Typically an obstetric fistula arises when a teenage girl, malnourished, circumcised and with an immature pelvis, tries to deliver her first baby. The foetus gets stuck and after several days of labour it is stillborn. But meantime some of the mother's internal tissues have been damaged and to her horror, she finds herself suddenly being incontinent, without knowing why. Since incontinence is a shame, these women are hidden and often the problem is misinterpreted as a sexually transmitted disease, for which the woman herself is to blame.
With surgery, fistulas can be repaired. There is a healing rate of 90%! But the problem is to reach women in remote villages and inform them about the possibility of an operation. However, most of them are too poor to pay for an operation, too poor even to pay the bus ride to the nearest hospital.
Apparently, 150 years ago, fistulas were a problem in the Western World too, and disappeared only when medical help became easily available. WHO reckons that 2 million women have untreated fistulas, and that the number increases by 50’000 – 100’000 women every year.