A fate worse than death for scores of African women

Story highlights

  • African women with obstetric fistula see themselves as the walking dead, doctor says
  • Fistula can be repaired with delicate surgery and follow-up care
  • Many African hospitals and doctors lack education and expertise
  • Thursday is the first-ever International Day to End Obstetric Fistula
It's a condition practically unheard of in the United States and most Western countries. But in a culture where a woman's status and dignity is decided by her ability to provide a husband with multiple children, it can be a fate worse than death.
"Obstetric fistula" is a mouthful. But to these women, it's much more than just a physical injury. They see themselves as the walking dead, says Dr. Justin Paluku Lussy, head of the department of obstetrics and gynecology at HEAL Africa Hospital in Goma, Democratic Republic of the Congo.
An obstetric fistula occurs when a woman withstands days of obstructed labor, when a baby's head is constantly pushing against her pelvic bone during contractions -- preventing blood flow and causing tissue to die.
This creates a hole, or a "fistula," between a woman's vagina and her bladder or rectum. Her baby is unlikely to survive. If the mother lives, she is unable to hold her urine and, in some cases, bowel content, Paluku Lussy says.
A woman with a fistula, who is perpetually leaking urine and sometimes feces, is often rejected by her husband and shunned by her village because of her foul smell and inability to bear more children.
"These women have so much shame and so much fear. They spend so much money on perfume trying to cover up the smell," says Alison Heller, a doctorate student at Washington University in St. Louis who is leading a research study of 50 women in Niger awaiting fistula surgery. The women range in age from 15 to 70.
An estimated 20% of Paluku Lussy's fistula patients report feeling ostracized by their communities, and divorce is common, says the doctor, who started his residency in 2001 at HEAL Africa, a 155-bed tertiary hospital with a fistula repair unit.
"People think fistula patients are witches and just have bad luck," he says.