Although there is no accurate count of the number of women suffering from an obstructed childbirth injury, incident rates could be as high as 2 to 3 per 1,000 women in countries with high maternal mortality rates.
“Approximately 800 women worldwide die each day from preventable pregnancy and childbirth-related causes. 99% of all maternal deaths occur in developing nations.” [World Health Organization (WHO) Fact Sheet May 2012].
Dr. Steve Arrowsmith, working with maternal health in Africa for 28 years, cites another fact that emphasizes this grim reality: “In Ireland, a woman has a 1 in 47,600 chance of dying in childbirth. In Africa, that same woman has a 1 in 12 chance of dying.”
The women and babies who perish from the lack of access to medical care, as Dr. Arrowsmith says, “are a cause for international outrage.” But the horror does not end there! As maternal health advocates like Dr. Arrowsmith know all too well, the women who survive prolonged labor (averaging four days) not only have to grieve the loss of their baby, but many also suffer physical and emotional consequences that make death seem kind in comparison.
Untreated obstructed labor means that the unborn child is lodged in a too-small birth canal. The force of pushing the fetus, usually no longer alive at this point, against the birth canal strangles the blood supply to the tissue. The tissue dies, sloughs away, and leaves a hole, or in medical terms, an obstetric fistula. Urine and in some cases, feces, now leak continually through the newly formed hole.
In 2005, the Journal of Midwifery and Women’s Health reported that, “While prevalence rates of obstetric fistula are unavailable due to inaccurate reporting, under-reporting and shame, incidence rates could be as high as 2 to 3 per 1,000 women in countries with high maternal mortality rates.” A best guestimate from WHO suggests that in Asia and sub-Saharan Africa, more than 2,000,000 women suffer from obstetric fistula.
These women, due to the unpleasant odors associated with their condition, are usually abandoned by their husbands and often become outcasts. But many of these women can cured through a surgical procedure like in the case of Nana:
Nana’s journey to this moment of hard-won triumph was sadly typical. At 15 years of age, Nana was given in marriage to Kabinet, a 20-year-old farmer. Pregnancy soon followed. After counting nine full moons, Nana prepared herself to give birth. The baby did not come. Another month passed, and Nana went to the traditional healer in her village. The mixture she took made her ill, but still no birth. After four more weeks, Nana began to feel excruciating pain. A village-wide collection of money paid for Nana’s transportation to the nearest hospital.
Friends carried Nana for many hours in a make-shift hammock to a taxi stand. She endured more hours of agony as the taxi sped over rough roads to the hospital. After three days of at the medical centre, doctors removed the lifeless baby. Nana was left with leaking urine, and her legs were paralyzed for months.
While recovering, Nana received a visit from her husband and his family. Nana recalls the words that seared her heart, “Kabinet announced that he would take me back as his wife only when I was healed.” As soon as Nana could move around on her own again, she secretly went to Kabinet, asking him with desperate hopefulness, “Even though I have this sickness, do you love me?”
Kabinet’s reply was stark in its finality. “No, I do not love you anymore.”
A physical and emotional wreck, Nana returned to work on her parents’ farm. She and her mother were tireless in their daily routine so that Nana always had a fresh supply of cloth pads. Despite the expense, Nana’s parents made sure there was ample soap for washing the cloths and her clothes. But, as much as they tried to stay ahead of the wet and the odor, cloth and soap were no match for the relentless leaking. Nana also turned to traditional healers, but, as she explains, “The results were awful, including bad headaches and terrible sores.”
New life for Nana
In 2009, seven years after her childbirth injury, Nana moved to the capital city of Conakry to access the surgery she had heard about for women with her condition. While Nana’s two surgeries at the big hospital in Conakry failed, her life took an unexpected turn for the better. She recalls with a brilliant smile, “Three years and four months ago, I met a wonderful mane named Djibril. He decided that he loved me, and he set about winning my heart. I told him about my condition, and he said that was all the more reason I needed him. Like my parents, Djibril never doubted that I would be cured. How could I not marry him?”
Djibril’s house-building business financed Nana’s three trips to a hospital in Sierra Leone known for fistula repairs, but each time reasons were given for the surgery not moving ahead. Despite these setbacks, Djibril and Nana had something new in their lives to focus on. A friend Nana met while both sought treatment, sent her eight-year-old daughter, Zenab, to live with them. In one of Africa’s traditions, family and friends give up one of their own children so that no one is ever childless. Zenab quickly became a beloved daughter to Nana and Djibril.
Then Nana and Djibril learned about a Mercy Ship coming to Conakry, offering free fistula surgeries. Nana attended the Mercy Ships screening with a group of friends who also suffered from obstetric fistulae. Some soldiers almost turned them away, but as Nana recounts, “A Mercy Ships nurse quickly stepped in and told the soldier that we would be screened.”
Although Nana’s first two surgeries onboard the Africa Mercy did not completely correct the problem, she never doubted that she would be cured. Nana’s determination bore fruit and her third surgery at the skillful hand of Dr. Judith Goh and much prayer from everyone around her resulted in a successful fistula repair. After a two-week healing period, Nana was finally dry! Even after this it still takes about 6 months after the surgery for the patients to completely recover from the surgery but after that they can live completely normal lives.
Even those women who are not completely cured, mostly those who have already had one or more failed surgeries in less advanced facilities, receive emotional healing on the hospital ward through the love and care expressed to them by the staff and by being shown they are beautiful people who do have value. They are also taught techniques to minimize the effects of the incontinence and provided with new clothing so they can leave the ship with their head held high!