Fistula Surgery

Today I had my first experience of fistula surgery in Ethiopia and I felt very emotional about it. It is impossible to imagine what women with fistula go through....

The problem that these women have usually results from obstructed labour: which is when the baby does not fit into the pelvis properly and so becomes stuck. In the UK we would perform a caesarean section and usually both mum and baby do very well. Due to the lack of resources here, that is not always possible, particularly in the more rural areas...What does happen is that the baby dies and after a couple of days the fetus becomes soft enough to pass through the pelvis. Unfortunately by that time there has been damage to the bladder and/or bowel meaning that urine and/or faeces leaks uncontrollably through the vagina. The resultant smell and uncleanliness can often lead her to be cast out by her husband/family. So she has to deal with the loss of a baby and the shunning of her family: the social isolation she suffers following this is devastating.

The operation aims to stop the leakage and restore the anatomy to as close to normal as possible. The surgery is free and transport to and from the hospital are also free. While the women are in hospital they are taught how to read and write and how to function successfully in the world. The hospital follow the women up when they are discharged and when women are cured it transforms their lives.

One of the many things that they are trying to do in Ethiopia is to reduce the amount of fistula happening and this is by training more doctors and associated health care professionals to recognise the signs in labour and to be able to perform the Caesarean section at the right time. It takes time to train people and get the infrastructure so things can improve but it is happening!!

A good book (non-medical) about the plight of the fistula patients is written by one of the doctors who founded the Addis Fistula Hospital - it is called "Hospital by the River" - it will make you weep...