Obstetric fistula is not easy to talk about, let alone solve. In the simplest terms, a fistula is a hole. An obstetric fistula is a hole in a woman’s vaginal tissue. Allow me to explain.
When a woman goes into labor without the aid of a trained medical professional, she can experience painful obstructed labor for multiple days. All too often, this difficulty occurs when the mother is young, and her pelvis is not yet fully developed. The pressure caused by the infant pushing against her pelvis for this length of time damages the surrounding tissue, which can create a hole. Once the baby is finally delivered, this fissure compromises the mother’s control over her bladder and bowels, which can make functioning in public quite difficult and embarrassing.
Over one million women suffer from this tragic condition, and many are shunned by their husbands and communities due to a leakage problem out of their control. But here’s the catch. Obstetric fistula can be completely cured with a simple surgery.
I feel honored to know an individual dedicated to connecting women with the medical resources needed to treat and prevent fistula. Meet Jasmine Kipke (my freshman year roommate!) who is currently tackling obstetric fistula in Mbarara, Uganda.
Jasmine is a senior at the University of Michigan, and she is majoring in Neuroscience. She is an avid runner and a devoted sister to her nine other siblings, two of which were adopted from Uganda in 2010.
Last fall, Jasmine received an email from the Progressive Health Partnership (PHP), an NGO focused on maternal and neonatal health, seeking volunteers interesting in joining the organization. “I remember staring at that email in surprise,” she said. “It was like it was written for me.”
Jasmine spent the previous summer working on a health and sanitation project in Uganda, and she wanted the opportunity to return to the country as soon as possible. “I joined PHP and learned that fistula is a problem that needs to be researched and addressed. I immediately felt drawn to this task,” she recalls.
Her passion for maternal health grew as she began to design a project through Davis Projects for Peace. This organization encourages students to create their own plans for resolving conflict in any part of the world, and the winners are awarded $10,000 grants to turn their designs into a reality. Jasmine’s project was selected, and she has been using the grant to work with the Progressive Health Partnership in Uganda since the end of May.
I was able to check in with Jasmine over Facebook and email to see how her time in Uganda is coming along so far. I learned that she is currently holding focus groups with men and women throughout the Mbarara area to gauge local perspectives on fistula, current maternal health practices, and existing medical services.
“Sometimes we wait a long time for people to show up [at a focus group], so we play with babies and talk to people (practicing new words in the local language) to pass the time. When everyone is there we sit in a circle, give our introductions, and go around and learn everyone’s names. We have our focus group, asking questions about fistula in the community and writing every response down.”
Jasmine and the PHP team then use the insight gained from these focus groups to create a formalized referral chain between pregnant women and local neonatal and fistula services. According to Jasmine, “Women get fistula from obstructed or prolonged labor, but many labors don’t have to transgress to prolonged labor and obstructed labor doesn’t have to lead to fistula.” A PHP referral chain will connect women with the medical care they need, preventing fistulas from forming in the first place.
But Jasmine understands the challenges to addressing root causes of an issue. “No matter how much careful planning you put into something, there are always complications that you didn’t plan for,” she notes.
“For example… you may think that providing women with money for transportation to the health center will prevent [fistula]. But what if there are few transportation options available on the isolated village roads? Or what if the health center is unequipped to deal with the influx of women now able to come for delivery? That’s the biggest challenge- changing an issue from the ground up and addressing every angle of the problem in order to effect sustainable change.”
Jasmine also emphasized that another underlying cause of fistula is poverty. Even when local medical professionals are able to perform fistula surgeries, clinics and hospitals are often understocked and overbooked. Patients are required to purchase their own medicine and gauze for surgeries, which automatically excludes impoverished mothers from the medical system. As a result, Jasmine is trying to organize a partnership with a local doctor who will work directly in Mbarara and will perform fistula surgeries for free.
After learning the details about how Jasmine and the PHP are working to eradicate fistula, I still had one more question. What could I do to help? I asked Jasmine, and she said, “Once people know about and acknowledge fistula and inequities in maternal health, they can decide how they’re going to be part of the solution.”
“...the global health world is vast and encompasses many different fields and professions. It’s not just fistula, and it’s not just in Uganda: there are all kinds of health inequalities everywhere, even right at home. Having the awareness and courage to step outside of one’s comfort zone to blatantly see these disparities for what they are can make a huge difference.”
Acknowledging a gruesome and prevalent affliction is the first step toward finding a solution, and luckily, Jasmine is already ahead of the curve. By the end of her time in Uganda, she hopes to have reduced the amount of time it takes for a woman to decide to go to a health center, given mothers the ability to get to a clinic before delivering, and ensured these women receive immediate care upon arrival.
“Seeing a mother with her new baby in the health center, just beaming, and being able to greet her and see her joy is wonderful,” Jasmine said.
After researching an organization that you feel passionate about, there is always the option of donating money to fuel on-the-ground research and project implementation. To donate to Jasmine’s partner organization, the Progressive Health Partnership, click here.
To read more about Jasmine’s time in Uganda, you can access her blog here.