Approximately two million women worldwide suffer from an obstetric fistula, one of the most serious consequences of obstructed labour. A fistula is a hole between the vagina and the bladder or rectum, through which urine or faeces leak continuously. The injury is completely preventable and has almost disappeared in developed countries where there is universally available obstetric care.
Women relax in one of the tents at the MSF fistula camp in Boguila, CAR. 65 women had their fistulas repaired during the six week-long camp in 2010. November, 2010. Photo by Sarah Elliott for MSF
Women with fistula are often outcasts from their communities because of the smell associated with the leaking of urine/faeces, and in some cases they are abandoned by their husbands. Surgery can help them to start a whole new life: just like a butterfly, many women who lived secluded lives begin a fresh start after their operation. But chances for women to have their fistula repaired are slim, as many hospitals or health clinics do not have the proper instruments or knowledge and skills to carry out the specialised procedure.
In addition to offering maternal health services to prevent delivery complications in numerous countries, in 2010, MSF teams operated on and treated about 1,000 women suffering from obstetric fistula.
Below are some images from a fistula camp in Boguila, Central African Republic (CAR), and the stories of some of the women treated there.
Zanaba Amidou sits on a bed in the camp in Boguila. November, 2010. Photo by Sarah Elliott for MSF
Zanaba Amidou (16), from the Peuhl tribe went into labour three months ago. After three days of intense labour pains, her mother Deooda went to find a traditional birth attendant. On her seventh day of labour, Zanaba’s mother hired a motorcycle to transport them to the nearest clinic in Paua. The journey took the whole day. After arriving at MSF’s clinic in Paoua, doctors performed a caesarean section but the baby was
still born. Zanaba spent two months at the clinic in Pauoa before being brought to the MSF fistula camp in Boguila.
“I have suffered a lot; I didn’t lose much blood, but I suffered. I didn’t want to get married, but my father made me. Now I haven’t seen my husband for three months. My mother-in-law has been to visit me in the fistula camp, but my husband has not. I know he is aware what has happened to me, and yet he has not done anything for me. I am very happy to have had this operation. When I go home I will dance and sing and pray every day. I will pray and thank God for this doctor."
A patient in one of the camps. November, 2010. Photo by Sarah Elliott for MSF
This patient (46) has given birth twice. Her first child died at the age of two months, and her second child
was still-born. Her second labour, which took place at home, lasted for four days, and caused the fistula.
This was six years ago. Soon after, her husband left her, saying that if she could not produce children for
him, he intended to remarry. He now has two children with his new wife.
“I am the only woman in my village with this problem. I work very hard in my field all day, then come home and I am alone. I live alone. Sometimes I go to church, but the other women tell me not to stand or sit by them because of the smell. The children also say bad words and discriminate against me. I am used to it now, but it still hurts a lot. When I came to the fistula camp in Boguila, I still felt different from other people. I urinated more than the other women, so I kept myself away from them. I didn’t talk with them, or eat with them. My parents live in Boguila and came to visit me -– they were the only people I would interact with. After the operation, I felt better, and felt that it was ok to speak and be with the other women. Now I eat with them. We still have a lot of people in the bush who are scared to come here. This is a very big opportunity for us to come and be repaired. Last year I came to the camp too late to be operated on, so I am very happy this year to have had the chance.”
Esther Feibouko and her two-year-old daughter Abigail. November, 2010. Photo by Sarah Elliott for MSF
Esther Feibouko (28) has had four pregnancies. One child died soon after birth, and her three remaining children are six, four and two years old. Esther developed a fistula in 2008 after being in labour with her daughter Abigail for 12 hours. Esther is from Ndormboli village, and made three separate trips
by motorcycle, each of 112 kilometres, to Boguila Hospital to make sure that she was on the list for the fistula surgery. Her husband accompanied her to Boguila for the surgery and while she recovered from the operation.
“I didn’t feel good about myself when I realised I had this problem. When I walked, I would leak urine, and it made me feel bad. I have heard that a lot of husbands leave their wives after they have such a problem, but my husband did not have an issue with it. Even though I know the surgery may not work, I pray for healing.”
More information about obstetric fistula can be found on the Focus page here.
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