Monday, February 3, 2014

The injustice of a fistula.

This post has been written by one of Dominique Vidale-Plaza, the founder of one of our partner organisations, Channel Initiative.

Image: Channel Initiative (c)
Fistula has virtually been eliminated in the developed world. This abnormal opening between a woman's anus and vagina, or urethra and vagina, is extremely rare in developed countries, simply because there is access to emergency obstetric care, and a range of sexual and reproductive health services and rights.

Fistula is not a disease or condition that we do not know how to cure. It is not a mystery that is continuing to leave us befuddled, with no solution in sight, with tests being run in labs the world over, with the WHO issuing us warnings and cautionary tales. No. Not at all. In fact, most people in the USA and other countries, do not even know what it is, because it is simply not a factor to us anymore. We know exactly what it takes to stop it from occurring, and yet, it continues to exist, predominantly in sub-Saharan Africa.

Fistula can be of obstetric, traumatic or surgical origin. Obstetric fistula is the most common, in this part of the world at least, as a result of prolonged or obstructed labor, and a combination of indirect factors like – too early marriages, too early births and too frequent births for example. Without access to health-care facilities to provide birth-spacing options, ante-natal consultations and emergency obstetric care, like C-sections and assisted labor, obstetric fistula is a very real threat in the sub-Sahara.

Traumatic fistula is typically restricted to countries in conflict or post-conflict settings, where rape is used by military groups as a means to debilitate and subjugate societies. In Congo for example, while the majority of fistula that occurs is obstetric, and not directly related to the conflict or the infamous rape paradigm, there are still several instances of traumatic fistula, particularly in young survivors of sexual violence.

These are the two main types of fistula occurring in the Democratic Republic of Congo, and regardless of the origin, the long-term physical and psychological devastation of both, are immense.

Fistulas cause incontinence, meaning that women constantly ooze fecal matter and urine, uncontrollably. The physical result – an offensive odor, infection, rashes, sexual dysfunction and at times even physical disability. The long-term psycho-social effects are also incredibly disturbing – very often, women with fistula are shunned by their families, locked away to sit in their own filth, divorced by their husbands – often because of their seeming inability to fulfill their sexual obligations – and all in all, faced with complete and unqualified stigmatization and ostracism .

Wall, in his 1998 publication - “Dead Mothers and Injured Wives” says “the affected woman suffers from a continuous and uncontrollable stream of urine or feces coming out of her vagina. This is both a physical and social catastrophe. No escape is possible from the constant trickle of urine, the constant ooze of stool, 24 hours a day. These women become physically and morally offensive to their husbands, their families, their friends and their neighbours. Indelibly stigmatized by their condition, they are forced to the margins of society, where they live a precarious existence”.

What causes fistula?

Predominantly, the lack of access to obstetric care can be listed as the overwhelming factor behind it, but it also goes far deeper than this. Some studies have even claimed that a short stature is a risk factor for developing fistula. By and large, the agreed upon factors include though: illiteracy, low social standing, lack of employment, overall poverty, rural residence and of course lack of access to both antenatal and emergency obstetric care.

These factors tell us then, unequivocally – that fistula is a condition restricted to the poor, the vulnerable, in fact, the majority of the sub-Saharan region.

Where, women who live in rural villages, without access to health-centers, who give birth at home, who get married very young, who do not have the ability to exercise their sexual and reproductive health and rights and reject sexual advances, who are poor and illiterate and are not knowledgeable about their own health and how to protect it, are at extreme risk of this terrible, terrible condition.
There is an inherent injustice to all of this, that speaks to the vast inequities that exist in this world, and a sense of how gaping the disparity is, among the have's and the have nots. For the haves' the word fistula need not exist. For the have nots' it is a very realistic threat, a part of their everyday lives.

To me, and I hope to many of you supporters of the Red Elephant Foundation, fistula is one of the greatest indicators of the plight of women living in sub-Saharan Africa, particularly in the DRC, a culmination of so many terrible, unacceptable, and all too common factors, resulting in a physical manifestation of a ripping apart of their bodies, their persons.

It is a sign of how very far we still have to go, in this process of building a better world etc etc etc, because how can it be a just, peaceful, democratic world community, if only very few people get to reap the benefits of that? How can that be?

How can it be, that in some countries we may be able to pride ourselves in the branding of our clothes, our ability to use Instagram and document every single moment of our lives, how shiny our new electronics are, and in others, the very act of bearing a child – is dangerous.

There are crimes upon crimes upon crimes against humanity, that are all grave, but to think that simply being a woman, is one that if I were to be born with a different passport, would place my life, and the integrity of my body at even more risk than I suppose it already is.


Dominique Vidale-Plaza
 is the founder of Channel Initiative, a non-profit organisation that seeks to serve under-resourced and under-served communities across the world. Channel Initiative is currently in the process of running its flagship campaign in the DR Congo, called Build Hope. Follow Dominique on twitter as @DvidalePlaza and Channel Initiative as @buildhopedrc