The Blog

To Speak Plainly: Obstetric Fistula

"It is absolutely devastating. When they get undressed for medical exams you will see they're wearing so many layers, plus plastic wrapped around them. The smell is so overwhelming some people can't go into the same room."

Last week, spellchecker wouldn't recognise the word 'feces'.

An accidental switch between U.K./U.S. dictionaries had invited that aggressive zigzag, along with passive-aggressive suggestions for words that might be more appropriate.

Fences. Fetes. Faces. How nice.

Such prim behaviour from modern technology, right before the International Day to End Obstetric Fistula, was particularly problematic. Because you can't talk about one of the most medieval, punishing, hateful conditions to affect women in the world without it.

Obstetric fistula is a hole in the birth canal, caused by prolonged obstructed labour. The first thing to know is that it is entirely preventable with medical and surgical intervention. The second is that it causes leakage of urine and feces. Constantly.

"Have you ever met a woman with fistula?" asked Barbara Margolies, Founder of IOWD, a charity providing fistula repair surgery to women in Rwanda.

"It is absolutely devastating. When they get undressed for medical exams you will see they're wearing so many layers, plus plastic wrapped around them. The smell is so overwhelming some people can't go into the same room."

Think about how uncomfortable it was, that last rainy day in sodden socks and wet feet. The mortifying cliché of getting your period while wearing white trousers.

Now spend some time with Priscilla, a passionate, gift of the gab student in Kenya. She developed a fistula after four days of obstructed labour, the result of rape when she was 15.

"You'll always be scared, because you smell bad," she says, shifting forward on the edge of the bed, sharing her story in global surgery documentary The Right To Heal. "If you are sitting with people it's very complicated for you to walk away from there. So you wait for them to walk away first."

There are at least two million women living with the condition, and an estimated 50,000-100,000 new cases each year.

Thankfully fistula repair surgery has a high success rate, and the average cost of treatment is just $400. UN Secretary-General Ban Ki-moon spoke this week about the 47,000 operations that the United Nations Population Fund (UNFPA) - which launched the Campaign to End Fistula with a growing number of partners worldwide - has supported.

But that's 47,000 procedures in the last 12 years: insufficient to cover 12 months' worth of new cases, let alone the ones that came before. And so for a week and a month and a decade and more, millions of women have never been dry.

Haven't heard of obstetric fistula? You're not alone. Once a universal risk of childbirth (at least 15% of pregnancies result in complications requiring emergency medical intervention), many healthcare systems around the world have managed it out of existence. Of all the fears that expectant mothers in high-resource settings confront in the night, fistula simply isn't one of them.

In fact the last fistula hospital in New York closed in 1895, on the site of what is now the Waldorf Astoria hotel.

Obstetric fistula isn't a death warrant, but it's a sentence of life in limbo. It isolates women from their families and communities, steals their babies and denies them another chance at childbirth. But it doesn't have to be the end of the story, and healthcare workers involved in the management and treatment of fistula speak powerfully of the experience of watching women emerge from the periphery together.

Hilary Fenton-Harris, who coordinates the Poole Africa Link, recalls working at a hospital in South Sudan at the same time as a visiting fistula team. They went round the villages with loudspeakers and vans to announce their arrival, and women would walk in to the hospital from far around for the chance to have surgery.

"I used to go every day to the wards where patients were recovering," she explains. "They'd be resting, talking, lying along the beds - enjoying the company of other women."

It can even become an opportunity for celebration. "We try to have a ceremony on the ship for the ladies who have had successful fistula surgery, as a way of showing that they are valued, appreciated," says Dr Michelle White, Head of Anaesthesia on the MV Africa Mercy.

"We give them a new dress, symbolizing a new start. There's applause and dancing - it's incredibly moving, after the many years of hardship they've suffered. And it's powerful to see how generous they are in their love and affection for each other."

But you can't end on an optimistic note of healing something that should never have been broken, and community for women who should never have been outcast.

They should never have had to find their way back in the first place.