On March 8 and 9, MSF is organizing a workshop in Geneva to improve the treatment of obstetric fistula. This condition, a cause of great shame, affects two million women worldwide, mostly in Africa.

"The sun should not rise or set twice on a woman in labour." Despite this proverb, endless labours before delivery are legion in Africa, where a majority of women give birth at home. When they finally come to the hospital, it is often not only too late for the newborn, but sometimes for the mother.

A woman with a fistula rests on an outdoor bed in MSF's fistula camp in Boguila, CAR. [? Sarah ELLIOTT for MSF]

Among women who survive this ordeal, many emerge infirm. Obstetric fistula is one of the most serious consequences of obstructed labour and occurs when the soft tissues of the pelvis are compressed by the baby's head. The lack of blood flow causes the tissues to die, creating a hole between the vagina and bladder, the vagina and rectum, or both. It results in urinary and/or faecal incontinence. Women with fistula live in shame and are often rejected by their own families and communities.

An estimated two million women live with fistula worldwide, most in Africa. This problem is largely hidden because it often affects young women who live in poor and remote areas, with very limited to no access maternal health care.

Women affected are like Zanaba, 16, a patient treated by MSF last year in the Central African Republic (CAR). At the end of her pregnancy, and after three days of intense pain, her mother went looking for a traditional birth attendant.

On the seventh day, Zanaba was brought to the nearest hospital after travelling the entire day on a motorcycle. When she arrived, the baby had already died. The young mother was saved but the prolonged, obstructed labour caused a fistula, which required a second surgery. "I did not know that fistulas exist and how the can occur. But I am glad that I receive the operation.", she said.

Improve access to obstetrical care

On March 8 and 9, MSF will organize a workshop in Geneva to improve the management of fistulas. The meeting coincides with International Women's Day and will bring together actors involved in fistula treatment: surgeons, experts working for MSF and for other organizations.

Fistulas are largely preventable and have disappeared in developed countries where there is universal access to obstetric care.

The operation to close a fistula is delicate and requires specific skills. Depending on the severity of the case, the operation may take several hours. In order to operate on fistula, a long and specific training is needed and there is only a few specialised centres in Africa.

Treating fistulas far exceeds the surgical aspect. Because of the flow of urine and faeces, affected women can develop multiple infections or skin diseases. Following childbirth, they may also have difficulty walking and, because of their exclusion, they are likely to suffer from malnutrition. After surgery, in case of residual incontinence, patients often require a physiotherapeutic rehabilitation. Psychosocial care is also needed in order to reintegrate the affected women into their communities.