Box 9: Push for Legislation on Fistula in U.S. Congress On International Women’s Day, March 8, 2011, U.S. Democratic representative Carolyn Maloney (NY), introduced a bill that would enable the President to assist in the global prevention and treatment of women suffering from obstetric fistula.39 In an effort to declare the U.S.’ commitment to maternal and child health in all countries, “The Fistula Prevention, Treatment, Hope and Dignity Restoration Act” would direct assistance to increase access to prenatal care, emergency obstetric care, postnatal care, and voluntary family planning. Included in the bill are additional measures to build local capacity and improve existing national health systems; support reintegration programs for treated women; and coordinate donors, institutions, NGOs, and the private sector. The bill, which was co-sponsored by nine other House representatives, was referred to the House subcommittee on Africa, Global Health, and Human Rights.
Box 10: SIM builds on history of treating leprosy in Danja, Niger FIOs often have many years of experience to build upon in the communities where they work. In Danja, Niger, Serving in Mission (SIM) (see also: Box 12) has run a Center for Health and Leprosy since 1956. Building upon this infrastructure, as well as established relationships and familiarity with local culture, SIM has established a Fistula Surgery and Training Center, in collaboration with Dr. Lewis Wall and the Worldwide Fistula Fund (WFF). The center is modeled on the Addis Ababa Fistula Hospital in Ethiopia, a facility at the forefront of treating fistula in Africa, and the WFF plans to replicate the center elsewhere in regions where fistula is a common problem. The center will offer surgeries as well as training programs for African doctors and community-based programs targeting the causes of fistula, reflecting the comprehensive approach characteristic of FIO-provided healthcare. In an interview, Ray Caggiano, Special Projects Manager at SIM’s US headquarters, explained, “We have a desire and a drive to deal with what’s going on in an entire community – not just in terms of medical work. In terms of maternal health, for example, our people speak to the lives and the marriages and the interpersonal relationships of the people they are serving – to every aspect of their life. The approach tends to draw the men in as well as the women, because that’s an important part of the situation.” Messages encouraging delayed pregnancy are just one example of how FIO health work often extends beyond the clinic into the community to work on important preventative measures. ago.37 It costs US$300 to repair a fistula using low-tech surgery under spinal anesthesia and 90 percent of them can be repaired. But in reality, most afflicted women are poor and never receive the opportunity for this basic care.38 “Poverty is the breeding-ground where obstetric fistulas thrive,” says Dr. Lewis Wall, the world’s foremost advocate of helping women with fistulas.40 The constant leaking of urine and feces associated with a fistula create a social stigma that can cause divorce, abandonment, and severe depression. This ‘blaming the victim’ norm leads Wall to state that “for many women the consequences of surviving this ordeal [obstructed labor] may be
worse than death itself,” adding that women with fistulas are the walking half-dead of the maternal mortality issue, likening them to modern-day lepers.41 Faith communities and organizations have strong records handling issues associated with stigma, from leprosy to HIV/AIDS, making them powerful agents of change not only in taking initiative to treat and care for fistula patients, but also to work within communities to address the conditions that lead to obstructed labor and fistula in the first place.
21 RELIGION AND GLOBAL DEVELOPMENT • NOVEMBER 2011