Innovation Blog

2 Million Women Suffer — Who Cares?

The Terrible Shame of Fistula

By Shlomo Maital

Oct. 27/2009

   If two million American, French, British or German  women suffered from a life-destroying humiliating and unbearable condition — how many thousands of innovators and billions of R&D dollars would be devoted to finding a rapid solution?

   But, fear not, it is only African, Asian and Arab women.  So, who cares?

   The condition is fistula.  It is horrendous just to read about it.  And despite a global campaign launched by that powerful, effective and efficient body called the United Nations, little progress has been made.  We have excuses rather than results.  It is a true disgrace, and a dark blot on the alleged humankindness of the wealthy half of the world.  

    The cost of curing the 2 million African, Asian and Arab women who suffer from the condition is $600 m., or $300 per woman,   a sum equal to about 12 hours’ worth of crude oil production, or 0.1 per cent of what the world spends annually on advertising. 


    According to the UN:


 Obstetric fistula is a hole in the birth canal caused by prolonged labour without prompt medical intervention, usually a Caesarean section. The woman is left with chronic incontinence and, in most cases, a stillborn baby.  The smell of leaking urine or faeces, or both, is constant and humiliating, often driving loved ones away. Left untreated, fistula can lead to chronic medical problems, including ulcerations, kidney disease, and nerve damage in the legs.  A simple surgery can normally repair the injury, with success rates as high as 90 per cent for experienced surgeons. The average cost of fistula treatment and post-operative care is just US $300. Sadly, most women with the condition do not know that treatment is available, or they cannot afford it.   Like maternal mortality, fistula is almost entirely preventable. But at least 2 million women in Africa, Asia and the Arab region are living with the condition, and some 50,000 to 100,000 new cases develop each year. The persistence of fistula is a signal that health systems are failing to meet the needs of women.



    If philanthropy is absent, where is creativity — a cheap effective solution poor women can afford?  Where are the world’s creative gynecologists? What about a mass-production ‘assembly line’ surgical unit, portable, that can do hundreds of such operations, for example?  What about enlisting 3,000 gynecologists  and surgeons to donate a month a year curing fistula?    


   In 2003, UNFPA spearheaded the global Campaign to End Fistula, “a collaborative initiative to prevent fistula and restore the health and dignity of those living with its consequences.” What a relief.  Rather — what a joke. 

      Perhaps we need a campaign to end the Campaign to End Fistula, and get down to some real action.  I don’t see how we wealthy people sleep at night when so many people are suffering so badly, and so needlessly.

Postscript:   Nicholas Kristof wrote his Sunday Oct. 31  NYT column on this subject — a topic he has been writing about since 2002.  Here are the first paragraphs…

October 31, 2009, 10:10 pm

<!– — Updated: 8:48 am –>A Heroic Doctor, a Global Scourge

By Nicholas Kristof

My Sunday column is about obstetric fistula, a horrendous childbirth injury that rarely gets attention or treatment because the victims are the most voiceless of the voiceless. Dr. Lewis Wall, the hero of the column, taught me about fistulas years ago, and so I’ve been writing about them periodically since my first column on the topic back in 2002.

For years, I’ve watched with admiration as Dr. Wall has persevered to try to build a fistula hospital in West Africa — and I’m thrilled that he is now fulfilling his dream. Those who want to help his Niger hospital can support his organization, the Worldwide Fistula Fund; tax-deductible donations to the hospital are possible right on the site, so please don’t send any money in my direction. For now the surgeries in Niger will be done in the existing leprosy hospital there, and he still needs significant sums to construct the new fistula wing beside it.

There’s another great fistula organization, the Fistula Foundation, that supports the Addis Ababa hospital and other places such as the remarkable Edna Adan maternity hospital in Somaliland.

Above all, I hope that we go even further and eradicate fistula globally. In the column, I mention Dr. Wall’s careful 12-year $1.5 billion proposal (written with Michael Horowitz of the Hudson Institute) to eradicate fistula. It’s also an effort to tackle maternal mortality; my sense is that fistula may be the best way to get traction for maternal health