Editorial This issue of Dispatch has a special focus on fistula advocates, women who experienced obstructed labor without timely access to the care they needed, and now work as advocates to raise awareness about the problem.
Fistula champions and advocates praised for their work Global The annual meeting of the International Obstetric Fistula Working Group,
We were delighted to have two fistula survivors with us for the
from 10-12 October 2011, offered an opportunity to discuss local
annual meeting of the International Obstetric Fistula Working
advances in the fight against fistula. According to Ms. Gillian Slinger,
Group. They participated actively to help steer activities forward in
Coordinator of the global Campaign to End Fistula, “it was a pleasure to
the areas of fistula prevention and social reintegration of survivors.
meet national authorities and to pay special tribute to some of the heroes
Prevention is undoubtedly the most important factor to stem the tide of women living with fistula. However, we still need to address the huge backlog of cases, which demands that we work on solid training and credentialing processes to ensure high-quality treatment.
in the fight against fistula.” Dr. Alexandre Manguele, Minister of Health of Mozambique, paid a special tribute to Dr. John Kelly, a British fistula surgeon who has worked for more than 40 years on fistula in different parts of the world. Professor Gordon Williams of the Addis Ababa Fistula Hospital accepted a certificate and gift on behalf of Dr. Kelly, who was unable to
Champions in this area were also praised for their commitment
attend the meeting. Fistula surgeon Dr. Aldo Marchezine was also praised
to train other professionals and keep up with their work.
for his outstanding contribution to the fight against fistula in Mozambique.
Yet, despite the advances, about five percent of fistula patients will
The Minister of Health of Mozambique, Dr. Alexandre Manguele,
still be deemed inoperable, while up to 25 per cent will experience
met fistula advocates Ms. Sarah Omega and Ms. Norah Amisi Otondo,
a degree of incontinence following surgery. Such cases need the
praising them for their efforts and achievements as fistula advocates in
dedication of specialized professionals and long term follow-up
Kenya and congratulating them for their participation in the meeting.
and support. The challenges are many, we know. But we must have hope and be inspired by the hard work and courage of our advocates and champions. As beautifully said by Dr. Joseph Ruminjo, of EngenderHealth, “for these most vulnerable of the vulnerable, a culture of possibility and hope is now overdue.” Gillian Slinger
During the meeting in Mozambique, there was a high-level dialogue among fistula experts from around the world, partners and national officials to review the situation of more than 2 million women and girls who still live with the condition. “The story unfortunately is the same in so many places. A neglect of the serious needs of these women, who have no option to access needed services that would have avoided the shame and suffering that has come to them as a result,” said Mr. Mark Bennett, CEO Hamlin Fistula Ethiopia.
Coordinator, Campaign to End Fistula
What is fistula? Obstetric fistula is a childbirth injury caused by prolonged, obstructed labour, without timely medical intervention—typically a Caesarean section. During unassisted prolonged labour, the sustained pressure of the baby’s head on the mother’s pelvic bone damages her soft tissues, creating a hole—or fistula—between the vagina and the bladder and/ or rectum. The pressure prevents blood flow to the tissue, leading to necrosis. Eventually, the dead tissue sloughs off, damaging the original structure of the vagina. The result is a constant leaking of urine and/or feces through the vagina. It’s estimated that over 2 million women live with the condition in the world, with up to 100,000 new cases every year. Fistula is both preventable and, in most cases, treatable.
COVER PHOTO: After a successful fistula repair, Adeila Pinto, 33, teaches in the local school on the mountainside of Mossurize. She developed fistula four years ago after prolonged obstructed labor when she was pregnant with her third child. The baby didn’t survive. Adeila is thrilled that she is able to teach again since she believes that education is key to end fistula. “I wish that women would learn to read and write, as education brings women new opportunities and self-worth.” Photo: Gloria Santos, Mozambique, 2011.
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Dr. Alexandre Manguele praises Sarah Omega and Norah Amisi Otondo for their efforts and achievements as fistula advocates.