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Dispatch from Dakar: Gathered to Fight Fistula

Obstetric fistula, a devastating consequence of childbirth that is both preventable and treatable, draws nongovernmental organizations and health care companies to pledge to fight it.

Today [Dec. 9] is the final day of the International Society of Obstetric Fistula Surgeons meeting in Dakar, Senegal. It has been an incredibly busy few days as fistula surgeons and health professionals have come together to share diverse experiences, research findings and recommendations for improving quality of treatment, management and prevention of obstetric fistula. Representatives from more than 40 countries are participating in the conference, all sharing the common goal of working together to improve fistula care and ultimately, a vision for eradication of this preventable condition that develops as a result of failures in maternal health care.

Representing Direct Relief, I have had the unique opportunity to engage with many of the eminent fistula surgeons in the world. Many of the pioneers in the field are here, surgeons who have dedicated their careers to treating women with fistula, training surgeons and spearheading research to improve the outcomes for fistula care. Many more youthful faces from the next generation are here: Motivated, committed, primarily African surgeons from all parts of the continent have come to learn from each other and improve their expertise in the region where the burden of obstetric fistula is highest.

The surgeons provide an essential service for helping restore the dignity of women living with obstetric fistula. Also present are advocates, community organizers and public health professionals that are addressing the important areas of prevention of fistula through improved obstetric care and also social reintegration of women back into their communities after their physical wound has been healed. This community recognizes that it is not simply enough to surgically repair the fistula and send a woman on her way after she has lived often for many years with a highly stigmatizing and socially humiliating condition. The conference theme acknowledges the increased effort that must be made not only to treat the physical condition, but to ensure that women can return to live normal, healthy lives in their community.


What is fistula?

A fistula is simply a hole between an internal organ and exposure. There are two primary causes of fistula in women in developing countries: childbirth, causing obstetric fistula and sexual violence, causing traumatic fistula.

An obstetric fistula develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Women who develop fistulas are often abandoned by their husbands, rejected by their communities and forced to live an isolated existence.
The Fistula Foundation

There is a great deal of good work being done by many organizations across Africa and Asia to address obstetric fistula. A shared understanding of exactly where these services are located and the current treatment capacity is something that remains elusive. Together with ISOFS and other key stakeholders, Direct Relief is supporting a process to help make this information more readily apparent. Utilizing Direct Relief's IT platform and experience in use of GIS technology to present data in a meaningful and transparent way, we hope to create a robust mapping tool to help inform stakeholders on the key issues in obstetric fistula care and treatment. This platform can be used to aggregate the current work that is being done, help illuminate areas of unmet need and provide a tool to help inform future allocation of treatment and prevention resources.

Direct Relief is currently providing surgical supplies to support fistula repair programs in seven hospitals across Africa, many of which are represented here at the conference. It is very clear through the level of engagement at this conference, and reinforced by the preliminary results of the fistula treatment mapping exercise, that there are many more facilities where surgical supplies could be well utilized. Working together with the Fistula Foundation and our partner health care companies like Johnson & Johnson, Ethicon, Covidien and CR Bard, we hope to be able to support more surgeons have the supplies they need to do this valuable work.

I feel good about Direct Relief’s decision to keep obstetric fistula care and prevention a central part of our maternal health strategy over the next five years. Treating a woman with obstetric fistula is completely life-transforming; preventing obstetric fistula from occurring is possible. There is a lot of good momentum and energy here at this conference, but we all agree there remains a lot to be done.

Now off to the closing ceremony and to the work ahead!

Founded in 1948, Direct Relief is a California-based nonprofit organization focused on improving quality of life by bringing critically needed medicines and supplies to local health care providers worldwide. Direct Relief has provided more than $1.4 billion in privately funded humanitarian aid since 2000, including more than $225 million in assistance in the United States. It has earned a fundraising efficiency score of 99 percent or better from Forbes for nine consecutive years, receiving a perfect score of 100 percent for eight of those years. Direct Relief is ranked by the Chronicle of Philanthropy as California’s largest international nonprofit organization based on private support. For more information, please visit