Fistula

Physically she is tiny.  She has the face of a 13-year old, quick to laugh, quick to cry, with big eyes that draw you in like a baby bird’s.

But she is no baby bird. She is 31 years old, and she told me one of the saddest stories I have ever heard. I will call her Evelyn.

Evelyn is one of a handful of women I met in Dembi Dollo, Ethiopia. They had been to the Addis Ababa Fistula Hospital for surgery. The stories they told were remarkably similar, and remarkably moving.

Fistulas have a high “ick” factor. Let me quote the hospital’s website answering the question, “What is a fistula?”

“A fistula is a hole. An obstetric fistula of the kind that occurs in many developing countries is a hole between a woman’s birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder (called a vesicovaginal fistula or VVF) and sometimes between her vagina and rectum (rectovaginal fistula, RVF). This hole results in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their inability to have children and their foul smell.”

Like most of the other women I interviewed, Evelyn told me that she was in labor for three days. Sometime in that third day she stopped feeling movement from her baby. Her family managed to get her to a hospital then, where a cesarean section delivered the dead child. Evelyn was lucky: if she had not reached a hospital she probably would have died too.

Who can imagine the exhaustion of three days of labor? Beyond it was the grief of losing her only child. And on top of that was the dawning realization that she had been badly damaged in the experience.

Thankfully, and unusually, her husband has stayed with her. But apart from him, she became isolated from society. Her husband washed her clothes; she saw no one else. For two and a half years she lived without a future. She knew she would never have children. She expected that she would never have friends.

Then, after nearly three years, she heard that the clinic run by the Daughters of Charity offered help. She was examined and sent by bus, along with 11 others, on the two-day trip to Addis.

The Fistula Hospital is a simple, clean and pleasant collection of buildings. Some of the women being treated are obviously depressed, but others seem strikingly peaceful. For many, years have gone by since they have been able to interact with other women. (An earlier group from Dembi Dollo found that none of the hotels in Addis would have them, because of the smell; a series of restaurants turned them away.)

Evelyn was at the hospital for seven weeks—being operated on, then recovering and relearning bladder control. She remembers the long trip home as though it were a dream. “I thanked Jesus,” she told me.

I found it so startling to meet women who lacked basic obstetric care. For most of the history of the world, cases like Evelyn’s happened with no help. They still happen, in many places, for thousands of women. Meeting Evelyn made me a lot more appreciative of medical care.

If you want to know more, see http://www.fistulafoundation.org/

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