ETHIOPIA: Two million women across Africa wait treatment for fistula, a humiliating injury now unknown in developed world

Western medicine and funding has almost won the war against the crippling virus of polio in African countries and is leading campaigns against other diseases of poverty but the world has turned a blind eye on two million women who are left to wither away in humiliation. The childbirth injury, obstetric fistula, is caused by prolonged labour, averaging 3.9 days, usually in young and undernourished women. The tissue between the bladder and birth canal and the rectum in the birth canal dies due to pressure on the mother's pelvis, resulting in the birth of a stillborn baby and a tear which allows for an uncontrolled steady stream of urine, faeces or both. In 97.3% of the cases, the fistula can be sealed with proper treatment. Without the procedure, urine will continue to leak for the rest of their lives and they are cast aside from society. The average cost of fistula surgery and post-operative care for one woman is just 300 U.S. dollars. Australian gynaecologist Doctor Andrew Browning has over the past decade worked to cure these women, most of whom come from rural areas in Ethiopia and have no access to modern medical treatments. Browning, a devout Christian, tells of the horrors he frequently hears from patients, some of whom have been locked away in huts for as long as 10 years. "They can't hold any urine in themselves, so they smell, they're ashamed, usually the husbands divorce them, the families reject them and they live a life of poverty and misery and being an outcast for the rest of their lives," said Browning who lives with his wife in the town on the banks of the Blue Nile. Browning has treated 981 patients since the Centre for Fistula Bahir Dar was founded two years ago as an extension of the main Addis Ababa Fistula Hospital, founded by two Australian gynaecologists in 1974. The centre which often has double the patients then what it can accommodate, is one of five extended branches being built in remote locations across Ethiopia. Supported by non-profit foundations and private donors, such as famed Television host Opra Winfrey whose contribution paid for the nursing aids house, the small centre in Bahir Dar provides medical treatment, education on health care and hygiene, food and wages for the small staff. For over 10 years, Alem, now 30, lived with a fistula. The unpleasant smell of urine led her husband to divorce her and she was left isolated from the rest of her village in the Wollo province in northeastern Ethiopia. Lacking education or the knowledge that proper medical treatment could cure her injury, Alem dipped herself in natural spring water. "I tried to cure myself in holy water but my body was already swollen and the baby had already died," said 30-year old Alem covered in a colourful woven blanket. Alem's poverty stricken family did not have enough to get her to the nearest clinic. Today she lies among 43 other women in the Bahir Dar centre for fistula awaiting treatment after a woman from her village accompanied her to the same place where she was treated just days before. The last known Western case of the painful and degrading condition was reported in the United States in the 18th century, thanks to the introduction of surgical incision, known as a caesarean section provided at childbirth when vaginal delivery might pose a risk to the mother or baby. Today, 200,000 women are suffering from fistula in Ethiopia alone and every year an estimated 9,000 more will suffer obstructed delivery. 21-year old Fanta Kaptam smiled shyly as she tightened the soap bags wrapped around her patient's neck to tone down the foul odour of urine as they stood outside the Bahir Dar centre. She recalled the day her dream of becoming a mother at age 12 was shattered by a tear in her inner organs, leaving her hopeless and injured. Kaptam is one of 13 Ethiopian nurses at the centre who has decided to devote her life to working with women with fistula. "I want to help the other ladies who are suffering from this problem," said Kaptam. "I hope to expand this hospital and give treatment to other women who have fistula, this is why I am here". In 2003, United Nations Population Fund, UNFPA, and partners launched a global "End Fistula" Campaign in more than 40 countries in Africa, Asia and the Arab region, with a target date for fistula elimination by 2015. "Fistula is now becoming a more prominent health issue and there's estimated to be about 2 million patients waiting predominantly in Africa for treatment and currently the world's capacity in dealing with the problem is about 8,000-10,000 cases being done every year," said Browning. "We are really touching the tip of the iceberg". Many women think they were cursed by God and prefer not to test their fate. 25-year old Zimzim who has undergone several surgeries but has not yet been fully cured only wants to go home and live among her close family. "I don't want to get married or have children, I just want to live with my close family, I suffered enough problems".

ITN Source | March 31, 2007

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