By Madison Miller, One By One Young Global Leader 2013/14
What is obstetric fistula? It is a tragic medical condition and reason that women become social outcasts. It is also a problem with a solution.
Before becoming involved with One by One’s Young Global Leaders Program, I understood the medical explanation of fistula. I knew that it was a hole in a woman’s bladder or rectum caused by prolonged obstructed labor. I did not realize, however, its far-reaching effects –not just on the women with the fistula, but on their own families and communities.
Many women and girls who live with their fistula untreated leak urine, are poor, and live in rural communities far away from hospitals. As a result, when women develop a fistula, they often do not go to the doctor because it would cost too much money and be too much of a struggle to get there. Sometimes these women don’t even know what is wrong with them. In fact, many think they are being punished by God for something they did.
Additionally, many women are cast out by their families, friends, and community because their fistula results in an awful, unbearable odor. In some areas of Western Kenya, where One By One works, communities believe that women with fistula have a curse, so women are deserted by their husbands.
In the Young Global Leaders Program, I have heard stories about women who’ve experienced fistula and how their lives are changed for the worse. Fistula is not just about a hole in the body, it ends up being about education, money, child marriage, medical care, and culture. In some parts of the world, women and girls are not treated as equal to men and boys. Girls go without an education and are not respected. Families also marry their young daughters when they are just little girls in order to receive a dowry, or a bride price. The family may be stuck in financial hardship and see girls as less valuable than boys. This and other issues women and girls face situations contribute to the high rates of fistulas in developing countries.
Fistula is an issue that is not commonly talked about in the United States because women give birth in hospitals where they have access to advanced medical care. For women in developing countries, the nearest hospital may be hours away and they have no means of transportation to get there.
Part of One by One’s mission is making women aware of fistula and that it is a treatable medical condition. One By One works with women in Kenya, many who have had their fistulas repaired by their program, to spread awareness, allowing women to learn about fistula from women who have been in their situation. These are their friends and neighbors, women they know and trust.
One By One is unique because it empowers fistula survivors to become advocates and active members of their communities – putting women who were ostracized into positions where they are in charge and have the power to change their communities. Through their work, One by One has shown that fistula is more than its medical definition; it includes many social and cultural issues. The first step to eradicating fistula is awareness.
Madison Miller is a Junior at Holy Names School in Seattle, Washington and one of 11 Young Global Leaders, ages 13-17, in One By One’s nine-month global health education and advocacy training program.