In Somalia, restoring dignity

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Obstetric fistula is a devastating childbirth injury, and a neglected public health and human rights issue.

2 million women in low-resource settings have an obstetric fistula, and up to 100,000 develop one every year. Leaking urine and / or faeces and living in despair on the margins of their own life, only 1 in 50 will ever receive treatment.

FIGO Fellows, trainee fistula surgeons from some of the world’s most underserved regions, are committed to closing this gap in care. Dr Abdirisak Hassan Artan, from Keysaney Hospital in Mogadishu, Somalia, shares his story.

Why is obstetric fistula a human rights issue? Because it is a problem restricted to women with certain circumstances, to a woman who is poor, who can’t access health facilities. 

We need a much stronger plan and a long-term vision if we are going to end the tragedy. International efforts focused on reducing maternal mortality are not sufficient, because there are still too many women delivering without skilled personnel, and complications arise when they should be prevented.

My home country, Somalia, ranks at the bottom of maternal and child health indexes. It is my great pleasure to be a FIGO Fistula fellow, with the training and the skills to help make a difference.

Obstetric fistula is the darkness of sorrow. So many women I have met would choose to die, rather than living with the injury.

Recently I admitted a 55 year-old woman who had lived with an obstetric fistula for the last 30 years, suffering three failed operations. Our anesthesiologist wanted to postpone the operation, because a scar in her lungs from a tuberculosis lesion made sedation a risk.

She proposed to die because of the anesthesia, rather than living any longer with a fistula and wetness. It was difficult to discuss, but she said it like this:

“I lost everything in my life. I lost my friends, my family, even my lovely husband.”

I advised the anesthesiologist to do his best, and we completed the operation together. The patient’s fistula is now closed, and she is finally dry.

Her plan is to go back to her family and her husband, to live normally again. This surgery is so important: it restores dignity and returns women to their community. My patient got her life back from the dead.

Maternal mortality is addressed in the 2030 Sustainable Development Agenda but maternal morbidity is not, even though it is a greater burden. Saving a woman from death and leaving her incontinent, isolated and devastated is not life-saving: it is a human rights violation.

On the International Day to End Obstetric Fistula, it’s time that obstetric fistula was brought back to the forefront of global conversation, to ensure that no woman is left behind. #EndFistula