Obstetric fistula is a debilitating medical condition faced by
impoverished women mostly in Asia and Africa. In Rwanda, the
International Organisation for Women and Development (IOWD) is
doing an exemplary service by reaching out to these remote
communities. Rubina Singh speaks to IOWD volunteer Tracy Glenn
and discovers the far reaching impact of this largely avoidable calamity
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While the name might sound unfamiliar, technical and even complicated, obstetric fistula nonetheless remains an easily avoidable medical problem that even in this day and age still continues to afflict more than 2mn women worldwide. According to World Health Organisation (WHO) statistics in 2010, in spite of medical science being able to prevent it, more than 100,000 new cases develop each year worldwide.
While cancer and diabetes are well known and much feared, the little known obstetric fistula is a condition that is just as, if not more, debilitating. Rampant in isolated, strife torn, remote communities, not much is spoken about it in everyday life.
The 1994 genocide in Rwanda killed close to a million people, another 2mn fled the country, in some ways a situation that is perhaps dangerously close to being duplicated in present times in Syria.
The International Organisation for Women and Development (IOWD) is a charitable organisation that organises medical professionals interested in volunteering, to visit countries like Rwanda to perform surgeries that can make a difference in these remote communities. Unlike other charities where the donations also cover the costs of functioning and the staff, with IOWD, each volunteer pays their own fare and upkeep and this way ensures that the entire donation is used only for the needy.
A Canadian living and working in Qatar, Tracy Glenn is a nurse by profession and at heart. She is passionate about volunteering her skills to those in need. And with this purpose, Tracy often contributes her time and service to welfare projects organised by IOWD. Recently, Tracy was in Rwanda, to support a group of volunteer medical specialists performing surgeries on tribal women in Kibagabaga who still continue to bear the burden of circumstances created by the genocide almost two decades ago. Excerpts ...
How does the infamous 1994 genocide in Rwanda still continue to impact the lives of the people?
Nineteen years ago, one tribal group in Rwanda massacred another tribe, many amongst these being the qualified intelligentsia. The young generation that has lived through the genocide doesn’t have the benefit of learning from those experienced professionals from the previous generation. This has resulted in a paucity of trained professionals particularly medical professionals, such that even avoidable complications like obstetric fistula are still wreaking havoc in the community.
What causes obstetric fistula and how does it impact society?
Obstetric Fistula is a hole in the vagina or rectum caused by labour that is prolonged — often for days — without treatment. Mostly rampant in poor countries, there are 2mn young women in the world living with untreated obstetric fistula.
Simply put, the wall between the bladder and vagina gets damaged by the prolonged pressure of the baby’s head, and a fistula or hole develops. Consequently, these women lose control on urine or faeces and hence are incontinent all the time.
Very often, after an unbearably long spell of painful obstructive labour, while they are still struggling to come to terms with the tragic loss of their unborn child, the woman are often divorced by their husbands and family and they become an outcast.
Disowned and deserted, their misery is further compounded by poverty. With no resources to tackle the problem, they live in isolation, leak, smell, are extremely susceptible to infections and are ostracised from the community.
Obstructed labour, early childbearing before pelvic growth is complete, malnutrition, lack of obstetrical and antenatal care, unskilled health personnel, limited or no access to emergency care, remote locations and extreme poverty are some of the factors that contribute to this situation.
Due to the war and other reasons, there are very few qualified surgeons and medical professionals left in Rwanda who can do complicated surgery and hence these women have no future without help from charitable organisations and people.
What do the IOWD team of voluntary medical professionals do that stops the leaking?
Basically we repair the hole, a fairly simple procedure but often the lack of medical knowledge and facilities result in it becoming a very complicated and long surgery. Sadly though, for some women, the damage is too complicated and the post-recovery care needs to be extremely specialised. There are times when we cannot ensure that we will be there for the post-surgical care and in those circumstances we have to put them off to another visit.
Unfortunately there are also many cases that are beyond repair and for these unfortunate women, the only help we can give is to give them waterproof underwear with a washable liner.
Barbara Margolies, the founder of IOWD, has these specially made to help them ‘manage’ if not ‘fix’ the condition. The liners can be washed out, reused, are not disposable and hence help them in a sustainable way. So in such cases we are able to make a difference in so far as to enable these women to stop leaking in public and therefore give them back some of their life and dignity.
What happens to women in developed countries that have similarly long drawn out complicated labour?
It’s almost unheard of in developed countries because they have access to emergency care, so women don’t have to go through 4-6 day labour pains and a caesarean section would be done before irreparable damage is done. It’s virtually eradicated in the developed world. But after the genocide in Rwanda, many of the professionals were killed and the poverty, illiteracy does not help the cause either.
Are there many other countries in the world, which would be in a similar situation?
Obstetric fistula is primarily found in remote areas in sub Saharan Africa and many parts of Asia. Often in these areas there is absence of healthcare clinics and skilled midwife or surgeon that could do a caesarean section in the case of an obstructive labour. Often they have no access to transport and if they live in the mountains or in rural areas, their only transportation is walking. They have no ambulance or car and no one to take them. So they deliver the child at home or in the clinics which have neither the equipment nor the expertise to take care of this situation.
Any incidents from the trip that stand out in your memory?
The first day I arrived at the Kibagabaga Hospital in Kigali — the capital, I went out to find the tents that housed these women and upon asking for directions, I was told to “just walk behind the hospital and follow your nose because you’ll smell them before you get to them!”
I did find them that way. I was in my scrubs. The tents were huge and as I opened the flap and went inside, I waved to the women and said “Amakuru!” which is hello in Kinyarwandan and all of the women put their hands up and waved and gave me the biggest smile. They looked so hopeful and so happy, despite their medical issues!
What inspires you to do this time and again and what do you get in return?
I’m a nurse and for me to give a day or a weekend is so little in comparison to what difference my time and input can make to these tragic cases. For example, the government hospital in Rwanda does not even have sheets, blankets, pillows or food for the patients. So somebody has to bring food to them every day, or they don’t have any food or essentials. So when IOWD went to Rwanda, they took almost a $100,000 worth of supplies with them which was all donated to these communities. There is an incredible sense of contribution towards such a just cause. Personally, it’s a great feeling to know that I’ve been able to help somebody; it’s also part of the nursing culture.
How can like-minded people in Qatar contribute towards supporting similar projects?
Most medical professionals and other healthcare providers aren’t aware that these opportunities to volunteer exist, so spreading the word with the help of media is a very important step. Non-medical people can help by donating money to IOWD that goes towards providing supplies for the clinic, hospital and patients.
People can also do some fundraising events to collect money for such charitable causes. Another way to help is by contributing diapers, old and used baby and women’s clothes, blankets etc. In Qatar particularly, where most people are affluent, a lot of clothes and commodities which are still in a good condition are just thrown away and could be used by these poor people for whom they would be a real luxury.
So if a community member wants to help who should they contact?
People can go to IOWD’s website for further information as well as donate money through the website. Donations are used solely to provide basic necessities for the patients and the needy.
For those who can’t spare money but would like to contribute old used clothes, who can they contact?
That is a little bit more difficult because each volunteer that goes there is allowed the same baggage allowance as any other passenger and while most carry as many donated items as possible, the amount is still very insignificant.
If an airline/ freight company would offer to help by waiving off the transportation cost, we could help these people a whole lot more. Until then, I am happy to take donations of baby clothes and carry them with me.
You took baby clothes the last time you went. What was their reaction?
It was a very tender moment when we went into the neonatal intensive care unit and gave out the baby clothes to these women for their little newborns. They were so immensely grateful. I think most of them had never had anything new.
How has this experience impacted your perspective to life?
I think I’m more aware of the state of women’s healthcare in developing countries. Every time I travel somewhere to volunteer in a nursing capacity I see that women particularly are more affected by the lack of emergency healthcare resources and obstetric fistula is a problem that we can do something about. So every day I think I’m lucky that my family and I are healthy and I have these skills that I can share and hopefully help other people with.
IOWD continues to return to Kibagabaga Hospital three times each year, with those visits pre-arranged with the ministry, one year in advance. For more information on how you can help log onto http://www.iowd.org