In November 2013, a team of health officials were in South Sudan to perform reparative surgery on scores of women with obstetric fistula, a condition that causes incontinence and is linked to obstructed labor, a leading cause of maternal mortality.

This is one of many similar campaigns conducted in the country every so often.

Health officials estimate more than 60,000 South Sudanese women suffer from obstetric fistula—which leaves a hole between the birth canal and the bladder or rectum, leaving a woman incapable of controlling her bodily functions.

For this particular campaign, which I covered, more than 80 women turned up for operations at Juba Teaching Hospital alone. Many of the women were repaired but some needed more care, while others were simply turned away due to lack of time.

Lilian Pita, like many others I met had had more than one surgery trying to correct their situation. For Pita, this was her fourth surgery and luckily, a success.

Speaking to me after her surgery, I felt warm in her voice. She said, “I am now OK. I am happy that there is no urine in my bedding. Before I felt sad and everyone insulted me. But now, I am fine. When I go home, those who insulted me will now be embarrassed.”

This is just a glimpse of the silent pain, stigma and discrimination women with obstetric fistula face across the world.

Many women just like Pita, suffer fistula after complications during their first delivery.

Dr. Merghani Abdalla, an obstetrics and gynecology specialist at the Juba Teaching hospital, says an overwhelming majority of obstetric fistula cases is caused by prolonged obstructed labor.

According to the Fistula Foundation, around five percent of all pregnant women worldwide experience obstructed labor.

The foundation also says that like in many sub-Saharan countries, South Sudan has few hospitals, few doctors, and poor transportation systems aggravating the fistula situation.

But Dr. Anthony Lupai who is one of only two obstetricians based in Juba who can perform the surgery blames cultural practices to the high numbers of fistula cases in South Sudan. He says early marriages, a tradition practiced in most South Sudanese communities, exposes young girls to child delivery before their bodies are fully developed. The UN estimates that almost half of all women in South Sudan are married by the time they turn 18.

Lupai also says the situation is made worse by women who deliver in their homes without a qualified birth attendant. He says many of those suffering are too stigmatized to seek medical treatment.

Elizabeth Leyo has been suffering from fistula since she gave birth two years ago. She made her way to the treatment facility alone as her family was too embarrassed to be seen with her. Her husband abandoned her immediately he realized she was leaking. So did her family and friends. She had been locked up and could not attend any social gathering. An announcement of one of the free fistula campaigns was the only reason she came out, hoping that her situation could be reversed. Her story is typical of thousands of South Sudanese women.

As bleak as it seems, obstetric fistula is a preventable condition. And as the South Sudan health ministry along with other health stakeholders exert efforts to organize more and more fistula campaigns to repair those suffering, even more if not equal efforts are needed at the prevention level of this depressing condition, which in part will reduce maternal mortality.

Providing widespread basic health education on importance of attending pre-natal clinics, eradication of child marriage, and importance of delivery at health facilities are great ways to start.


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