Beyond stillbirth, shame: Women with a fistula
BAHIR DAR, Ethiopia (Reuters) - Thirty-year-old Alem wears two small bags of perfumed soap around her neck to mask the stench of urine and feces that has accompanied her for 10 years since she suffered a fistula.
The childbirth injury almost unheard of in the developed world still afflicts as many as two million women in the developing world.
Obstetric fistula is caused by prolonged labor which forces the unborn baby's head against a woman's pelvis -- killing the baby and destroying the trapped tissue in the birth canal, the rectum and the urinary tract.
Alem, whose name doctors have changed to preserve her anonymity, says the smell caused her husband to divorce her and her family to shun her.
Standing outside a specialist clinic in the impoverished northern Ethiopian town of Bahir Dar, Alem recalls the traumatic labor which killed her baby and wrecked her bladder and her rectum.
"I tried to cure myself in holy water but my body was already swollen and the baby had already died," she says.
For the sufferer, the grief of coming to terms with a still-born child is compounded by the misery of losing control of bodily functions.
"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 Dr Andrew Browning, an Australian gynecologist who has been working at the fistula clinic here for two years.
The condition was almost totally eradicated by western medicine with the advent in the 18th century of the Caesarean or C-section -- a surgical procedure to remove the baby and shorten labor.
FOUR-DAY Labor
Today, a woman in the developed world will go through an average of 12 hours of labor compared with almost four days of labor which is the average in Ethiopia, according to Browning.
Fistula is particularly prevalent among malnourished women. Ethiopia, one of the world's poorest countries, has 200,000 women currently suffering the condition with an estimated 9,000 new cases every year.
Treatment is available to repair the damage done by a fistula -- it is successful in more than 97 percent of cases, says Browning.
At $300 for the operation it seems inexpensive by western medical standards but that is a fortune in Ethiopia.
The clinic here, and the Addis Ababa Fistula Hospital in the capital, 500 km to the south, rely on donations to operate.
American television host Oprah Winfrey is a high-profile supporter of the clinics and the United Nations has launched an 'End Fistula' campaign with the goal of eradicating the condition by 2015.
But Browning worries the condition does not have the 'donor appeal' of diseases like HIV/AIDS and malaria that have attracted pledges of billions of dollars from charities and western philanthropists like Microsoft chief Bill Gates.
"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."
Patients here in the clinic are nursed back to health by women, former fistula sufferers themselves, who have been through the same ordeal.
Zimzim, 25, has already undergone the operation. As she recuperates in her hospital bed she pictures her new life -- not completely normal, but free of some of her burden of shame.
"I don't want to get married or have children," she says. "I just want to live with my close family. I have suffered enough problems."
