April, 2012

Their girlish voices echo down the hallway. Every morning I hear them counting in Hausa – "diya, biyu, uku." It’s helped me learned my numbers so I can ask a pregnant woman how many months she is. Maternity is surprisingly quiet so I head over to the fistula, to see them. In two rows facing each other, the girls do their morning physiotherapy to strengthen their pelvic floors. Most of them have urinary catheters and carry around their bag of urine in a colorful plastic bowl. Some of them limp, some grimace in discomfort, but I can only imagine how much worse it’s been for them. Obstetric or vesicovaginal fistula, what happens to a young woman or girl who gets pregnant too early and/or whose pelvis is too small to give birth. She labors for days and eventually tries to push her baby out. Maybe family members push and lean on her belly to try and force it out. But the baby cannot come and at some point dies. The mother is left with a stillborn, stuck, putting pressure on her pelvis and the wall between vagina and bladder and vagina and rectum. The tissue loses circulation and becomes necrotic. A hole forms. A c-section may save her life but the sequela can be disastrous. She leaks urine or feces or both from her vagina, a steady stream that make her reek and prone to infection. She becomes ostracized. Her husband almost always leaves her.