Obstetric fistula: life shattering but preventable.

Imagine a world without obstetric fistula. The result of an obstructed childbearing labour that sometimes lasts for days without access to timely medical attention, obstetric fistula has a devastating impact on the lives of women. During labour, the continuous pressure of the baby's head against the soft tissues of the mother's pelvis causes fistula or a hole between the woman's vagina and either her bladder or rectum, which leaves her chronically leaking urine, excrement or both.

[ILLUSTRATION OMITTED]

The consequences are life shattering; in most cases the baby dies. Unable to control the constant trickle of bodily fluids, the mother is abandoned by her husband and shunned by the community because of the terrible odor and stigma associated with her condition. Without treatment, her prospects for work and normal family life, including childbearing, are greatly diminished. Filled with shame, she is relegated literally to the outskirts of her community and left to live in isolation.

Virtually non-existent in industrialized countries, obstetric fistula occurs primarily in poor areas of Africa, Asia and some Arab States. The World Health Organization has estimated that there are more than 2 million women and girls, some as young as 12, in developing countries suffering from it, with 50,000 to 100,000 new cases occurring each year. Yet, the condition is completely preventable and reparable. According to the United Nations Population Fund (UNFPA), "the success rate of fistula repair for experienced surgeons can be as high as 90 per cent. After successful treatment, most women can resume full lives". Sadly, many living with the condition either are unable to afford or access treatment or do not realize that treatment is available.

In January 2004, American television personality Oprah Winfrey dedicated an entire hour of her show to this little known, devastating childbirth injury. Heidi Breeze-Harris of Seattle, Washington, was among millions who tuned in that day. Three months pregnant at the time, she was deeply shocked by what she saw and heard and was so moved that by the end of the hour she felt compelled to help. Learning that the cost of reparative treatment for one woman is $300, she thought: "I've got that! This is an astronomical sum of money for these women, but it's so little by our standards, especially relative to the absolute devastation for the women left untreated."

[ILLUSTRATION OMITTED]

Tired of quietly lamenting the fact that issues affecting women and children are often left for last, Ms. Breeze-Harris, a self-described "sled-dog" ("Hook me up, I like to work!"), in her quest to fight fistula has ended up charging uphill as the co-founder of a volunteer initiative called "One by One". She began by talking about obstetric fistula to everyone she knew, quickly learning that few people had even heard about it. A few months after viewing the Oprah show, she met Kathy Bushkin, Executive Vice President of the United Nations Foundation (UNF), who was familiar with the condition. This contact eventually led her to Emily Courey of the UNF Women and Population Division, and over many phone calls they exchanged strategies and ideas as they devised the best way to work together.

UNF supports the work of the United Nations by helping it to forge new partnerships. Ms. Courey contacted UNFPA, the UN agency that with other partners had launched the global Campaign to End Fistula in 2003. According to Allyson Ryan, Partnership Development Associate for the Campaign, the overall goal is to make obstetric fistula as rare in the developing world as it is in industrialized countries today. Three strategic interventions are used toward this goal: prevention, treatment and social reintegration. In a short time, a triangular partnership was created between One by One, UNF and UNFPA. One by One works to raise funds that support the efforts of the Campaign, while UNF, acting as One by One's fiduciary, makes it possible for all donations to be fully tax deductible. The Campaign is currently under way in more than 30 countries affected by fistula.

[ILLUSTRATION OMITTED]

As the demands of One by One's partnership grew, Ms. Breeze-Harris contacted her long-time friend Katya Matanovic. Bringing ten years of experience in the non-profit sector to the project, Ms. Matanovic introduced the idea of an adapted giving-circle model that has become the foundation of One by One's fund-raising efforts. Traditional giving-circle models typically require participants to identify a cause that they would like to collectively support. In the adapted version, the cause is clearly defined for participants who wish to join: "Our goal was to make One by One very accessible so that anyone could jump in at any time", Ms. Matanovic stated. "Many of the complexities involved with the traditional model are stripped away because the cause and means are already defined for the group and set in place." In fact, "jumping in" is so easy, that all it needs is a group of ten people, each donating $30. "Thirty dollars seems like so little", Ms. Breeze-Harris stated, "but $30 times ten people would equal $300 ... enough to cover the cost of one woman's surgery, post-operative care and rehabilitation." She added that "a circle can be 300 people, each donating $1, or one person giving $300, or more". Most important, One by One wants the process to be easy. "This model connects people to the power of their money. It's straightforward and really gives people the sense that their contribution, at whatever level, can make a huge difference. One person here can literally affect one person there, so it really is a one to one exchange," she stated.

[ILLUSTRATION OMITTED]

Committed to the initiative before the birth of her son and only a few months into her work with UNF and UNFPA, Ms. Breeze-Harris became more personally connected to the issue and recommitted to the cause after suffering an obstructed labour herself that required an emergency Caesarean section, as well as a second surgery to stop internal bleeding. Without access to timely medical intervention, she might well have become a woman suffering from fistula. "My birth experience brought the work closer to my heart", she shared, "so close that I was back in the saddle, working again, only three weeks after my son's birth."

According to UNFPA, "prevention is the key to ending fistula. The same interventions that can prevent fistula could also save many of the half million women who die each year from complications of pregnancy and childbirth". Kate Ramsey, Project Specialist with the Campaign to End Fistula, said three things are essential to prevention: family planning, the presence of skilled birth attendants during labour, and accessible quality emergency obstetric care. "Fistula is a very good indicator for us of what we need to do in terms of improving maternal health care for all women in these countries. That requires a political will, human resources ... communities to be aware and mobilized."

Ms. Breeze-Harris was mobilized to create One by One because of compassion for and a desire to help women living with fistula. As such initiatives help to raise awareness, people will better grasp the complexities associated with the condition and in turn better understand the broader issues related to maternal health care in general. According to the Campaign's 2004 Annual Report, "fistula puts a human face to reproductive health and provides an entry point for advocacy around broader issues of universal access to reproductive health services and gender empowerment". Ms. Courey of UNF stated: "You say the words 'reproductive health' and all the different camps raise their banners. Fistula is a place of common ground for people of very different political persuasions. [It] acts as a unifier in a topic that's very divisive."

As Ms. Ramsey said, "this is an issue that really seems to grab people's hearts. We get calls from people who want to volunteer almost daily". One such caller was Dr. Bill Meyer, a panel member during One by One's official launch in March 2005. He got involved in the UNFPA Fistula Fortnight--a groundbreaking two-week advocacy, treatment and training programme to address the problem of fistula in Nigeria. In four Nigerian hospitals, teams of international and Nigerian doctors, including Nigerian trainees, performed a total of 545 fistula operations, the largest fistula surgical effort to date. "We operated for 13 straight days", Dr. Meyer said. "Everyone who participated donated their time for two weeks. It's a need that will never run out in my lifetime."

Success stories, such as the one quoted by the BBC on the UNFPA website of a Tanzanian woman who was successfully repaired, help us grasp more profoundly the importance of personal action. "I will be able to go to church again", Rukia said. "I will be able to help a bit in the fields. I will be able to go shopping and go on the back of someone's bicycle--all the things that other people normally do."

In a world that spins at an ever-quickening pace where we are constantly inundated with information from every corner of the globe, we as individuals can easily feel overwhelmed. Thoughts such as "where do I begin?" often engender confusion and inaction. It is up to us to sift through the mountain of information and make choices. Stories like the one in the UNFPA literature about Saida, a 28-year-old Eritrean woman who sold her only possession of value--gold earrings--to make the long journey to a health centre in the hope of being repaired, must make us stand up and pay attention.

It is a choice to become involved or not. For many of us, it is our great fortune that we have the freedom to even contemplate to act or not. Imagine a world without obstetric fistula--words spoken at the first One by One conference in Seattle in 2005. While it will require much effort and time, one by one we can help to make fistula as rare in the developing world as it is in industrialized nations today.

Jessica Bankes Beattie is a freelance writer and a small business owner for twelve years. She is passionate about global issues affecting women, children and motherhood, and enjoys travel and foreign languages.

[ILLUSTRATION OMITTED]

(For more information about fistula, please go to www.onebyoneproject.net)