I recently had the opportunity to visit Eritrea as a part of the Eritrean Maternal Health project. The Maternal Health project was founded by Stanford Medical School and supported by UNFPA and the Eritrean Ministry of Health. One if its major concerns is obstetric fistula.
Obstetric fistula is a childbirth injury that happens as a result of obstructed labor in places where medical care is largely unavailable. As a woman- typically young, extremely poor and illiterate- squats for days alone, attempting to deliver her baby, the trauma adds up and an internal hole develops. Contents from the bladder and rectum cannot be willfully controlled, so the fistula victim constantly leaks urine and/or feces. The corrective solution for the medical aspect of this disease is a surgery, which costs around $300 and is often done for free usually in endemic areas, but barriers to surgery include transportation, lack of infrastructure and limited resources of the state to reach out to very pregnant woman in the countryside.
Eritrea is a rural nation with hills and rough terrain. Traveling in the rural areas consists of riding on a camel, constantly going up and down and potentially causing more trauma to the fistula patient. Dr. Hapte, one of the OB/GYNs (and father figure for the fistula patient) at the Mendefera Hospital ( the same site of the Eritrean National Fistula Center) spoke of the shame of traveling on buses when the fistula patient is still leaking- sometimes other bus riders forcibly evict the leaking woman because of the strong urine smell.
I am a Somali-American woman who practices covering my hair with hijab- so in many ways, I looked like many of the woman. Many of the patients in Eritrea were Muslim women. Names like “Fatima”, “Zahra”, “Mariam” and “Zeinab” filled the pages of the simple hospital logbook. My “salaams” were met with timid smiles and then eager questions about who I was, where I am came from and why a Somali-American was in Eritrea. After sometime, I realized that these women were expecting that I would turn my nose in disgust and were hiding their catheters (bags that hold urine) from me, hiding their shame. It was strange to them that people would care to talk to them when from the past months and years, their families and societies had pushed them away. Many women have internalized this and believe that the fistula condition was “God’s will”.