Many are accustomed to hearing the phrase “Behind every great man there’s a great woman.” Yet, if this is the case, why are many women of the world being tormented physically, mentally and emotionally every day? And how does medicine take a role in this dilemma?
Fistulas are an abnormal connection or passageway between an organ, vessel or intestinal structure. In the Western world, obstetric fistulas are commonly due to obstructed labor or lack of care during childbirth. In the developing world, these fistulas are often due to rape, abuse, genital mutilation or childbirth injuries. Trauma causes tissue death or necrosis, which leaves a hole where the trauma occurred–between the vagina and bladder, or between the vagina and rectum–leading to constant leakage of urine or stool through these holes. The World Health Organization estimates that more than two million women live with a fistula, and that approximately 100,000 new cases are diagnosed each year. However, the number is considered an underestimation. Many women do not come forward and go untreated due to cultural or social beliefs.
Due to the odor, inability to continue daily functions, and overall physical and mental handicaps, many of the victims are ostracized and forced to live in shame. Could you imagine being rejected from everyone you loved, forced to leave in isolation, especially due to something preventable? Obstetric fistulas can be avoided by delaying the age of the first pregnancy, ceasing harmful practices like genital mutilation, and providing access to high-quality obstetric care in rural areas. This high-quality care includes maternal health care, family planning education, skilled care at birth, emergency obstetric care, affordable treatment and hospital care for fistulas, and education of the consequences of trauma and mutilation done to female genitalia. An understanding of the culture and education on both equality and obstetric care has been shown to decrease obstetric fistulas.
Sometimes it feels like women live in a man’s world. But it does not have to be so. While we spend millions in philanthropy for cancer, AIDS and heart disease, we should also make a combined effort to affect the mothers, daughters, sisters and wives of the next generation. As a clinician, or even a medical student, it is important to remember that patients are people. We focus so much on the diagnoses, illnesses and symptoms, and forget that the so-called patient is someone’s father, daughter, mother, son, brother, sister or friend.
I recommend that the next time you have a break, pick up a book–one related to medicine or clinical practice–and become overwhelmed by the numerous serious health issues that still affect the developing world in the 21st century. A combined effort full of education, volunteerism, philanthropy, and overall humanitarianism can surely help us hold up at least Half the Sky.
“Half the Sky” is a phenomenal documentary, novel and movement that “turns oppression into opportunity for women worldwide.” Even though it largely covers a variety of forms of oppression, the medically relevant stories have a gut-wrenching appeal as they put into perspective the clinical scenarios we so commonly hear in classes. To watch inspirational stories or read more information on obstetric fistulas and the oppression of women, please view the documentary “A Walk to Beautiful” as well as the PBS film “Half the Sky” or read the national bestseller “Half the Sky”.
Contributing Writer Emeritus
University of Alabama School of Medicine
Toral Patel is a BS and MS graduate of the University of Alabama at Birmingham in molecular biology. She is currently a Class of 2015 student at the University of Alabama School of Medicine in Birmingham, AL.