I have a soft spot for many things in life: cat videos on YouTube, quirky coffee shops and Pittsburgh Steelers paraphernalia, to name a few. In my work, I’ve also developed a soft spot for issues that are classified as “neglected” — the underdogs of global health.
We never came up with great answers, but the marching orders were clear. In order to end the neglect, we had to raise attention, understanding, political will, and money.
So it’s no surprise that when I first heard about obstetric fistula — arguably among the most neglected of health issues — I wanted to learn and do more. If you don’t know what fistulas are, you’re not in the minority; my blackberry didn’t even recognize the word “fistula” as I typed it, if that’s any indication, and it’s a topic very few people talk about.
A fistula is a hole in a woman’s birth canal caused by prolonged, obstructed labor, which isn’t relieved in a timely manner by a medical intervention. It’s most common in sub-Saharan Africa and Asia, in large part due to a lack of access to C-sections and other emergency obstetric care. Women with fistulas develop chronic incontinence — a polite way of saying that they cannot control when and where they urinate or defecate. These women are humiliated, and are ostracized in their communities.
The indignity of transforming from a proud, strong, expectant mother into an outcast suffering from intense physical and emotional pain is one of the most tragic things I can imagine. Participants on a ONE-led tour of Sierra Leone in 2010 learned about this injustice from women experiencing it first-hand as they toured the Aberdeen West Africa Fistula Center. Upon return from the trip, former White House Press Secretary Dana Perino reflected that she had “not been able to get it out of my mind since.”