Fourth International Consultation On Incontinence. Vesicovaginal Fistula In The Developing World.
The pressure of obstructed childbirth is so much and so long that it cuts out blood irrigation to surrounding tissues, which die and decompose leaving internal ulcers where urine and feces leak from constantly.
The increasing attention to vesicovaginal fistulae (VVF) in the developing world continued with the first presentation of the afternoon by Dr. DeRidder. He noted the challenges in this area with respect to presenting levels of evidence and recommendation grades due to a scarcity of randomized controlled trials and high-level evidence. The committee evaluated 149 articles published over the last 5 years, which included only 8 trials, most being observational in nature and Level 3-4 evidence.
The incidence of VVF globally is anywhere from 10,000-50,000 cases, depending on methodology of surveys with a worldwide prevalence of approximately 2 million cases. Dr. DeRidder presented a graph from the 2005 World Health Report that showed maternal mortality as a surrogate risk indicator for VVF. Rates are highest in sub-Saharan Africa and likely reflect common risk factors including poverty, young maternal age and limited access to prenatal care. Dr. DeRidder presented a 2007 study from Nigeria that showed the number of cases surgically corrected dependent on external funding to the surgical clinic. The etiology of VVF was reviewed including the obstructed labor complex, iatrogenic injuries, cases of abuse/rape and traditional practices such as Gishiri cutting. The obstructed labor complex was highlighted as the primary cause in the developing world and consists of not only VVF but also a high incidence of fetal death, vaginal scarring, complex urologic injuries, secondary infertility, neurological injuries (foot-drop) and pelvic floor injuries, among others. VVF can have devastating consequences for women in the developing world, and Dr. DeRidder highlighted two publications from 2007 that showed a divorce rate of 36%, a fetal death rate of 85%, and frequent maternal loss of self-esteem, depression and suicidal thoughts. Women with VVF are often ostracized from their communities.
A strikingly beautiful, petite girl of 17, Wubete’s sorrows began during her motherless childhood. Her father married her off at age 10, but stubborn and longing to go to school, she ran back home. Her father beat her, but the cycle of running away from forced marriages and enduring beatings continued until she got pregnant by her fourth husband. She was 15 years old and too small to delivery a baby safely. Wubete’s fistula is closed surgically but by her third visit to the Fistula Hospital, her injuries have proven so severe, she still suffers from incontinence. She finds hope in a medical device that helps her lead a productive life.Today she is mother to four adopted children at Grace Village in northern Ethiopia.
Read update on Wubete's story(May 2008).
WHAT IS FISTULA?
Obstetric fistula is an injury to a woman's reproductive organs, usually occurring during prolonged, obstructed labor and without Caesarean section which would relieve the problem. Tears in the vagina occur which also tear other organs, producing leakage of urine and feces. Labor that lasts several days creates pressure on tissues, which cause tissue death. After 2 to 3 days of obstructed labor, the infant usually dies, but even so the labor may continue several days or more if medical treatment is not provided. It is painful, dangerous for the mothers, and devastating to their lives if left untreated.
To tell the story of women hiding in shame in a remote corner of Africa posed inherent problems in the making of "A Walk to Beautiful." How could we show their loneliness and isolation while at the same time time entering their intimate space? How would we follow a woman smelling of urine on a long bus ride to Addis Ababa, Ethiopia's capital, and remain true to the experience she and so many like her have endured? At the end of a day of shooting, how should we respond to 10 people suffering from various illnesses lined up outside the family compound hoping to get help from us—foreigners with cars and money?
Vesico- and Recto-Vaginal Fistulas
At the same age as Swiss girls start their final years in school or begin an apprenticeship and experience their first romances, thousands of young women, especially in Africa, already have to live through terribly painful labour without any medical help.
In many Third World Countries, the woman’s role is to satisfy the sexual needs of her husband, to give birth to children, and to work hard in the house and in the fields. Childbirth injuries make it impossible for a woman to fulfill these duties, therefore her self-respect and self-confidence are destroyed. The mere right to exist in the village society is put into question.
Having a baby can be one of the most joyous events in a woman's life. Yet for the millions of young women in the developing world who develop severe injuries called fistulas from obstructed labor, it's the beginning of a living nightmare, one that can last the rest of their lives. Since 1974, when she and her late husband Reginald established the Addis Ababa Fistula Hospital in Ethiopia, Dr. Catherine Hamlin has given her all to curing fistulas and restoring life to these women, many of whom are just teenagers. In this interview, conducted at the fistula hospital by "A Walk to Beautiful" codirectors Mary Olive Smith and Amy Bucher, Hamlin talks about just how heartbreaking this tragedy can be for poor women—and how miraculous the cure.