By: Habiba Cooper Diallo
Anafghat was a young girl from Tarbiyat, Niger who suffered an obstetric fistula, arguably the most devastating affliction known to humanity. It results from a prolonged, obstructed labour in which the baby is malpositioned in the uterus or the pelvis is to small to accommodate the passing of a baby. A tear eventually forms in the bladder or rectal wall of the distressed women as the baby struggles to come out. The child is usually stillborn while the mother develops urinary or fecal incontinence.
This post contains excerpts from my TEDx Talk for Halifax West High School:
Medically, a fistula simply means a hole and there are different types of fistula, for example a tracheoesophageal fistula, but then there's also an obstetric fistula, the one I am talking about. Waste products leak from the woman's bladder or rectum; from the affected area. By waste products, I mean urine and feces. See the diagram below which illustrates the area of fistula.
Waste products constantly leak from the woman's punctured organs. Due to this condition fistula patients are abandoned and ostracized by their families and communities.
Following an agonizing and unsuccessful, four-day labour, Anafghat’s father took her to the Hopital National de Niamey in Niger’s capital where her fistula was cured. Her life was so affected by the experience that when she returned home, she made it a point of duty to help eradicate fistula and other women’s health-related issues.
She quickly returned to school and came first in her class, being dubbed “the college student” by her peers. She became an advocate in her community and an authority on female empowerment. She spoke on the local radio station, spreading awareness among her peers and relatives about the importance of educating young women and girls.
“I want to be a doctor, and an important woman-” these are the words of Anafghat.
I learned about Anafghat when I was 12—years old after reading an article in the Wall Street Journal that detailed the events of her experience with fistula.
Not only did her story resonate with me on a humanitarian and empathic level, but it also resonated with me culturally.
I have West African origins from Guinea and Liberia which means that I share certain elements of my humanity with Anafghat.
Hence, I realized that although fistula is currently an issue of the Global South, it is not mutually exclusive to the health issues of African-descended women living in Canada, America, Europe and other parts of the Global North.
Nor is it mutually exclusive to the health or social problems faced by the general population of young Canadian women in high schools or universities. Fistula is merely an indicator of a bigger problem, and that problem is the condition of women in today’s world. I am a high school student myself Young Canadian girls are affected by the blatant misogyny and rape culture that is prevalent in our countries. In schools, terms like, bitch, cunt, pussy, etc. are thrown around loosely by both young men and young women. What’s insidious about such language is that it becomes accepted; hence, subconsciously we learn to accept and validate the denigration of women. A statistics Canada report found that 1 in 4 Canadian women are sexually assaulted before the age of 16.
Another example of this is the acceptance of the sexist activities tolerated during frosh week on university campuses across Canada and the United States.
A recent Globe and Mail article stated that, “no fewer than one in five women will be the victim of rape or attempted rape by graduation.”
This rape culture is indicative of the inequality experienced by women in the same way that fistula patients in Ethiopia or Niger experience inequality. The cases of: Lisa Marie Young, Maisy Odjick, Tanya nepinak, Carolyn Sinclair, Reteah Parsons Steubenville, and the list goes on, attest to the pervasiveness and rampancy of sexual assault, gender inequality, and violence experienced by North American women. Today in Canada we are faced with the tragic reality of murdered and vanished native women. The Native women’s association of Canada reports more than 580 cases of missing or murdered Native Canadian women.
Fistula has been recognized as a maternal health illness for about 3 and half millennia.
In 1550 BCE an inscription found at Thebes, Egypt alludes to a patient suffering from fistula. I will quote directly from The Hospital By the River,by Dr. Catherine Hamlin, which states the inscription as follows: ‘prescription for a woman whose urine is in an irksome place: if the urine keeps coming and she distinguishes it, she will be like this forever.’ Then 250 years later, Egyptian physicians looked for ways to treat this disease.
The Kahun Gynecological Papyrus, the world’s oldest medical text from Kahun, Egypt, which dates back to about 1800 BCE, makes a direct reference to obstetric fistula.
Today there is LITTLE to NO AWARENESS OF FISTULA IN CANADA. Yet there was a time when it was a significant problem in North American obstetric care.
Late 19th century physician Dr. Marion Sims, known to many as the “father of gynecology,” made his claim to fame by operating on the fistulas of several slave women, including Betsy and Anarcha. He bought them from their masters and forcibly performed obstetric fistula surgery without the use of anaesthesia despite its discovery the time.
Dr. Marion Sims
Anarcha was made to undergo 30 excruciatingly painful operations before he cured her fistula. Simms’ exploitation of Black women’s bodies to perform medical experiments was what allowed for the development of the methodology currently used to perform obstetric fistula surgery. These operations were part and parcel of the scientific mindset of the day in which the current thinking was that Black bodies— male and female— were exploitable and disposable.
The world’s first known fistula hospital was founded by Dr. Sims in 1855 in New York. Around 1925 it was renamed the ‘Women’s Hospital’ as fistula no longer required significant medical attention.
The Women's Hospital, New York
Yet in parts of the Global South like, Uganda, Niger, India Ethiopia, Guinea, Liberia, Bangladesh Sierra Leone obstetric fistula care is lagging behind. The problem with this is that it means an estimated 2 to 3 million women are constantly robbed of their dignity, denied their humanity and shut out from the rest of the world.
Fistula is a women’s problem. It is a poor woman’s problem, but it is also a man’s problem, a child’s problem. We are all somehow tied into it, because we are all a product of pregnancy. Fistula is an indicator of how women are treated, especially poor women. Eradicated in North America by the early 20th century, it remains a problem for women and girls like Anafghat. Fistula is an indicator of poverty. It is an indicator of the inequality between men and women. It’s really something for us to consider if we want to claim and uphold morality as a people.
Fistula is so associated with filth, and when we think of filth when think of garbage we think nastiness, we think repulsion. So in that sense, fistula patients are perceived as disgusting and off-putting. No one wants to associate with them. Imagine developing fistula at 12 years of age, and living with it until 17 years of age— and here I’m citing a specific case— some women live with it until death; some women never receive treatment. Imagine that during those 5 crucial developmental years, you receive so much disdain and contempt from the world and from everyone around you. Every time you step outside, no one wants to associate with you; people turn their backs to you. What kind of life is that? That is no life at all. But this is the plight of the fistula patients; this is their life; a lived, mundane everyday experience.
Now I’ll take you back to Anafghat. Anafghat’s paradigm shift made her see the world in a new way. She was now more determined than ever to pursue an education and effect change in her community. Had it been for this, along with improved medical facilities, today Anafghat would have been 23 years old and on her way to becoming a practicing physician to address the health needs of women and children within her community.
For the past 6 years I have been engaged in fistula advocacy. I am passionate about the empowerment of women through the improvement of their medical experiences. I couple this with the quest for social justice and equality for women. We’re all bound by the common thread of our humanity.
Habiba Cooper Diallo
I am a Canadian fistula advocate and blogger, and the founder of the Women’s Health Organization International, WHOI. I have been doing fistula awareness-building in Canada for the past 10 years. My work on fistula has led me to Guinea, Ethiopia, and Sierra Leone. I have been featured in Forbes, the HuffPost, and UNFPA