Written by Erin Anastasi, Coordinator, Campaign to End Fistula & Technical Specialist at UNFPA in New York, USA and Kevin Nalubwama, fistula survivor, midwifery student, journalist, Operation Fistula Expert Client Advisor and informal advisor to Campaign to End Fistula in Kampala,
Alone, uncertain and afraid, this crisis alienates and isolates them at the same time that they crave the human presence, the comfort of friends. They do not understand this “enemy”, this scourge that was unheard of only a short time ago, but now the source of seemingly endless suffering. Unsure if they can or will ever work, ever be a “productive” part of their society, robbed of their self-esteem and power.
No, this, for once, is not the profile of a victim of COVID-19 in the developing world. For millennia, women with obstetric fistula have walked an emotional path similar to the one we are all walking now in this awful pandemic. The stigma of fistula causes absolute social distancing. the mystery of the causes and effects of fistula as real for these women as the confusion the world now faces about a still poorly understood coronavirus.
Fear, loneliness and hopelessness drove me home recently when I contacted my colleague and friend, Ms. Kevin Nalubwama (fistula survivor/midwifery student/journalist/Fistula operation Experienced Client Advisor and informal Advisor to Campaign to end fistula) to wish her a happy Easter and was shocked to read her panicked, desperate response several days later. She told me she had nothing to feed her children but plain black tea last week. “Hunger is the order of the day, night and week. Frankly, I fear we may starve to death. I am beginning to lose hope,” he lamented. Like many fistula survivors, Kevin suffered abject poverty, child marriage, teenage pregnancy and, later, abandonment. As a single mother raising two children and supporting other fellow fistula survivors, life was very difficult, even before Covid-19 hit. But the lockdowns and hardships imposed by the pandemic exacerbated the multi-layered, intersecting inequalities and vulnerabilities that Kevin and others faced, driving them, quite literally, to the brink of starvation. Fortunately, Operation Fistula stepped in and “came to her rescue”, enabling her to feed her children again.
This year’s theme for the International Day to End Obstetric Fistula (May 23): “End Gender Inequality! End health inequalities! End Fistula Now’ is a call to action to keep alive the visionary goal of Sustainable Development Goalswho envision a world in which no one is left behind[1]. However, with the devastating impact that the arrival of COVID-19 has had, vulnerable and marginalized people, including those with obstetric fistula, are being left even further behind and increasingly invisible.
The pandemic has damaged the effort to make the whistle as precise as a missile. Obstetric fistula occurs disproportionately in poor, vulnerable and marginalized girls and women. Often ‘invisible’ – hidden and forgotten, these same women and girls are most at risk of dying in childbirth. Those who experience fistula suffer devastating consequences, including chronic incontinence, shame, social isolation, poverty and physical, mental and emotional health problems. Social and emotional isolation makes it difficult for affected women and girls to maintain sources of income or support, thus deepening their poverty and magnifying their suffering[2]. the “double tragedy” of obstetric fistula – where over 90% of women with fistula lose their baby – is a result of a lack of timely access to quality maternity and emergency obstetric care services. services are deeply threatened as local facilities find themselves increasingly overwhelmed. Elective surgery has been discontinued worldwide and fistula repair has been largely limited as a result. The world is at risk of increased levels of maternal and neonatal mortality and morbidity – particularly among the poorest and most marginalized – if it is necessary and lifesaving sexual and reproductive health services are disrupted and support is diverted to an effort to deal with the pandemic. The risks of the COVID-19 pandemic reversing progress and exacerbating pre-existing inequalities[3]blocking and vulnerabilities. As noted fistula surgeon and Order of Australia winner Dr. Andrew Browning, Medical Director, Barbara May Foundation, Australia, “We have heard from many hospitals that patient flow has dropped dramatically. I can only imagine the ‘collateral damage’ this will cause.”
And so, the UNFPA– was driven Campaign to end fistula and its member countries and partners are facing unprecedented challenges as a result of the pandemic. How can we promote safe and accessible maternal/newborn care services – including Midwifery and EmONC – in the face of a COVID-19 disease tsunami? What is the most ethical approach to balancing the needs of the general population such as this with those of particularly vulnerable and marginalized women with fistula? How can we rebuild what has been damaged in momentum and capacity for fistula prevention, treatment and care?
More than ever, the Campaign (and programs like it) need increased, not decreased, levels of support and resources. As emphasized by the WHO, special care and protection is required supporting the human rights of vulnerable populations during this pandemic[4]. Let’s not forget this fragile, deeply troubled and amazingly brave and resourceful group of people as they navigate their personal disaster within a global catastrophe.
Let us heed the call of the editor of The Lancet Richard Hortonwhose recent “surfacing” reminds us not to allow critical health and human rights issues such as extreme poverty, gender inequality, safe water and sanitation, and peace through health to fall victim to this pandemic[5].
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
