If you do not breathe through writing, if you do not cry out through writing, or sing in writing, then don't write, because our culture has no use for it.

Anais Nin





Monday, December 6, 2010

Fistula



In the bush, just out of screaming distance, she bled alone for an hour. Not so long, perhaps, maybe someone saw her sooner, by herself, on her side, and saw the blood. She remembered waking up in the hospital, and was not grateful.

There had been no crying. For a moment perhaps she was not alone, but bleeding with her son, or daughter. She did not know which, or what became of him or her. The infant did not bleed as well or long as she did, and had faded into heat to join the little girl, that name, that daughter she once was who bled to death that day.

I’m glad I do not have to name this girl, she isn’t real, I made her up to play a part, which is un-staged life for two million women worldwide. 

The narrative is my remote conception of a stillborn delivery, for young African women. Not all are forced into seclusion by shame at some archaic extra-marital pudendal taboo, as she. Most are simply too remote, in terms of time as well as geographic distance, from the most basic perinatal care. Compounding are cultural traditions of pre-to-early teen marriage for many girls. The latter tribal relic makes women more vulnerable and likely to incur injury in labour, and a sepsis there developed makes them lepers, bodily inflicted and exiled from comfort by mass pathologies whose biological reducibility is in debate.
In the developing world, obstetric fistula is almost always the result of obstructed labour. During prolonged obstructed labour the soft tissues of the pelvis are compressed between the descending baby’s head and the mother’s pelvic bone. A traumatic injury called a fissure results when the lack of blood flow to the soft pelvic tissues leads to necrosis and ultimately a hole forming between the mother’s vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal), or both, which immediately results in urinary or fecal incontinence, or both.

The progressive complications of fistula are devastating. In nearly every case the baby is stillborn. Women and girls with fistula are unable to stay dry. They smell of urine or feces, and are shunned by the community and, at times, even by their own husbands and families. They remain hidden, shamed, and forgotten.

Fistula is an easily preventable disease, but it will take time to alter deep-seeded cultural institutions, and prevention will not ease suffering of women who already live with fistula.

Treatment is available through reconstructive surgery. This surgery for uncomplicated cases has a 90% success rate, and successful surgery enables women to live normal lives, even have more children, by a cesarean section to prevent the fistula from recurring.

Some women are not candidates for this surgery, but can seek out alternative treatment called a urostomy, wherein a bag for the collection of urine is worn on a daily basis. If treated early, fistula cases can also be treated through urethral catheterisation.

Unfortunately, while at US standards the price of surgery and care of $300-450 sounds almost laughably low-priced, a great majority in Africa could never save as much however frugal, not to mention how elusive must be employment when soiled beyond personal control.
The largest challenge that stands between women and fistula treatment is information. Most women have no idea that treatment is available. Because this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence with no relief.

We can train counselors and clinicians in the social as well as technical steps to remedy. In fact, think for a moment of the satisfying efficacy of trained and empowered fistula survivors animated by new hope and knowledge, with a capacity to impart it with tangible empathy, who can go to suffering women still doomed to live alone, as emissaries with an invitation.





Kenneth

In 2003, UNFPA and partners launched a global Campaign to End Fistula with the goal of making obstetric fistula as rare in developing countries as it is in the industrialized world.








This 5-minute film features Nigerian fistula surgeon Dr. Zubairu Iliyasu and Natalie Imbruglia, a
spokesperson for the global Campaign to End Fistula.

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