A few weeks ago, I had an assignment in one of my classes. The assignment was to watch A Walk to Beautiful documentary, and submit a written response on the topic of vaginal fistulas.
The documentary itself was very well done. The topic was not only slightly disturbing, but also very eye-opening. The more research I did, the more it became clear to me that this is a topic that should be brought forth, should be discussed, and that more education on this is sorely needed.
You can watch the documentary: A Walk to Beautiful YouTube
or visit the https://www.fistulafoundation.org/ to learn more
Without further ado, here is my humble paper on the topic:
Vaginal fistula is an operable tear
in the vaginal wall that results in a hole between the vagina and another organ,
frequently leading to fecal or urinal incontinence. There are six types of
vaginal fistulas:
·
Vesicovaginal fistula – an opening between the vagina and the urinary
bladder.
·
Ureterovaginal fistula – an opening between the
vagina and the ureters (ducts that carry urine from kidneys to the bladder)
·
Urethrovaginal fistula – an opening between the vagina and the urethra
(the tube that carries urine out of the body).
·
Rectovaginal fistula. – an opening between the vagina
and the rectum.
·
Colovaginal fistula. – an opening between the vagina
and the colon.
·
Enterovaginal fistula – an opening between the vagina
and the small intestine.
Vaginal fistulas are usually caused by an injury; however,
they can also result from both radiation treatment and infection, although this
is less common.
The most prevalent cases of vaginal fistulas
develop due to obstetric trauma during prolonged childbirth, which, in some
instances, produce a double fistula, also know as a vesico-rectovaginal fistula.
This is particularly common in the developing countries in northern Africa,
Asia, and Middle East, where access to healthcare is
either extremely limited or nonexistent altogether. The lack of accessible
hospitals, combined with strong religious beliefs and low levels of education,
only exacerbates the impact these injuries have on the lives of the women
affected by this medical condition.
Additionally, sexual violence in conflict
zones such as Congo,
Sudan, or Rwanda,
a second leading cause of vaginal fistula, cannot be overlooked. There are
recorded instances where soldiers sexually assault women with broomsticks,
rifles, or even bayonets, inflicting traumatic injuries to the vaginal and
pelvic regions. This horrendous practice serves to not only demoralize the
population, but also as a population growth control tool since the victims of
sexual violence are less likely to bear children in the future.
The prevalence of obstetric vaginal fistula
cases in South Asia and sub-Saharan Africa
can be traced to several factors, such as young child-bearing age,
malnutrition, lack of accessible healthcare, and women’s status in traditionally
misogynistic societies. Women in Pakistan,
Bangladesh, Mali,
Ethiopia, Niger,
Kenya, Uganda,
Nigeria and
other countries, are frequently subjected to hard labor since young age, which
results in growth retardation or poorly developed skeletal structure.
Furthermore, despite laws adopted to prevent child marriage, these women are
often married off before their bodies mature, with almost one third married by
age fifteen, and sometimes before they turn ten years old. Additionally, poor
intra-partum care contributes to the high rate of injuries during childbirth.
Due to poor infrastructure, lack of access
to healthcare in developing countries, and especially in rural communities,
adversely affects an already complex situation. Research shows that less than
60% of women in sub-Saharan Africa deliver their
children with the help of a qualified doctor or a midwife, and only 36% of
women in Nigeria
give birth under skilled medical care. Poverty and remoteness both play a
central role in women’s inability to reach a hospital for obstetrics care.
These factors contribute to difficulties
during child labor, where an underdeveloped pelvic girdle contributes to labor
dystocia, or obstructed labor, increasing the risk of uterine rupture or
infection. Often times, child labor lasts considerably longer than usual, resulting
in tissue damage from pressure exerted by the child’s head, ultimately leading
to vaginal fistula. Many of these women also experience stillbirth, which can
cause postpartum depression.
Unlike in Western societies, where vaginal
fistula is easily repaired immediately after childbirth, women in the
developing world are often impacted for the rest of their lives. In Africa,
in particular, husbands and immediate family tend to abandon the women who
suffer from vaginal fistula. Due to an uncontrollable foul smelling discharge,
society, in general, views these women as unclean, and often prevents them from
partaking in day-to-day activities. These women, who already deal with the
psychological impacts of stillbirth, are shamed to leave, and have to fend for
themselves on the outskirts of society without access to traditional family
support structures.
Poverty, lack of education regarding
available medical treatments, and deeply-rooted religious beliefs prevent these
women from seeking the help they need to heal. Oftentimes, vaginal fistula
patients suffer for years without knowing that their condition is treatable
with a simple surgery. In rural areas, there are simply no hospitals, and if
these women seek care at a regular urban hospital, guards often turn them away
due to their foul smell, and they leave without ever seeing a doctor.
Unfortunately, in countries where this condition is most prevalent, specialized
fistula hospitals are scarce, and not easily accessible for the majority of
women from rural areas.
Ultimately, women suffering from vaginal
fistula who are either unaware of, or unable to access treatment options, end
up living alone, and often without their previous children. Their medical condition
prevents them from leading productive lives, and contributing to the overall
economy. Without the ability to advance their education and learn new work
skills, these women are confined to a low social-economic status, which plays a
significantly adverse role in their chance for recovery. This influences future
generations of women, and perpetuates the current detrimental conditions.
