EIP Project Allysia Trindade

7/30/2019 EIP Project Allysia Trindade

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An under-developed pelvis, caused by a combination of age and malnutrition, is called

cephalopelvic disproportion, or CPD. CPD can cause the fetus to become stuck if the head is too

large. The prolonged pressure from the fetus can cut off the circulation to the vaginal tissue,

causing necrosis (Narcisi et al. 342). This is when the tissues die and the hole is formed (Addis

Ababa Fistula Hospital). Over 93% of fetuses do not make it through the long labor (Williams

55). Fistula can also be caused by violent sexual assault, something women may be in particular

risk for if they are living in a war torn country (Obstetric Fistula).

During the 19th century, fistula rates were high in America. At the turn of the century,

women began giving birth in hospitals with proper medical care and these numbers steadily

declined (Narcisi et al. 341). The problem of fistula was completely eradicated with the

introduction and wide availability of the caesarian section (Addis Ababa Fistula Hospital).

Today, the issue of fistula is obsolete in North America, with the last fistula hospital in the

United States having closed down in 1865. Somehow, there are still an estimated two million

people suffering worldwide (Obstetric Fistula). In Africa, the lifetime risk of dying due to

pregnancy or childbirth is 1 in 16. For a woman in the US, these odds are 1 in 2800 (Addis

Ababa Fistula Hospital). Africa accounts for 40% of the worlds births and 20% of its maternal

deaths. In Ethiopia, it is estimated that there are 2000 deaths per 100,000 births (Williams 54).

The women dealing with fistula are often abandoned by their husbands, families, and are

forced to become outcasts by their communities due to their lack of control over their bowels and

their odor (Wilson). Sub-Saharan cultures measure wealth by a familys children and a womans

worth is determined by her ability to produce multiple healthy children. Those with fistula are

considered to be inferior by both social and financial standards, and are shunned in turn. Unable

to maintain proper hygiene due to the distance from running water, they are not allowed to


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participate in community activities or religious practice because of their odor (Narcisi et al. 343).

When cast out, women are often given a dirt hut to live in that offers minimal protection from

weather and wildlife such as hyenas. There the woman will stay until she dies or is told that she

can be cured (A Walk to Beautiful). If the woman spends her time crouching or in her bed to both

hide and to prevent the leakage, muscles may become rigid and this could affect her mobility.

Physical therapy may be needed to restore her walking ability (Wilson). There is also a negative

stigma created by the lack of knowledge about fistula in the community. Many believe that

fistula can be caused by witchcraft, evil disease, or divine punishment (Narcisi et al. 343).

Poverty plays a crucial role in the development and treatment of obstetric fistula. Ruth

Kennedy, a midwife of the Addis Ababa Hospital, located in the capitol of Ethiopia, stated that

the enormous calorie consumption from daily tasks such as carrying water jars from such a

young age effect the stature of a young woman, which can lead to underdevelopment (Wilson).

The calories that the women consume are all put towards the work and not growth, which can

result in women that are small for their age and, in turn, a smaller pelvis (A Walk to Beautiful). A

lack of information and education can cause the women to become desperate and try to cure

themselves through harmful methods such as the insertion of stones or rags into the vagina as an

attempt to stop the leaking (Wilson). These women are cast out, penniless, and without

protection and support. This also makes it extremely difficult for them to reach care. Without

access to transportation, making the journey can leave them at risk to hungry wildlife because of

their odor (Narcisi et al. 343).

Addis Ababa Fistula Hospital is located in Addis Ababa, the capitol of Ethiopia.

According to Dr. Catherine Hamlin, co-founder, many women are not accepted into general

hospitals due to the fact that they have an odor, are poor, and are often overlooked for more


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urgent matters (A Walk to Beautiful). The hospital was founded in 1974 and is the only one in the

world that is exclusively dedicated to curing fistula. Each surgery is performed free of cost

(Addis Ababa Fistula Hospital). The typical patient is between the age fifteen to twenty, but

there are more extreme cases on both ends of the spectrum (Wilson). At the hospital, the fistulas

are closed in 93% of the cases. Thirty women are operated on per week with the annual goal of

1,500 cured women per year. However, there are over one hundred thousand women suffering in

the Ethiopian countryside alone (A Walk to Beautiful). The typical procedure is very

straightforward and consists of the separation of the bladder and the vagina and sewing up the

hole (Wilson). The rate of stress incontinence following the fistula surgery is only 26%

(Williams 56). Upon leaving the hospital, each woman is given new clothes as a symbol of their

health, money for transportation, and a chance for a new beginning (A Walk to Beautiful).

There are many preventative measures that can be taken against fistula, such as

withholding marriage. Girls under the age of fifteen are considered to be five times more likely

to die or suffer during childbirth (Obstetric Fistula). Daughters are considered to be property,

and a family may give her hand in marriage for a dowry. Young girls are typically married after

their first menstrual cycle, and these plans are usually arranged from age nine to fifteen

(Narcisiet al.342). Other measures such as family planning can allow women to have options,

and access to timely and decent medical attention can prevent fistula (Obstetric Fistula).

According to Dr. Ambaye Woldemichael, a fistula surgeon at Addis Ababa Fistula Hospital, the

main cause of fistula in Ethiopia is the lack of obstetric care. For a population of seventy-seven

million people, there are only 146 gynecologists in the country. Most of them are located in the

cities, and the women of the countryside are neglected (A Walk to Beautiful). Brenda Wilson

from NPR describes this lack of trained doctors and gynecologists to be a brain drain. With


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about 5% of all labors requiring medical assistance, there is a serious lack of institutions

prepared to deal with the effects of fistula (A Walk to Beautiful). The cultural tradition of early

marriages is so deeply engrained that education and accessibility to medical assistance are

essential to ameliorating the problem of fistula (Narcisi et al. 345).

The effects of fistula can be deeply psychological and can lead to depression or suicide

attempts. Many women with fistula will no longer be able to have children, or even sexual

intercourse. These women may be considered useless back in their communities. Some women

will be forced to wear an external bag to collect their urine and feces for their entire lives, which

makes it difficult for them to function in a normal rural village. In response to this, the Joy

Village has been created specifically for these women outside of Addis Ababa (Wilson). This

village contains brick houses, sporting facilities, farms, and livestock. This allows the women to

become self-sufficient in a positive environment (Williams 56). At Addis Ababa Fistula

Hospital, they begin the mental healing process as soon as the women enter the clinic. The

women mingle and regain their social lives in an atmosphere where they are not rejected for their

leaking urine (A Walk to Beautiful). The mere realization that they are not the only women

suffering and that many of the other women are being cured is enough to begin the

transformation to better social and mental health (Williams 55). The psychological treatment

educates the patients by explaining the cause of their incontinence and reassuring the women that

their pain is not divine punishment (Narcisi et al. 345).

Many organizations exist to aid those who suffer from Fistula, such as The Fistula

Foundation and One by One. These groups encourage individuals to host informational meetings

to raise awareness and fundraise for the women in need of fistula surgeries (Narcisi et al. 346).


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Along with the Hamlin hospital, UNFPAs campaign to end fistula have allowed the women who

have suffered through fistula to find a voice and inform others (Obstetric Fistula).

In the documentary,A Walk to Beautiful, Dr. Ambaye Woldemichael described fistula as

a silent epidemic because it is a problem of poor women. Fistula is a condition that is not

mentioned often by the media or in casual conversation; in fact, I had never heard of it until that

day in my Anatomy class. I never knew just how much women, just like me, are suffering just

across the ocean. Not only did this documentary make me realize how fortunate I am to live in

this country and have access to proper medical care, but also how uneducated I am about the

struggles of the rest of the world. Awareness is the key to curing these women and raising the

money required to do so. Getting involved in charity work or even just educating oneself about

the problems in the world can help us find ways to reach out to those less fortunate than us.

Many high rate nonprofit organizations exist to provide aid in the struggle against fistula. I find it

difficult to stomach that in the 21st century there are women suffering from problems that have

been long forgotten. Obstetric fistula is a saddening, preventable condition that can and needs to

be stopped.


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Works Cited

Addis Ababa Fistula Hospital. Hamlin Fistula International, 2009. Web. 5 Nov 2012.

A Walk to Beautiful. Dir. Mary Olive Smith.PBS, 2011. Film.

Narcisi, Lina, Andrew Tieniber, Leslie Andriani, and Timothy McKinney. "The Fistula Crisis in

Sub-Saharan Africa: An Ongoing Struggle in Education and Awareness." Urologic

Nursing30.6 (2010): 341-46. Web. 16 Oct. 2012.

Obstetric Fistula.International Womens Health Program. The Society of Obstetricians and

Gynecologists of Canada, n.d. Web. 15 Oct. 2012.

Williams, G. The Addis Ababa Fistula Hospital: An holistic approach to the management of

patients with vesicovaginal fistulae. Surgeon 5 (2007): 54-57. Web. 5 Nov. 2012.

Wilson, Brenda. Hospital Gives Ethiopian Women a Chance at Care. NPR. 18 Jan. 2007.

I know this is not the proper way to include a summary

at the end, but I tried to copy yours without actually

knowing how to do it. But I digress. Your project is

informative and interesting, and definitely persuasive

for your cause. I am now knowledgeable about fistula

and supportive of the cause to end it, but the only thing

Im not too sure about is how to go about doing so other

than spreading awareness. The only suggestions I have

are to possibly explain more about how to solve the

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EIP Project Allysia Trindade