A Social Death

As a consequence of fistula, the mother emanates an unpleasant odor often driving her husband away and causes her to be socially ostracized, pushing her to isolation and depression. She is condemned to a life of loneliness – without the companionship of her husband, friends and children. While she does not die, the development of a fistula is akin to social death as the village treats the fistula victim as a scourge- pushing her to live at the edge of the community with no social support. Research shows that girls and women with fistula often eat alone, sleep alone, and pray alone. As the women were wheeled into the surgical floor, I noticed the how frail the women were- most exhibited physical signs of extreme malnutrition, some women’s backs curved and others with deep cracks on their feet, skin peeling off.

Many of these women were brought to the hospital by their parents or brothers. One of the doctors had become particularly close to a 16 year old girl with a clubbed foot, who was accompanied and supported by her doting father- she did not have fistula but a congenital abnormality that caused her to leak. Not all patients are shunned by their families and many women had been supported by their parents, husbands or siblings to seek care. The persistence of the women who actually make it to the hospital is not an indication of success, because for every 1 woman who comes 10 more couldn’t afford the journey or were too scared to travel outside their house when confronted with the ugly side of humanity. So, these surgeries are only treating the ‘tip of the iceberg’ since nearly 3 million women with obstetric fistula still need treatment.

The commitment of the Eritrean government* to repair the health infrastructure is a hearting sign of developing countries diagnosing their weakness and not simply applying bandages in the face of crushing poverty. These stronger health infrastructures are crucial to the achieving better maternal health- so that fistulas never occur.

*The Eritrean fistula team have consistently partnered with the Ministry of Health, the UNFPA, and local healthcare providers to shape brighter futures. In the past six years, together they have helped to strength the country’s fistula policies and established the Fistula repair center and hostel. For more information about the Eritrean Maternal Health Project and the UNFPA’s programs in Eritrea please refer to http://obgyn.stanford.edu/gynonc/eritrean.html