On the 100th anniversary of International Women's Day, MSF is raising awareness of a little-known but devastating womens' health issue that affects up to two million women in developing countries.

Extra: Interview with Dr. Volker Herzog, and nurse Helen O'Neill in Scope

A devastating, yet preventable injury

Obstetric fistula is one of the most serious consequences of obstructed labour and occurs when the soft tissues of the pelvis are compressed by the baby’s head. The lack of blood flow causes the tissues to die, creating a hole between the vagina and bladder, the vagina and rectum, or both. It results in urinary and/or faecal incontinence. The injury is completely preventable and has almost disappeared in Ireland and other developed countries where there is universal access to obstetric care.

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Esther Feibouko (28) and her two-year-old daughter Abigail (in background). Esther has had four pregnancies. One child died soon after birth, and her three remaining children are six, four and two years old. Esther developed a fistula in 2008 after being in labour with her daughter Abigail for 12 hours.

Social stigma

In Burundi, obstetric fistula is known as 'the Backyard Disease'  as women suffering with fistulas are often outcasts from their communities because of the smell associated with the leaking of urine/faeces.   In some cases they are abandoned by their husbands and families. This problem is largely hidden because it mainly affects young women who live in poor and remote areas, with very limited or no access maternal health care.

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Zanaba Amidou (16), from the Peuhl tribe went into labour three months ago. After three days of intense labour pains, her mother Deooda went to find a traditional birth attendant. On her seventh day of labour, Zanaba's mother hired a motorcycle to transport them to the nearest clinic in Paua. The journey took the whole day. After arriving at MSF's clinic in Paoua, doctors performed a caesarean section but the baby was stillborn. Zanaba spent two months at the clinic in Pauoa before being brought to the MSF fistula camp in Boguila.

Surgery to repair the fistula can help these women to start a whole new life: many women who were ostracized from their community begin a fresh start.  The operation is delicate and requires specific skills. Depending on the severity of the case, the operation may take several hours. In order to operate on fistula, a long and specific training is needed and there are only a few specialised centres in Africa.

MSF Fistula Camps "I will sing and pray every day"

 As Zanaba says, "I have suffered a lot; I didn't lose much blood, but I suffered. I didn't want to get married, but my father made me. Now I haven't seen my husband for three months. My mother-in-law has been to visit me in the fistula camp, but my husband has not. I know he is aware what has happened to me, and yet he has not done anything for me. I am very happy to have had this operation. When I go home I will dance and sing and pray every day. I will pray and thank God for this doctor."

 MSF treats obstetric fistula in three permanent centres in Burundi, Chad and Nigeria, as well as running ad hoc fistula camps in Democratic Republic of Congo, and Central African Republic.  In 2010, MSF operated on and treated 1,000 women suffering from obstetric fistula.

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