Repairing fistulas in Tanzania

On February 24, 2009, in Africa, reproductive health, by Karen Grepin

A recent NYTimes carried a gut wrenching story of women suffering from fistulas in Tanzania. The women in this story, fortunately, had some hope of recovering from these injuries thanks to the availability of expert foreign surgeons who had been flown in to provide assistance to these women.

Fistulas are common injuries suffered as a consequence of prolonged obstructed labor. A fistula is a general term given to a hole between organs that should not normally exist, in this particular case it usually means an abnormal opening between the bladder and the vagina, or between the rectum or vagina (other terrible combinations also exist). You can imagine the repercussions of such injuries. Women with fistulas are frequently outcasts in their communities due to the fact that they are unable to prevent themselves from uncontrollably releasing urine or feces.

Fistulas are relatively rare in developed countries since women who have prolonged childbirth generally quickly receive a caesarian section averting further complications. However, the incidence of these injuries is relatively high in developing countries. When births are prolonged the baby can push up against the mother’s insides causing tissue and nerve damage causing the tissues to die, leaving a fistula. In many ways, fistula prevalence is a good proxy for the availability of essential obstetric care.

It was nice to read that many of the women in this story eventually recovered from their injuries after undergoing reconstructive surgery, however, the vast majority of women never receive access to such services. Prevention should be the goal, but health systems in much of the world are so under resourced that such a goal is out of reach for the time being. Kudos to the NYTimes for covering this largely neglected global health issue.

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