Obstetric fistula: Natalie Imbruglia sheds light on devastating condition.

Obstetric fistula may not be a familiar term to many, but Australian singer/actress Natalie Imbruglia is hoping to change that. A spokesperson for the United Nations Population Fund (UNFPA)-led Campaign to End Fistula, she used a recent visit to Nigeria to focus public attention on the little known childbearing injury that affects more than 2 million women in developing countries. She first heard about obstetric fistula from Richard Branson, Chief Executive Officer of the Virgin Group of companies. In January 2005, she visited fistula hospitals in Nigeria and Ethiopia with representatives from UNFPA and Virgin Unite, the charitable arm of the Virgin Group and a partner in the Campaign. Deeply moved by what she saw, she felt compelled to act. "It just struck a chord with me. It was so devastating to me that all these women are suffering from a condition that is preventable. I didn't think it should be happening in this day and age."

In August, Ms. Imbruglia returned to Nigeria to meet with patients, surgeons, government officials and religious leaders, accompanied this time by a group of journalists, photographers and filmmakers from the United States, the United Kingdom and Australia. The goal was to absorb as much as she could from those closest to the issue so that she could be a better advocate back home. Why another visit? "You have to have a starting point. With more than 400,000 cases of fistula in Nigeria alone, this seemed a good place to begin", she said. Fistula is most common in poor communities of sub-Saharan Africa and South Asia, where access to obstetric care is limited. Studies show that Nigeria may have one of the highest fistula prevalence rates in Africa; an estimated 400,000 to 800,000 Nigerian women are living with the condition, with 20,000 new cases each year. The problem is particularly severe in the country's northern states.

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Ms. Imbruglia's August agenda included a return visit to Kwalli Rehabilitation Centre, a facility that supports women during the critical two weeks of post-operative care and teaches them basic skills, such as literacy, knitting and sewing. It aims to arm women with the tools they will need to be self-sufficient after returning to their communities. When she first visited the centre in January, she was told of an urgent need for a new van to transport patients to and from their villages and the nearby Murtala Muhammad Specialist Hospital. The facility's van was on its last leg. Ms. Imbruglia raised funds to purchase a new van--a "small token of support" that will no doubt make a difference in the Centre's day-to-day operations. With a group of patients at Kwalli, they gave the vehicle their own personal touch: painted handprints. "I wanted the girls to feel like this was really their van", she said. "I saw this as a way for us to do something together that was spontaneous and fun."

While in Katsina, Ms. Imbruglia visited a UNFPA-supported maternity clinic that provides free pre-natal care and Caesarean section-key interventions to prevent fistula. "There are certain places like this where you can see change happening", she stated, adding that "loads of women" were taking advantage of these services. Later that day, she accompanied a group of Red Cross volunteers on a community outreach visit to a nearby village, where she met a treated fistula patient who had successfully reintegrated into her community. "Her mother and grandmother were by her side. She seemed to have a very loving family and did not appear ostracized in any way", said Ms. Imbruglia. "It was nice to see that first-hand and not just be told."

An interview with 27-year-old Aisha, a patient at Babbar Ruga Fistula Hospital, was far less encouraging. Aisha had arrived at the hospital three years prior with unusually severe injuries. Since then, she has had four unsuccessful fistula repair operations. Her mother had died, her husband had divorced her and she had lost all contact with other relatives. "It broke my heart because there was just nothing good in her story", Ms. Imbruglia said. "All I could do was wish her well and hope that she'd have more luck with her fifth surgery." During the trip, she reunited with Zainab Ibrahim, a patient she had met on her previous visit and who she had hoped to see in her village. "Then I got the sad news that she was back at Babbar Ruga for a second fistula operation," Ms. Imbruglia said. "She and her husband had sex too soon when she went home." Women with fistula are advised to abstain from sexual relations for six months in the post-operative period to allow time for their wounds to heal; to that end, educating husbands is essential.

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Recognizing the critical role that traditional and religious leaders can play in addressing fistula, Ms. Imbruglia met with the Emir of Katsina and the Wambai of Kano (second-in-command). "The Honourable Commissioner of Women's Affairs in Kano told me, 'If the Government tries to implement something, people can turn a blind eye. But if it's embraced by the Emir, they will take it to heart'", the Campaign's spokesperson noted. She was especially encouraged by the actions of the Emir, who had put together a fund to ensure free food for all women at a local fistula hospital. "He seemed to really be behind it."

Consistency is key. "We have to keep going back to the same places and stay on the same messages", Ms. Imbruglia said, acknowledging that the process would likely be slow. Partnership with the Government, community groups, non-governmental organizations and health professionals is also vital to the success of the Campaign to End Fistula. Back in the United Kingdom, she said she was more resolved than ever to spread the word about fistula and raise resources for the cause. "I'm 100-per-cent committed, and I'm confident we can get those numbers [of women with fistula] down. We have to! It's not an option."

Saira Stewart is a journalist currently working as a media consultant for the UNFPA-led Campaign to End Fistula.

(For more information, visit http://www.endfistula.org)

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Obstetric fistula, caused by prolonged and obstructed labour without prompt medical intervention, usually through a Caesarean section, leaves women with chronic incontinence and in most cases results in a stillborn baby. Unable to stay dry, women with fistula are often abandoned by their husbands and rejected by their communities.