, the Addis Ababa Fistula Hospital runs an awareness programme in conjunction with the Ethiopian Women Lawyers Association.
“We have a women lawyer who gives talks to the girls, here in the hospital, about their rights: that they don’t need to be married early, and should be going to school instead,” says Hamlin.
“But it is very difficult to alter the culture when you’re sitting in Addis Ababa, unless it comes from the people in the village,” she adds.
“So we have to go to the villages, I reckon, to talk to the people there, if we want to see change.” — IPS