New York Times Examines Foundation Performing Fistula Repairs In Sub-Saharan Africa

Main Category: Women's Health / Gynecology
Also Included In: Pregnancy / Obstetrics
Article Date: 26 Feb 2009 - 2:00 PDT

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The New York Times on Tuesday examined efforts to treat women with the birth injury fistula in sub-Saharan Africa and profiled two Tanzanian women receiving corrective surgery through the African Medical and Research Foundation. The foundation recently brought two surgeons to a regional hospital in Dodoma, Tanzania, to operate on women with the injury and teach other physicians the procedure. The surgeons aimed to complete 20 operations in four days on women ranging in age from teens to 50s -- a mission that "illustrates the challenges of providing medical care in one of the world's poorest countries, with a shortage of doctors and nurses, sweltering heat, limited equipment, unreliable electricity, a scant blood supply and two patients at a time in one operating room," according to the Times.

Although fistulas were eliminated in developed countries more than a century ago, the injury afflicts more than two million women and girls in sub-Saharan Africa and Asia. Fistula results from obstructed labor, in which the infant is too large or in the wrong position to pass through the woman's pelvis. Girls who become pregnant before their bodies are fully developed or women whose growth is stunted from malnutrition often have small pelvises that make them prone to obstructed labor, the Times reports. If prolonged, obstructed labor not only is life-threatening to the woman and the infant, it can injure tissue when the woman's bladder, uterus and vagina are crushed between the pelvic bone and the infant's skull. This injured tissue can develop a fistula, a hole that results in a constant urine stream through the vagina and, in some cases, nerve damage in the legs. Some women also suffer damage to the rectum, which can result in stool leakage. The Times reports that fistulas "are a scourge of the poor," who often cannot afford medical care or cannot obtain a caesarean section in time to prevent the injury. Although fistulas are preventable, avoiding the injury typically is second to treatment in developing countries, as prevention requires more health workers, education and better transportation, the Times reports. According to the Times, many experts believe it could take decades for fistula to be eliminated from Africa, and the injury's "continuing presence is a sign that medical care for pregnant women is desperately inadequate."

Jeffery Wilkinsin of Duke University, who works with Amref at the Kilimajaro Chrisitian Medical Center in Tanzania, said that in Africa, women with fistula are frequently outcast because of the odor that results from the injury. Although the cure rate for fistula is often cited as 90% or more, that figure is "not a realistic number," he said, adding that many women with extensive damage or scarring do not always regain nerve and muscle control needed to control urination, even with the repair of a hole. "Fistula is the thing to follow," he said, adding, "If you find patients with fistula, you'll also find that mothers and babies are dying left and right" (Grady, New York Times, 2/23).

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