Virtually
unheard of in wealthier nations, obstetric fistula (Latin
for hole) is an affliction of the
very poor, and is predominantly caused by neglected, obstructed labor. If the
obstruction is unrelieved, the baby usually dies.
Obstetric
fistula is particularly prevalent in Sub-Saharan Africa, and Uganda has been
reported to have the third-highest rate of fistula in the world.
The
persistent incontinence and the rank odour that result, together with myriad
other possible outcomes, such as secondary infertility, chronic infection,
excoriation of the skin, and neurologic injury, are debilitating and
humiliating enough in and of themselves, but a far more devastating outcome
awaits most of those with obstetric fistula.
Such women
frequently find themselves abandoned by their husband and family, shunned by
society, and barred from employment.
That the
condition is essentially an affliction of the very poorest of society seals the
fate of its victims, who often spend the rest of their lives alone and destitute.
Although
surgical repair can cure most cases of obstetric fistula, poverty, social
stigmatisation, widespread misconceptions about the condition, and a paucity of
surgical capacity effectively make treatment unattainable for most of these
women.
Virtually
eradicated in industrialised countries after caesarean section became routinely
available, obstetric fistula remains a scourge in large swathes of the
developing world.
