Health experts estimate as many as 800,000 women in Nigeria are living with fistula – an injury occurring from prolonged, obstructed labor. And there are another 20,000 new cases every year. The condition often results in the baby’s death and leaves a woman chronically incontinent and often abandoned or shunned. But recently, doctors from the United States and Britain joined 100 Nigerian surgeons in a project to help them.
It's called Fistula Fortnight – a two-week effort sponsored by the UN Population Fund to surgically repair the problem in over 500 women. All had suffered from obstructed labor lasting days. What happens is that soft tissue is squeezed between the baby’s head and the mother’s pelvic bone. That prolonged compression damages the soft tissue, causing it to die and leave a hole in the bladder, bowel or both.
The problem is largely unknown in countries where women have access to good medical care. Prompt treatment usually involves a Caesarean Section delivery, which means the baby is delivered through an incision in the woman’s abdomen and uterus. But in many developing countries, especially in rural areas, fistula is common. And not all women survive.
The Fistula Fortnight in Nigeria took place from February 21st to March 6th.
One of those taking part in the project is Dr. Ambereen Sleemi of Maimonides Medical Center in Brooklyn, New York.
"I recall a woman who was almost 52 – maybe 53 we’re not really sure – who had lived with leakage for 25, maybe 30 years because she didn’t know there was a cure. She thought it was an infection. And the young woman, Charity, who had lost her job as a primary school teacher because she delivered her last child in traditional fashion, which was in a remote area at her parents home, where she developed a fistula. The school officials said she couldn’t work until she got repaired. And without a job she couldn’t afford the surgery. When we left, finally, from the fortnight, she was dry," she says.
Also contributing to Fistula Fortnight is Dr. William Meyer, of the University of Arizona College of Medicine. He says he had been practicing medicine for 25 years before he read a newspaper column and learned about fistula in developing countries.
Dr. Meyer says, "Basically, their life has been taken away from them. They’re ostracized or marginalized because of the fact that they don’t smell very good. And when you get a chance to operate on these patients and cure their leakage it’s not an exaggeration to say you’re giving them their life back. And that to me was one of the most gratifying things involved in the care of fistula. Because as awful a thing as it is ninety percent of these patients are cured in the first attempt to close their fistula."
The surgeries during Fistula Fortnight were done in four northern Nigerian states: Kano, Katsina, Sokoto and Kebbi. Dr. France Donnay, Chief of the UN Population Fund’s Reproductive Health Branch, says further fistula projects are planned.
"We will continue working with those governments and actually with other states in Nigeria. We have strengthened an already existing relationship with those governments. So we will continue working in those sites. The fortnight is just a step in the global campaign," she says.
That campaign is underway in thirty countries, most of them in sub-Saharan Africa. Dr. Donnay says the ultimate goal of the campaign is to prevent fistula.
"We want to help women who are affected by fistula, but we also want to prevent fistula from happening in the first place. And that means strengthening the maternal health programs in all those countries. So that those women who are pregnant do have access to good maternal care; do have access to a C-Section when they need it; and their life and the life of their baby are saved," she says.
Dr. Ambereen Sleemi agrees.
"Operating at this rate for years would start to make a dent in the backlog of thousands patients with fistula. However, the prevention of almost 20,000 new cases a year in Nigeria is also of paramount importance. And the need for prevention cannot be overstated," she says.
By Western standards, the surgeries are done at bargain prices. Each fistula operation costs about $300. Depending on the amount of fistula damage, repair surgery could take anywhere from twenty minutes to over four hours. The procedure known as a Caesarean Section – or C-Section – costs only $60.
There’s an African proverb about giving birth. It says, “The sun should not rise or set twice on a woman in labor.”