Raising Awareness

Today I want to write about something outside of my usual sphere of interest. This weekend I watched a social documentary called "Walk to Beautiful" about Ethiopian women who suffer from obstetric fistulas. If you have Netflix, you can request the DVD, or watch it instantly on your computer or TV.

A fistula is essentially a hole between the birth canal and one or more internal organs, which causes permanent incontinence of urine and/or stool. What causes a fistula? There are a few different causes, but most commonly it occurs in women in remote areas of the world who do not have professional help during labor & delivery. In Ethiopia, for example, less than 60% of women have anyone trained present for their labor and delivery. When complications arise, which they do in approximately 15% of cases, there is no one there to help get the baby out in a timely manner (via vacuum extraction or Caesarean section), and a woman will literally be in labor for days (called obstructed labor), until the mother and/or the baby die. When a woman survives, commonly the baby does not, and she is left with the devastation of the loss of her child and a fistula.

Due to the stench of constant leaking of urine or feces, the woman is shunned by her husband and community, and forced to create a shelter for herself away from her family and friends. She can no longer work, and is destined to live out the remainder of her days until death alone. Due to lack of information, women will likely not even know what their problem is called, or that there is hope for a complete recovery with a surgical procedure to repair the fistula.

If a woman somehow hears this message of hope, they will often walk for hours or days to the nearest bus stop, enduring a hot, smelly & humiliating bus trip for many more hours or days to the Addis Ababa Fistula Hospital. At the hospital they will meet other women with the same condition. They will be taught about things like domestic violence, rape, and labor & delivery. They will know they are not alone, and will find out what has caused their problem. They will form friendships with the other women there, and be treated with kindness and compassion by the doctors and nurses at the hospital. A doctor will examine them and take a history, asking how long the woman was in labor, if the baby lived or died, and how it was delivered. (One woman on the documentary had been in labor for a week, the baby had died, and eventually it had been 'pulled out' of her. Another woman reported her dead child being removed piece by piece.) I know this is not easy to read, and it's certainly not easy for me to write about. It breaks my heart. After the history & exam, the doctor will tell the woman where the hole is, and explain how it can be repaired.

A trained fistula surgeon will operate, repairing the hole with an intravaginal procedure. The patient will then be cared for post-operatively for about 2 weeks, while she and the medical staff wait to see if the operation was successful. Once her bed is consistently dry (the Addis Ababa Fistula Hospital has over a 90% success rate), the woman is given a new dress, bus fare, and discharged back to her community, taking with her knowledge to share with the women in her area about the importance of going to a hospital when they are ready to have their baby. According to one Ethiopian woman, "Most people don't know that a hospital can help them, but if they knew, they'd go." At a hospital, women who develop complications during labor or delivery will have doctors to perform a C-section, thereby preventing a fistula caused by prolonged, traumatic labor.

Once back to their village, women are accepted back into their families' homes and slowly they can rebuild a new life. Some women choose not to go back, due to the horrible way in which they were treated. One (very young) woman on the documentary refused to go home, and a nurse at the fistula hospital put her in touch with a lady who runs an orphanage for babies and children whose parents have died of HIV. The young woman went to live there permanently, and I cannot tell you how touched I was to see her paired up with a parentless child, as the director of the orphanage told the child, "This will be your mother now."

Fistulas used to be common in Europe and the United States, but since the development of easily accessible emergent obstetrical care and common practice of using C-section to resolve obstructed labor, the vast majority of fistulas occur in remote places around the world where there are either no hospitals or trained professionals, or where there is a lack of knowledge regarding the importance of laboring at a hospital or near one. Today the World Health Organization estimates there are roughly 2 million women world-wide living with fistula, and another 100,000 women will develop fistula each year. Fistula is most common in sub-Saharan Africa and Asia.

Fistula sufferers are broken physically, socially, and psychologically. Many consider suicide. Their life is essentially ruined. It is a heartbreaking problem, and it's amazing to consider that if I lived in one of these remote areas of Ethiopia, I could easily have lost my firstborn daughter in labor, without a doctor to perform the vacuum extraction that brought her into the world. She was face up and had her arm up by her head, making it impossible for me to deliver her on my own. If the vacuum extraction had not worked, I would have had a C-section. Neither of these options would have been available to me in remote areas of Africa or Asia. I also had a miscarriage and a handful of surgeries as a result. Without access to medical care, I would likely have died from at least three of the problems requiring the surgeries. We are excessively blessed to live in places with hospitals nearby, trained medical professionals, medication, clean water, medical insurance, and nutritious food.

I want to help. I want to do something to give my Ethiopian sisters a chance at recovery and a new life. It costs approximately $450 US dollars to give one woman a fistula repair operation, post-operative care, education, a new dress, and bus fare home. $450! Not just for hope, but for a whole new life.

If you want to help, and I pray some of you do, you can donate to the Fistula Foundation here. Any amount will help. If you want to give the entire $450 to give an Ethiopian woman a new life, participate in the Love-a-Sister program here. There is even an option to have your credit card charged $37.50 monthly for a year. At the end of the year, you will have given $450, the total amount needed to bless an Ethiopian woman.

I thank you for reading and considering. For more information on the Fistula Foundation, click here.


  1. Thank you for bringing this to our attention. We often times take for granted the luxuries we have. We don't realize that had we'd been born in a different part of the world our lives would be drastically different.

  2. I remember Oprah doing at least one show about this which was included in her anniversary DVD edition. I figured there must be places in the world still impacted by the lack of medical assistance with childbirth--as all the world used to be, resulting in high rates of infant and maternal death. You know my views on medical assistance for childbirth!

    Your post prompted me to do a (very) little research on childbirth, modern and historical. Thank you for the link to be able to help.

  3. Yes, the female doctor (Catherine Hamlin) interviewed on the Oprah show, developed the surgical technique with her husband. He has passed away, but she is still working (in her 80s) at the hospital I mentioned in this post. She has been nominated for a Nobel Peace Prize for her work.

  4. I have recently learned about fistulas in school, but had no idea about obstetrical ones. Your beautiful, open heart and generosity are inspirational, Jenn. I'm going to have to get the DVD from Netflix and watch it.

  5. Jenn, if you're interested in a firsthand look at how these women are being served and loved back to health, check out Lindsay's blog atlindsayreneekathleen.blogspot.com/. She works as a nurse on Mercy Ships with these women, and is a fantastic writer.
    Also, thanks for your comment on my blog. So glad my post spoke to you:)

  6. Jenn, so glad you found my blog and commented! I am always so glad to meet other women who are interested in women's health issues in the developing world, especially VVF. I am so glad you enjoyed the movie A Walk to Beautiful too-- it makes me tear up every time. Although the movie is filmed in East Africa and I work in West Africa, the stories of the women are the same... breaks my heart. I'll be coordinating our VVF program on the ship this year, so I will be doing lots of posts about the ladies this year!

    Am looking forward to exploring your blog as well.

    Thanks again for saying hello!

  7. Thanks for reposting this on Facebook. The authors of Half the Sky included the fistula hospital in their book. The movie made for a good follow up.


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