Saturday, March 11, 2017

Two Amazing Tales: Obstetric Fistula Repair, and Women on Waves outside Guatemala

Obstetric Fistula: Women in some African countries may endure days of obstructed labor, due to an immature pelvis secondary to early marriage, or a contracted vaginal opening due to female genital mutilation.  (See my latest column on genital mutilation at  The baby is often stillborn, or the woman dies in labor because of a lack of hospitals performing Cesarean sections.  If she survives, the prolonged pressure on the vaginal walls often causes openings to appear between the vagina and the rectum or bladder.  She will leak urine and feces, becoming an outcast, often living alone and prone to suicide.  The story of one such woman is remarkable.  After three days of obstructed labor in Ethiopia, and a dead baby, she was taken to a hospital in Addis Ababa that specializes in fistula surgery. The hospital is run by two Australian doctors, who spend their lives in fistula reconstruction. The patient, Ms. Mamitu, was cured and decided to stay on at the hospital.  She was given a job making beds for other patients.  Then she began helping out during surgeries. After a couple of years of watching, the doctor asked her to cut some stitches.   Eventually, she was performing the entire fistula repair herself.  .  She gradually became an experienced fistula surgeon, teaching gynecologic surgeons from many countries.  Still illiterate, she decided to go to night school to learn to read and write.  When last heard of, she was in third grade. This is a wonderful story of enormous perseverance and a drive to help regardless of qualifications.

                Women on Waves (WoW) has sent a ship to international waters outside of Guatemala. Women on Waves is a Dutch prochoice, non-profit organization created in 1999 by Dutch physician Rebecca Gomperts, in order to bring reproductive health services, particularly non-surgical abortion services, to women in countries with restrictive abortion laws. Other services offered by WoW include contraception and reproductive counseling. Services are provided on a commissioned ship that contains a specially constructed mobile clinic. When WoW visits a country, women make appointments, and are taken on board the ship. The ship then sails out to international waters (where Dutch laws are in effect on board the ship) to perform the medical abortions (abortion performed in the first 10 weeks of pregnancy with pills).  Abortion is legal in Guatemala only if the woman’ life is in danger from the pregnancy, and if the procedure is endorsed by two doctors. As a result an estimated 65.000 illegal and unsafe abortions take place in Guatemala each year. Yearly, approximately 21.600 women are hospitalized with complications, and unsafe abortions are the third cause of maternal death in the country. Especially at the dawn of the Zika crisis, access to safe abortion is fundamentally an issue of social justice. WoW is asking the Guatemalan government to remove abortion from the penal code, to provide evidence based sexual education in schools and to ensure  access to contraceptives;
On 22 February 2017, the WoW ship docked in Puerto Quetzal on the Pacific coast for a planned five-day visit. On 23 February, a scheduled press conference was shut down shortly after it started and a blockade
was imposed by Army troops, preventing the activists from disembarking and visitors from boarding. 
WoW  is active in many countries throughout the world where abortion is illegal.  When contacted by phone or Internet, they will send abortion pills by mail, with careful instructions for use.  They have sent pills into Poland by drone!  You can donate to Women on Waves by check or credit card - by going to their

Sadja Greenwood, MD, MPH

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