Diarahi, 27, is hopeful about her life.
Her tenacious spirit has wavered over the last twelve years, but somehow has never broken—not when she suffered from more than three days of obstructed labor and mourned the loss of her baby, not when weeks later she realized she could no longer control her bladder, and not when her husband shunned her. Not even when the grandmother who took her in passed away shortly thereafter.
Diarahi used to be among the two million women and girls worldwide who suffer from a devastating childbirth injury called obstetric fistula. Fistula is a preventable, treatable condition caused by prolonged, obstructed labor that leaves women with chronic incontinence of urine, feces, or both. It’s often accompanied by pain, nerve damage, kidney disorders, and infections.
The effects are not only physical. They are compounded by social isolation, depression, abandonment, shame, and deepening poverty. Many women resort to begging.
Fistula is almost entirely preventable for women who have access to skilled health workers for prenatal care and assisted delivery.
Before developing fistula, Diarahi and her husband cultivated a cotton field in her village of Banco in the region of Kayes. After, she worked the fields alone, and her husband sold the harvest without sharing any of the profits with her. When he eventually brought home a new wife, Diarahi left and took shelter with her grandmother.
A Condition of Social and Economic Inequities
Most fistulas occur among women and girls who live in poverty in countries that have significant gender-based social and economic inequities, where access to health workers is limited and health systems are weak.
Fistula is almost entirely preventable for women who have access to skilled health workers for prenatal care and assisted delivery, and who are supported by health systems that provide reliable emergency obstetric care, including cesarean sections.
Adolescents are more prone to fistulas as their bodies haven’t fully developed.
This is what happened to Diarahi. Her family had forced her to marry a cousin when she was just 15 years old. When she became pregnant, she received no prenatal care and was three days into an arduous labor before her brother-in-law arranged transportation to the closest health facility in Kita. Diarahi delivered her baby—who had already died—in the car en route.
Weeks later, when a health worker diagnosed her with obstetric fistula, she was told she’d need to travel to Bamako, the capital city, about 160 kilometers from her home for surgery. Her husband initially agreed, but then changed his mind because of the cost.
In Mali, an Ambitious and Feasible Goal of Zero Fistulas (Visons Zéro Cas)
The government of Mali is committed to “zero fistulas,” and we are proud at IntraHealth to be a key partner in this effort. We are working to restore dignity for the thousands of Malian women like Diarahi who suffer from the physical, psychological, social, and economic effects of this devastating condition. Our goal is to work alongside the government to end fistula and establish a holistic, sustainable model of care that goes beyond treatment to enable women to rebuild their lives.
This takes a health systems-approach.
Three weeks after my operation, I no longer leaked urine and the doctors confirmed that I was completely healed.
When we first partnered with the government in Mali on fistula in 2008, there was less than a handful of Malian surgeons in the country able to perform the surgery. Since then, we have expanded local capacity to prevent and treat fistula, decentralized services to be closer to where women and girls with fistula are living, and assisted community-based organizations’ efforts to reduce stigma, end child marriage, and recruit and support women who need fistula repair to re-integrate into their families and communities.
We conduct on-the-job training for surgical teams in their normal work settings through monthly fistula campaigns. At each one, about 30 women and girls have their fistulas surgically repaired. They also receive treatment for other conditions like malnutrition or infections. There are now nine Malian surgeons qualified to provide basic repair surgeries at two hospitals in Bamako and three regional hospitals. Twenty additional surgeons are undergoing training.
Mali can now reach about 400 women annually, but given the insufficient supply of qualified health workers, a weak health system, and ongoing insecurity in the north, reaching the current backlog of women and girls living with fistula plus the estimated 2,000 women at risk every year in Mali remains unsurmountable.
The Road to Independence
After Diarahi’s grandmother passed away, her uncle took her to Bamako, where she learned about one of our campaigns at Kayes Hospital. There, she could receive treatment free of charge.
“Thanks to God, upon arriving at the hospital I found a second family and was well taken care of day and night,” says Diarahi. “Three weeks after my operation, I no longer leaked urine and the doctors confirmed that I was completely healed.”
Diarahi intends to return to her family home, restart her social life in the community, and sell firewood—a business she started alongside her grandmother—to ensure economic independence and her ability to influence decisions that affect her health and her community.
It is a tragedy that the most vulnerable among us—women and girls representing the most marginalized and underserved groups—continue to suffer needlessly. We know what it takes to have strong and resilient health systems staffed with health workers who can prevent fistula. We can also offer urgently needed services like psychosocial counseling and economic livelihood training to help women and girls already affected.
It is possible to end fistula. The International Day to End Obstetric Fistula is May 23. IntraHealth joins this global call for renewed commitment, action, and investment.
Progress is possible. Zero new cases is possible. Dignity is possible.
IntraHealth’s work addressing fistula in Mali is currently conducted through the USAID-funded Capacity Building for Fistula Treatment and Prevention in Mali and is extended by IntraHealth’s 2014 Clinton Global Initiative (CGI) commitment. IntraHealth’s current partners in this CGI commitment include USAID/Mali, Orange Mali Foundation, UNFPA/Mali, Direct Relief, SamaHope, Inner Wheel Mali, the Peter C. Alderman Foundation, and three Malian NGOs (AMCP, IAMANEH, and GREFFA).This work is also made possible with private donations. Photo by Oumou H. Saade for Fistula Mali and IntraHealth International.