Think Global Act Local 2004 - Obstetric Fistula
Obstetric fistula (or vaginal fistula) is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available. Access to obstetric emergency care is one of the major challenges in preventing the development of obstetric fistula. The availability and access to medical facilities that have a trained staff and specialized surgical equipment needed for cesarean births is very limited in certain parts of the world.
Most women living with obstetric fistula also struggle with depression, abandonment by their partners, families and communities, and live in isolation because of the constant leaking and odor. Many women report feelings of humiliation, pain, loneliness, shame and mourning for the loss of their lives and the child they lost during delivery. Because of the constant leaking and smell, many women are isolated from food preparation and prayer ceremonies because they are thought to be constantly unclean. Suicide and attempted suicide are also common amongst women with this condition. Social isolation, increased poverty and decreased employment opportunities due to this condition force many women to turn to commercial sex work and begging.
During most of the 20th century obstetric fistula was largely missing from the international global health agenda. This is reflected by the fact that obstetric fistula was not included as a topic at the landmark United Nations 1994 International Conference on Population and Development (ICPD). The 194 page report from the ICPD does not include any reference to obstetric fistula. However, since 2003 obstetric fistula has been gaining awareness amongst the general public and has received critical attention from UNFPA, who have organized a global campaign to "End Fistula". New York Times columnist Nicholas Kristof, a Pulitzer-prize winning writer, wrote several columns in 2003, 2005 and 2006 focusing on fistula and particularly treatment provided by Catherine Hamlin at the Fistula Hospital in Ethiopia. Increased public awareness and corresponding political pressure have helped fund the UNFPA's Campaign to End Fistula, and helped motivate the United States Agency for International Development (USAID) to dramatically increase funding for the prevention and treatment of obstetric fistula.
Treatment is available through reconstructive surgery. This surgery for uncomplicated cases has a 90% success rate, and success rates for more complicated cases are estimated to be 60% successful. The cost for this procedure, which includes the actual surgery, post-operative care and rehabilitation support, is estimated to be US$300 – $450. Successful surgery enables women to live normal lives and have more children, but it is recommended to have a cesarean section to prevent the fistula from recurring. Post operative care is vitally important to prevent infection.
For TGAL 2004, the inaugural campaign, focused on raising awareness about the impact of Obstetric Fistula on women without access to treatment and raising fund to benefit the Fistula Hospital in Addis Abeba, Ethiopia.