Our upcoming Ethiopia clinical experience includes touring of the Fistula Hospital in Addis Ababa, and we also hope to set up a future clinical site there.
You are probably wondering, What is a fistula?
Below are excerpts from an essay I wrote last semester...
Many are familiar with the historical event that took place on April 15th, 1912, when a ship called the Titanic hit an iceberg and sank to the depths of the Atlantic Ocean. In 1997, the movie based on the historical event became the most expensive film ever produced at the time, with 20th Century Fox spending approximately 200 million dollars on its creation.1 Now, imagine a Titanic ship full of about 1,600 women sinking down into the ocean – every single day of the year. According to Nancy Durrell McKenna, founder of Safe Hands for Mothers, death is a reality for 500,000-600,000 women per year secondary to pregnancy-related causes. Ninety-nine percent of these deaths occur in developing countries, including Ethiopia.2 Put another way, every minute, 110 women experience a pregnancy-related complication – and one woman dies.2
Maternal mortality is clearly a worldwide issue that deserves much attention. If a woman does not die in childbirth, she is likely to suffer from a number of complications. The sad reality is that these women will likely face maternal mortality personally or with a relative or friend, and those who survive often suffer long-term consequences in the form of an obstetric fistula.
Of all of the statistics monitored by the World Health Organization (WHO), maternal mortality is the one that has the greatest discrepancy between developed and underdeveloped countries.3 Currently maternal mortality in developed nations is at record low, with improvements in antisepsis, trained personnel/facilities, and blood transfusions attributed to the changes.3 Direct causes of maternal mortality include hemorrhage, infections, hypertensive disorders including eclampsia, unsafe abortions, and prolonged labor. Indirect cited causes include anemia, tuberculosis, malaria, viral hepatitis, and malnutrition. High rates of HIV/AIDS and female genital mutilation are additional factors that may also contribute to maternal mortality, particularly in Ethiopia. Ultimately, a lack of access to adequate nutrition and medical care – beginning as a child but particularly during pregnancy and delivery – accounts for the astounding maternal mortality rates still present today in these developing nations.
A number of facts and statistics help paint the picture of the reality that so many women face. Women ages 15-49 are more likely to die due to complications from pregnancy and childbirth than they are from HIV/AIDS or malaria in developing countries. Uncontrolled bleeding and sepsis account for the majority of these deaths. While I mentioned that one woman dies per minute due to these complications, this number is accompanied by 70-80 more that simultaneously suffer debilitating injuries in the two minutes it takes to brush one’s teeth in the morning. In addition, a woman in Sub-Saharan Africa has a one in 16 chance of dying during pregnancy and childbirth, which is significantly higher than the one in 75 chance that is the average of all underdeveloped countries.2
Numerous socioeconomic and cultural factors contribute to maternal mortality and pregnancy related complications. As mentioned, factors like malnutrition beginning in childhood contribute to these statistics. It has been estimated by the WHO that if women were adequately nourished from a young age and received appropriate pre/postnatal and delivery care, infant mortality would be reduced by at least ¾.4 Undoubtedly, some of the predisposition in underdeveloped nations is also cultural, as women tend to marry and have children earlier when the female body, particularly the pelvis, is less prepared for childbirth.5 Socioeconomic status also likely contributes, as within Ethiopia, wealthier women have on average 3.2 children compared to the 6.6 average among the poorest women.
Physical access, resources and education also carry great implications for outcome. Fewer than 1 in 100 deliveries involve a doctor, nurse or midwife in the poorest regions of Ethiopia.4 Often, these births occur in areas that lack sanitation and clean water. Ethiopia as a whole is not much better off, as only 5% of pregnancies between 2000-2007 involved institutionalized delivery care.6 Most women in Sub-Saharan Africa also lack reliable family planning methods, and only 18% of married women in this region use modern contraception.4
Worldwide, about 100,000 women suffer from obstetric fistulas per year, and approximately 2 million cases are currently untreated.7 Compare this to the United States, where in 2007 not one fistula case existed. The obstetric fistula used to be present in the US and Europe in the 19th century, but have disappeared with improved obstetric care and the use of the c-section during obstructed labor.
An obstetric fistula describes the presence of an opening between the female vaginal and anal orifices or between the vagina and urinary bladder. This condition results from unrelieved obstructed labor, and without surgery the fetus either dies or is finally passed from the mother with accompanied tearing of the tissue.8 Often this condition leads to permanent urinary and/or bowel incontinence- in other words, the woman will constantly leak urine and feces from the damage sustained. Most of these women are then ostracized from their communities, divorced from their husbands, and find themselves living in even greater levels of poverty than before.8
In the PBS documentary “A Walk To Beautiful,” one is able to glimpse a small idea of what these girls and women go through. A specialized fistula hospital in Ethiopia provides free care to women, with hospital costs of about 450 dollars per person, which includes the surgical procedures, recovery, new clothing and even a bus ticket back to their village. However, while the hospital services are free to patients, many of the women lack the resources for the cost of traveling to the capital city to receive the care. Sadly, even more are unaware that their condition can be helped.
Follow this link to watch the excellent PBS Documentary for free!
http://www.pbs.org/wgbh/nova/beautiful/
Read this book on how the Fistula Hospital in Ethiopia came about - very good read: The Hospital by the River - A story of hope by Dr. Catherine Hamlin (available on Amazon.com)
And stay tuned for my next blog on how I think we as PT's can help the maternal mortality/obstetric fistula problem!
References
1. Titanic film information. http://en.wikipedia.org/wiki/Titanic_(1997_film). Accessed September 22,
2009.
2. Safe Hands for Women website.
http://www.safehands.org/index.php?option=com_content&task=view&id=12&Itemid=30.
Accessed September 22, 2009.
3. Maternal Mortality. http://dcc2.bumc.bu.edu/IH887/presentations98/mmpaper.html. Accessed
September 22, 2009.
4. PBS Film: A Walk to Beautiful. http://www.pbs.org/wgbh/nova/beautiful/women.html. Accessed
September 22, 2009.
5. Norman AM, Breen M, Richter HE. Prevention of obstetric urogenital fistulae: some thoughts on a
daunting task. Int Urogynecol J. 2007;18:485-491.
6.UNICEF website: Ethiopia statistics. http://www.unicef.org/infobycountry/ethiopia_statistics.html#59.
Accessed September 22, 2009.
7. The Fistula Foundation. http://www.fistulafoundation.org. Accessed September 22, 2009.
8. Wall LL, Arrowsmith SD, Briggs ND et al. Urinary incontinence in the developing world: the
obstetric fistula. Presented at the second international consultation on incontinence.
[Unpublished] 2001. Paris, France, July 1-3, 2001;40:893-935.
You are probably wondering, What is a fistula?
Below are excerpts from an essay I wrote last semester...
Many are familiar with the historical event that took place on April 15th, 1912, when a ship called the Titanic hit an iceberg and sank to the depths of the Atlantic Ocean. In 1997, the movie based on the historical event became the most expensive film ever produced at the time, with 20th Century Fox spending approximately 200 million dollars on its creation.1 Now, imagine a Titanic ship full of about 1,600 women sinking down into the ocean – every single day of the year. According to Nancy Durrell McKenna, founder of Safe Hands for Mothers, death is a reality for 500,000-600,000 women per year secondary to pregnancy-related causes. Ninety-nine percent of these deaths occur in developing countries, including Ethiopia.2 Put another way, every minute, 110 women experience a pregnancy-related complication – and one woman dies.2
Maternal mortality is clearly a worldwide issue that deserves much attention. If a woman does not die in childbirth, she is likely to suffer from a number of complications. The sad reality is that these women will likely face maternal mortality personally or with a relative or friend, and those who survive often suffer long-term consequences in the form of an obstetric fistula.
Of all of the statistics monitored by the World Health Organization (WHO), maternal mortality is the one that has the greatest discrepancy between developed and underdeveloped countries.3 Currently maternal mortality in developed nations is at record low, with improvements in antisepsis, trained personnel/facilities, and blood transfusions attributed to the changes.3 Direct causes of maternal mortality include hemorrhage, infections, hypertensive disorders including eclampsia, unsafe abortions, and prolonged labor. Indirect cited causes include anemia, tuberculosis, malaria, viral hepatitis, and malnutrition. High rates of HIV/AIDS and female genital mutilation are additional factors that may also contribute to maternal mortality, particularly in Ethiopia. Ultimately, a lack of access to adequate nutrition and medical care – beginning as a child but particularly during pregnancy and delivery – accounts for the astounding maternal mortality rates still present today in these developing nations.
A number of facts and statistics help paint the picture of the reality that so many women face. Women ages 15-49 are more likely to die due to complications from pregnancy and childbirth than they are from HIV/AIDS or malaria in developing countries. Uncontrolled bleeding and sepsis account for the majority of these deaths. While I mentioned that one woman dies per minute due to these complications, this number is accompanied by 70-80 more that simultaneously suffer debilitating injuries in the two minutes it takes to brush one’s teeth in the morning. In addition, a woman in Sub-Saharan Africa has a one in 16 chance of dying during pregnancy and childbirth, which is significantly higher than the one in 75 chance that is the average of all underdeveloped countries.2
Numerous socioeconomic and cultural factors contribute to maternal mortality and pregnancy related complications. As mentioned, factors like malnutrition beginning in childhood contribute to these statistics. It has been estimated by the WHO that if women were adequately nourished from a young age and received appropriate pre/postnatal and delivery care, infant mortality would be reduced by at least ¾.4 Undoubtedly, some of the predisposition in underdeveloped nations is also cultural, as women tend to marry and have children earlier when the female body, particularly the pelvis, is less prepared for childbirth.5 Socioeconomic status also likely contributes, as within Ethiopia, wealthier women have on average 3.2 children compared to the 6.6 average among the poorest women.
Physical access, resources and education also carry great implications for outcome. Fewer than 1 in 100 deliveries involve a doctor, nurse or midwife in the poorest regions of Ethiopia.4 Often, these births occur in areas that lack sanitation and clean water. Ethiopia as a whole is not much better off, as only 5% of pregnancies between 2000-2007 involved institutionalized delivery care.6 Most women in Sub-Saharan Africa also lack reliable family planning methods, and only 18% of married women in this region use modern contraception.4
Worldwide, about 100,000 women suffer from obstetric fistulas per year, and approximately 2 million cases are currently untreated.7 Compare this to the United States, where in 2007 not one fistula case existed. The obstetric fistula used to be present in the US and Europe in the 19th century, but have disappeared with improved obstetric care and the use of the c-section during obstructed labor.
An obstetric fistula describes the presence of an opening between the female vaginal and anal orifices or between the vagina and urinary bladder. This condition results from unrelieved obstructed labor, and without surgery the fetus either dies or is finally passed from the mother with accompanied tearing of the tissue.8 Often this condition leads to permanent urinary and/or bowel incontinence- in other words, the woman will constantly leak urine and feces from the damage sustained. Most of these women are then ostracized from their communities, divorced from their husbands, and find themselves living in even greater levels of poverty than before.8
In the PBS documentary “A Walk To Beautiful,” one is able to glimpse a small idea of what these girls and women go through. A specialized fistula hospital in Ethiopia provides free care to women, with hospital costs of about 450 dollars per person, which includes the surgical procedures, recovery, new clothing and even a bus ticket back to their village. However, while the hospital services are free to patients, many of the women lack the resources for the cost of traveling to the capital city to receive the care. Sadly, even more are unaware that their condition can be helped.
Follow this link to watch the excellent PBS Documentary for free!
http://www.pbs.org/wgbh/nova/beautiful/
Read this book on how the Fistula Hospital in Ethiopia came about - very good read: The Hospital by the River - A story of hope by Dr. Catherine Hamlin (available on Amazon.com)
And stay tuned for my next blog on how I think we as PT's can help the maternal mortality/obstetric fistula problem!
References
1. Titanic film information. http://en.wikipedia.org/wiki/Titanic_(1997_film). Accessed September 22,
2009.
2. Safe Hands for Women website.
http://www.safehands.org/index.php?option=com_content&task=view&id=12&Itemid=30.
Accessed September 22, 2009.
3. Maternal Mortality. http://dcc2.bumc.bu.edu/IH887/presentations98/mmpaper.html. Accessed
September 22, 2009.
4. PBS Film: A Walk to Beautiful. http://www.pbs.org/wgbh/nova/beautiful/women.html. Accessed
September 22, 2009.
5. Norman AM, Breen M, Richter HE. Prevention of obstetric urogenital fistulae: some thoughts on a
daunting task. Int Urogynecol J. 2007;18:485-491.
6.UNICEF website: Ethiopia statistics. http://www.unicef.org/infobycountry/ethiopia_statistics.html#59.
Accessed September 22, 2009.
7. The Fistula Foundation. http://www.fistulafoundation.org. Accessed September 22, 2009.
8. Wall LL, Arrowsmith SD, Briggs ND et al. Urinary incontinence in the developing world: the
obstetric fistula. Presented at the second international consultation on incontinence.
[Unpublished] 2001. Paris, France, July 1-3, 2001;40:893-935.
No comments:
Post a Comment