The Misconception About Fistula in Congo

I met a woman who has a fistula (a tear between the vaginal wall and the bladder) and has been leaking urine for 35 years. Why is she like this? Because 35 years ago she was in labor with her second child, she needed a caesarian section, and didn’t have access to medical help. She was in labor for 5 days; the baby died and she was left with a fistula.

I would like to take this opportunity here to dispel several myths that have infiltrated every single piece of media regarding Congo and sexual violence: not all of the women waiting for fistula surgery at Panzi Hospital and HEAL Africa Hospital have been raped. In fact, the majority has not been raped. And the amount of women who have fistula as a direct result of rape is even smaller. Here are the approximate statistics from both hospitals:

-85%-87% of women incur fistula as a result of complications in birth. For example, a woman desperately needs a cesarean section, but does not have access to healthcare.
-10%-12% of fistula results from doctors and nurses in rural areas not performing surgeries correctly and their lack of expertise results in cutting the woman where she should not be cut.
-2%-3% of fistula is a direct result of brutal rape where foreign objects are stuck into a woman.

The latter is of course the most horrific and unimaginable and this post’s purpose is not to diminish the abhorrent situations that rape survivors find themselves hurled into, but it is instead to show that the eradication of the suffering and stigmatization that many Congolese women face as a result of fistula is completely feasible. How many American or European women have you heard of incurring a fistula because of giving birth to their child? It never happens because regardless of what you think about our healthcare system, a woman will receive care to safely deliver her baby.

But if you are in rural Democratic Republic of Congo and you are trying to deliver at home and the traditional birth attendant doesn’t have the expertise to deliver complicated cases, or if you are fleeing from war and have to deliver in the forest, or if there is no one at the health center who is trained in performing c-sections, then you are in trouble and your child may not live and you may be left leaking urine uncontrollably as a result of fistula.

Billions of dollars of humanitarian aid money is poured into Democratic Republic of Congo, but women continue to pour into Panzi and HEAL Africa hospitals with a completely preventable injury. By investing in rural healthcare through training rural nurses to perform emergency obstetric care, by educating communities on the advantages of delivering at a health center, and through strengthening the reference systems between traditional birth attendants and health centers, the amount of women suffering from fistula can be significantly reduced. But, this takes more funding directed towards pre-natal and maternal health care and in eastern DRC the vast amount of funding is directed towards short-term relief projects.

So, if you are considering donating to a cause, please consider maternal healthcare programs, the affect on the woman, her child, her family, and the community as a whole will be insurmountable.