The following details and information about obstetric fistulas are based on an interview with Dr. Stephen Foster, medical and general director of the Clinica Centro Evangelico de Medicina do Lubango (CEML) in Lubango, Angola. Dr. Foster was born in Brantford, Ontario, but spent most of his childhood living in Zambia, where his father Robert Foster, MD, worked as a missionary surgeon. He completed his medical school at McMaster University in Hamilton, Ontario and later completed his general surgical training through the University of Toronto’s Gallie Course. He returned back to Angola over 30 years ago, where he has been serving as a surgeon at his CEML clinic and numerous other hospitals. Earlier this year, Dr. Foster received one of North America’s highest honours in the medical field, the 2010 Royal College Teasdale-Corti Humanitarian Award.
What is a fistula?
A fistula is an abnormal communication between normal structures. The bladder, vagina, urethra and rectum are all normal structures in the body. When there is an abnormal communication between any of these normal structures, this can lead to urinary incontinence or an inability to control the release of stool. A fistula is just a technical term for an “abnormal connection” in the body.
What are the most common causes of obstetric fistulas?
Usually the most common cause of an obstetric fistula is a prolonged labour period for women. Most women do not have frequent medical consultations during pregnancies. Women tend to experience pain, particularly during the process of birth.
During labour, forceful uterine contractions or the pressure of a baby’s head against soft tissues can lead to obstetric fistulas in women. Adolescent pregnancies also tend to increase the risk of fistulas. Pregnant girls between the ages of thirteen and eighteen do not have fully developed female reproductive organs.
How widespread is this issue?
Some sources suggest that there are about two million women in sub-Saharan Africa that live with fistulas. Hundreds of women in Angola suffer from obstetric fistulas. For every woman who presents with a fistula during medical consultations, there are many more women suffering from the same problem. These women are sometimes in the rural areas of Angola, far from clinics, medical posts and other health care facilities.
Presence of fistulas outside of sub-Saharan Africa
In North America and Europe, a fistula is usually a complication of an obstetric misadventure, which can include challenges with Caesarean sections and tearing. Most of the fistulas in this region are caused by lack of proper attention during the birthing process. Globally, it is estimated that 50,000 to 100,000 women are diagnosed with an obstetric fistula annually. This problem affects women of all ages – young and old. However, in North America and Europe, these situations are quite rare.
Women and their communities
Women are usually considered to be outcasts when they have fistulas. In sub-Saharan Africa, including here in Angola, cultural habits result in families marrying off girls at very young ages.
The use of “traditional and bush medicine” to “treat” women
The use of herbal medicines usually results in extended uterine contractions in women. Sometimes this “treatment” works like a charm. But more times than not, this can destroy the uterus.
Cost of Fistula Repairs
For the year beginning July 2010, the Fistula Foundation has provided CEML with a grant that covers 100% of each fistula patient’s operation and associated expenses – travel, lodging in the patient’s village, a weekly food stipend and treatment at the clinic. At present, the total cost for each fistula patient at CEML is about USD $1100.
Fistula Repairs at CEML
It is possible to prevent fistulas. Adolescent girls, and all pregnant women for that matter, should have medical consultations in order to make sure pregnancies move along smoothly. This can avoid surprises during labour periods. 90% of women who have fistulas have a possibility of having simple surgeries to repair the fistulas. These fistulas can be repaired. When he first started, Dr. Foster had about a 50% success rate on a woman’s first repair operation. After having done over four hundred fistula repairs in Angola, his success rate has significantly increased. For some of the patients, the 10% of women requiring more complicated surgeries, Dr. Foster has not been willing to call it quits on them, believing he should try and try again.
From July 2009 to the end of June 2010, CEML has done about 80 fistula repair operations. The recent grant from the Fistula Foundation will fund about 100 more fistula repairs between July 2010 and July 2011.
CEML has only hit the tip of the iceberg. Awareness about the work at CEML is spreading through Angola, and more and more women are finding their way to the clinic for proper treatment.
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Photo credit: Seth Cochran, Founder at OperationOF
The next part of this series will focus on the story of a 17 year-old fistula patient at CEML.
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