Three major barriers to treating fistula and what Direct Relief is doing

Today, on the second annual International Day to End Obstetric Fistula, Direct Relief continues its efforts to prevent obstetric fistula and expand life-restoring surgical treatment for the estimated one million women who suffer from the devastating birth injury.

Obstetric fistula is a hole in the birth canal that is caused by prolonged and obstructed labor. If untreated, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces. In addition to physical injuries, many women with fistula suffer humiliation, isolation, and stigma as a result of the smell and constant leakage. And in most cases of obstructed labor in which a fistula develops, the baby is stillborn.

In the year since the first International Day to End Obstetric Fistula was recognized, the efforts of many organizations and doctors around the world helped provide more than 14,000 estimated repair surgeries to women who were able to access care. But also in that time, thousands of additional women developed the condition. The world is currently losing the fight to end fistula. However, progress is being made to help turn the tide.

There are several major barriers to ending fistula. It’s impossible for any one group to sufficiently confront them all, but change is happening as partnerships continue to develop within and beyond the fistula community. Below are three of the major challenges to ending obstetric fistula and how Direct Relief is taking part in the efforts.

1. Material Resources

Surgical and medical supplies are a critical component of fistula care and can be expensive and difficult to obtain in areas of high need. According to the most recent Global Fistula Map survey, 64% of facilities reported that costs were a barrier to expanding treatment.

To ensure health providers have a reliable flow of supplies to improve access to treatment, Direct Relief maintains a robust inventory of surgical and medical supplies to meet the diverse needs of fistula care providers across the world. For more than ten years, Direct Relief has supported fistula repair centers throughout Africa and Asia with donations.

Direct Relief’s Fistula Repair Module includes essential medicines and surgical supplies and is provided at no cost to facilities providing fistula repair surgery worldwide. In the last year alone, Direct Relief has supported 18 hospitals in 14 countries with more than $650,000 in medicines and supplies – enough to support over 2,000 repair surgeries. This support will continue to grow going forward as Johnson & Johnson has made a Clinton Global Initiative commitment to provide Direct Relief with enough sutures to help facilitate 7,500 repair surgeries.

2. Trained Surgeons

It’s difficult to find surgeons who know how to repair obstetric fistula. In most of the countries where obstetric fistula occurs, doctors are scarce to begin with as few people can afford medical school and often the ones who can do not return to their home country. Additionally, the knowledge required to repair a fistula spans multiple medical specialties, including urology, obstetrics, gynecology, skin graphs and more. Not every surgeon can operate on a fistula patient. Only those who truly care about helping women suffering from the condition are willing to take the time to learn the range of skills needed and devote their time to a non-lucrative procedure. Lack of surgical staff trained in obstetric fistula surgery was cited by almost half of Global Fistula Map facilities as being a limiting factor in the facility’s capacity to provide care.

Direct Relief works closely with health facilities and doctors who conduct fistula repair trainings. Dr. Steve Arrowsmith, who has dedicated much of his time to training others on fistula surgery, is a valued partner, serving as an adviser to its fistula programs. With Dr. Arrowsmith’s leadership, Direct Relief has been able to target facilities for support that are investing not only in the women cared for, but the staff who care for them.

3. Awareness

Direct Relief’s Global Fistula Map survey found that the number one reported barrier to a woman accessing care and treatment for her obstetric fistula is lack of knowledge that help is available. An overwhelming 78 percent of facilities chose this lack of awareness as one of the top three reasons women do not go to their facility for care.

Not only is it an issue that the women with fistula often do not know what their condition is or how to treat it, but most people in general are not aware of it. Fistula was once common throughout the world, but over the last century has been virtually eradicated in Europe and North America through improved medical care. This means the countries with the biggest ability to aid the efforts have very few people who know what obstetric fistula is. Without broader awareness, it is difficult to find the support needed to reach the goal to end fistula.

To better help people understand what fistula is, where fistula exists, and where it is being treated, Direct Relief, in partnership with the United Nations Population Fund (UNFPA) and The Fistula Foundation, created the Global Fistula Map to consolidate and publish information on fistula treatment capacity and activity worldwide. With this third update of the map there are now four years of data that cover 262 facilities in 44 countries. Included in the map are also stories of the surgeons and women who bring the fight to end fistula to the fore of the work they do and the lives they now lead. The Global Fistula Map provides a range of information for anyone looking to learn more about the disease that can then be shared with others to help bring awareness to this devastating condition.

How you can get involved:

Donate to Direct Relief’s efforts

$25 can provide the tools needed for a trained midwife to protect a mother during birth and deliver a baby safely, helping prevent an obstetric fistula from developing.

$50 can be leveraged into nearly $2,500 worth of wholesale medical aid to stock fistula repair facilities with the medical supplies they need.

$100 can provide dignity kits to comfort five women living with obstetric fistula, a devastating childbirth injury.

$1000 can provide one life-restoring fistula repair surgery and post-rehabilitative treatment for a woman suffering from this devastating birth injury.

Spread the Word

Many of these women are abandoned by their communities and shunned from their social circles, leaving them without a voice. Be their advocate by telling your friends, family, and other people you meet about this devastating condition and how they can help end fistula. Whether you tweet, text, or talk, find ways to raise awareness.