‘Do not let the sun go up and down more than once for a laboring woman.’ ~ African proverb
An interview with Kate Grant, CEO of the Fistula Foundation
How did you learn about the issue of obstetric fistula and why has it become the focus of your life’s work?
In 1994, I visited the Addis Ababa Fistula Hospital in Ethiopia– that visit and meeting Dr. Hamlin changed my life. These young women were horribly injured simply for trying to bring a child into the world, but the fact that fistula is most often treatable with surgery was incredibly motivating. I feel fortunate to every day go to work with the goal of getting more women with this life-destroying injury repaired.
Please tell us a little bit about Fistula Foundation and how it addresses fistula.
Fistula Foundation is dedicated to one thing: treating obstetric fistula, because we believe that no woman should suffer a life of isolation and misery simply for trying to bring a child into the world. We partner with some of the most heroic doctors in the world to provide surgery to women with obstetric fistula. We support fistula treatment in 19 countries at 38 sites on two continents, Africa and Asia. Most women with fistula live in rural areas and are very poor, thus it is critical that surgery be provided for free to women who need it.
How does fistula impact women? How does it get repaired?
Fistula is the most devastating of all childbirth injuries. Not only is a woman left unable to control her bodily wastes, but 9 times out of 10 her baby does not survive. She also often is abandoned by her husband and ostracized from her community because they cannot stand her smell. The only cure for fistula is a surgery which, on average, takes one hour and can cost as little as $450. That might not seem like much, but this one hour and $450 completely transform a woman’s life!
Take Hamida, a 25-year-old from a small town in the southernmost point of mainland Bangladesh, at the Myanmar border. She was married at a young age, became pregnant and gave birth at home, as more than 95 percent of women do in her region because they cannot afford a hospital delivery. Most women in her region never see a doctor once during their entire pregnancy.
During the delivery, Hamida’s labor became blocked and caused her to endure three days of excruciating pain. The remote location of her town made emergency care impossible. Hamida’s baby did not survive. Afterward, Hamida found that she could not control her urine; her difficult labor had left her with obstetric fistula. Her husband divorced her and she returned to her parents’ home to live, but she felt isolated and miserable.
Hamida lived with fistula for several years before learning about Hope Hospital, where she finally received a successful fistula repair surgery that forever changed her life. No longer incontinent, Hamida’s life is now filled with hope and opportunity, free from stigma and shame.
It’s not so long since it was an issue in our own communities. Many of our great grandmothers would have faced this issue. What changed in the USA to end this problem here?
Yes, and in fact a fistula hospital once stood on what is now the site of the Waldorf Astoria Hotel in New York City. It closed in the late 1890s because fistula had largely ended in America by that time. The reason for this was a better understanding of the importance of maternal health generally, and access to emergency obstetric care if needed. In addition, with more economic prosperity and stability, the government put more money into public health.
What are the last hurdles that prevent us from ending fistula?
To end fistula we have to both prevent fistula and treat fistula. There are three big hurdles. First, there is a global shortage of trained surgeons. Because fistula has been nearly eradicated in high-income countries, it is no longer a relevant field of specialized training for most surgeons. That’s why Fistula Foundation funds training programs led by international experts in nearly all of the countries in which we work. Another hurdle is lack of awareness. Fistula is a humiliating and isolating condition that affects the poorest and most vulnerable women. Many of them don’t even know that treatment is available or are too ashamed to come forward. We fund outreach programs to help raise awareness in rural communities and identify these women who are too often hidden and ostracized from society. The final hurdle is a general lack of resources — when it comes to prevention, women need access to emergency obstetric care. Usually an emergency c-section within 24 hours of labor is what is needed to prevent fistula in a prolonged obstructed labor.
What do you want every woman who has faced this issue to know?
I want women with fistula to know they are not alone with this injury and it is not their fault, that they are precious and valuable and that their injury is most often treatable. But, as importantly, I want them to know that there is a good life for them after treatment, and that there is hope.
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