Obstetric Fistula: Africa’s silent epidemic

While all women of reproductive age are vulnerable to suffer fistula, the underage girls who are victims of child marriages, female genital mutilation and teenage pregnancies are at highest risk.

Obstetric Fistula is a silent epidemic in Africa. It’s a hole in the birth canal caused by prolonged, obstructed labour due to lack of timely and adequate medical care. As a result of this, in most cases, the baby is stillborn or dies within the first week of life, and the woman suffers a devastating injury, which leaves her incontinent. While all women of reproductive age are vulnerable to suffer fistula, the underage girls who are victims of child marriages, female genital mutilation and teenage pregnancies are at highest risk.

It’s a deeply unpleasant condition, resulting in constant leakage of urine and feaces through the vagina. Naana Otoo-Oyortey from the diaspora charity FORWARD tells me: “It’s a health issue that’s exacerbated by social factors. Many of these girls will be excluded from community life and abandoned by their husbands and families, isolating them socially and economically.”.

Another diaspora charity, MIFUMI, sent me a number of case studies. Justus Osuku, a peasant from Gweri in Soroti district, married his wife when they were both 14, during the infamous Teso insurgency in the 1990s. They were living in the Internally Displaced Peoples Camps in Soroti when his wife developed the problem. He resisted the social pressure to send her away: “I loved her. I married her when she was normal. I did not see the reason to send her away at a time when she needed me most.”

He is unusual: the overwhelming majority of husbands send their wives away, citing reasons ranging from the unbearable smell to community stigma. FORWARD is conducting research in Sierra Leone to explore the impact on the lives of women and girls who are blighted by it. The research involves 45 women affected by fistula and their recommendations will inform policy and decision makers in Sierra Leone and beyond.

One of those women, Jamma, was 18 when she got pregnant. When the labour started, she went to the local health centre but the nurse was away so she had to wait for three days. She finally gave to a stillborn baby and developed fistula. She suffered from it for two years until her friend told her about the treatment in the town. Her friend paid for her transport but the journey was very difficult. Nobody wanted to sit with her because of the smell. She was abandoned, first by her husband and then her grandmother.

On 23 May this year the UN celebrated the first International Day to End Obstetric Fistula. There is a lack of evidence as to how many women worldwide are living with the condition, but they live mainly in Sub Saharan Africa and Asia, and number in the hundreds of thousands. In Uganda there are at least 200,000 such women and 1,900 new cases are reported annually, according the National Obstetric Fistula Strategy.

“It’s a poor person’s illness,” Evelyn Schiller of MIFUMI tells me. “The issue of transport in rural Africa makes it difficult - there are very few cars in these areas. Surgeries can be lacking basic equipment like surgical gloves, clamps and oxygen. It usually takes three or four surgeries to correct it because it’s a complex repair process. We need to improve health education and antenatal care, train doctors to repair them, and above all raise awareness.” 

Mother and son walk together near the Ethiopia-Somalia border. Photograph: Getty Images

Alan White's work has appeared in the Observer, Times, Private Eye, The National and the TLS. As John Heale, he is the author of One Blood: Inside Britain's Gang Culture.

JAMIE KINGHAM/MILLENNIUM
Show Hide image

Snakebites and body parts

The city at the edge of an apocalypse: a love letter to Los Angeles.

I was emailing with Kenneth Anger, the film-maker, when the coyotes across the street in Griffith Park started howling.

That’s partially true.

I was emailing him to ask if he’d direct a music video for me. Maybe Lucifer Rising 2.0. Or anything.

Just him in the kitchen making tea, as recorded on his iPhone.

Kenneth Anger is alive and well in Santa Monica, so why not ask him to direct a video for me? Hopefully, he’ll respond. We’ve never met, so I sent an email to him, not with him. That’s the partial truth.

But the coyotes did start howling.

It’s the single best sound in Los Angeles, or any city. Is there another city where you can email an 89-year-old devotee of Aleister Crowley while listening to a few dozen coyotes screaming and howling and ripping the night into little pieces?

No. Just here. This oddness by the sea and an inch from a billion acres of Arrakis.

I never thought I’d end up living in Los Angeles, but I’ve ended up living in Los Angeles. This dirtiest, strangest paradise.

Yesterday I went hiking in a two-million-acre state park that’s 30 minutes from my house. A state park bigger than all of New York City. And it’s 30 minutes away. With no people. Just bears and pumas and coyotes and snakes.

And other things. Abandoned bridges. An observatory where Albert Einstein used to go to watch space.

What a strange city.

A perfect city. Perfect for humans at the edge of this strangely unfolding apocalypse. A gentle apocalypse with trade winds and Santa Ana winds and the biannual vicious storm that rips eucalyptus trees up by their roots.

What a strange city. And it’s my home.

Today I hiked to the back of the Hollywood sign. This was before Kenneth Anger and the coyotes.

The tourists were dropping like flies on the long, hot mountain trail, not aware that this isn’t a city with the safe European ­infrastructure that keeps them happy
and/or alive.

Every now and then, a tourist dies in the hills, bitten by a snake or lost at night. The emergency rooms are full of tourists with snakebites and heatstroke.

Where are the European safeguards?

Fuck us if we need safeguards. Go live in a place like this gentle wasteland where you’re not at the top of the food chain. If you’re not in danger of being eaten at some point in the day, you’re probably not breathing right.

I hope Kenneth Anger writes back.

 

22 May

I drove some friends around my neighbourhood. They want to live here. Why wouldn’t they? Pee-wee Herman and Thom Yorke live up the street.

David Fincher lives a block away. It’s blocks and blocks of jasmine-scented name-
dropping.

It’s warm in the winter and it’s weird all year round.

And there’s a Frank Lloyd Wright that looks like a lunatic Mayan spaceship.

And there go the coyotes again, howling like adorable delegates of death.

They’re so smart, I wish they would make me their king.

You hate Los Angeles? Who cares? You made a mistake, you judged it like you’d judge a city. Where’s the centre?

There’s no centre. You want a centre? The centre cannot hold. Slouching towards Bethlehem. Things fall apart.

Amazing how many titles can come from one poem. What’s a gyre?

Yeats and Kenneth Anger and Aleister Crowley. All these patterns.

Then we had brunch in my art deco pine-tree-themed restaurant, which used to sell cars and now sells organic white tea and things.

The centre cannot hold. I still have no idea what a gyre is.

Maybe something Irish or Celtic.

It’s nice that they asked me to write this journal.

Things fall apart.

So you hate Los Angeles? Ha. It still loves you, like the sandy golden retriever it is. Tell me again how you hate the city loved by David Lynch and where David Bowie made his best album? Listen to LA Woman by the Doors and watch Lynch’s Lost Highway and read some Joan Didion – and maybe for fun watch Nightcrawler – and tell me again how you hate LA.

I fucking love this sprawling inchoate pile of everything.

Even at its worst, it’s hiding something baffling or remarkable.

Ironic that the city of the notoriously ­vapid is the city of deceiving appearance.

After brunch, we went hiking.

Am I a cliché? Yes. I hike. I do yoga. I’m a vegan. I even meditate. As far as clichés go, I prefer this to the hungover, cynical, ruined, sad, grey cliché I was a decade ago.

“You’re not going to live for ever.”

Of course not.

But why not have a few bouncy decades that otherwise would’ve been spent in a hospital or trailing an oxygen tank through a damp supermarket?

 

24 May

A friend said: “The last time I had sex, it was warm and sunny.”

Well, that’s helpful.

October? June? February?

No kidding, the coyotes are howling again. I still love them. Have you ever heard a pack of howling coyotes?

Imagine a gaggle of drunk college girls who also happened to be canine demons. Screaming with blood on their teeth.

It’s such a beautiful sound but it also kind of makes you want to hide in a closet.

No Kenneth Anger.

Maybe I’m spam.

Vegan spam.

Come on, Kenneth, just make a video for me, OK?

I’ll take anything.

Even three minutes of a plant on a radiator.

I just received the hardcover copy of my autobiography, Porcelain. And, like anyone, I skimmed the pictures. I’m so classy, eating an old sandwich in my underpants.

A friend’s dad had got an advance copy and was reading it. I had to issue the cautious caveat: “Well, I hope he’s not too freaked out by me dancing in my own semen while surrounded by a roomful of cross-dressing Stevie Nicks-es.”

If I ever have kids, I might have one simple rule. Or a few simple rules.

Dear future children of mine:

1) Don’t vote Republican.

2) Don’t get facial tattoos.

3) Don’t read my memoir.

I don’t need my currently unmade children to be reading about their dear dad during his brief foray into the world of professional dominatrixing, even if it was brief.

The first poem I loved was by Yeats: “When You Are Old”. I sent it to my high-school non-girlfriend. The girl I longed for, unrequitedly. I’m guessing I’m not the first person to have sent “When You Are Old” to an unrequited love.

Today the sky was so strangely clear. I mean, the sky is almost always clear. We live in a desert. But today it felt strangely clear, like something was missing. The sun felt magnified.

And then, at dusk, I noticed the gold light slanting through some oak trees and hitting the green sides of the mountains (they were green as we actually had rain over the winter). The wild flowers catch the slanting gold light and you wonder, this is a city? What the fuck is this baffling place?

I add the “fuck” for street cred. Or trail cred, as I’m probably hiking. As I’m a cliché.

You hike, or I hike, in the middle of a city of almost 20 million people and you’re alone. Just the crows and the spiralling hawks and the slanting gold light touching the oak trees and the soon-to-go-away
wild flowers.

The end of the world just feels closer here, but it’s nice, somehow. Maybe the actual end of the world won’t be so nice but the temporal proximity can be OK. In the slanting gold light. You have to see it, the canyons in shadow and the tops of the hills in one last soft glow.

What a strange non-city.

 

25 May

They asked for only four journal entries, so here’s the last one.

And why is # a “hashtag”?

Hash? Like weird meat or weird marijuana? Tag, like the game?

At least “blog” has an etymology, even if, as a word, it sounds like a fat clog in a drain.

A friend who works in an emergency room had a patient delivered to her who had a croquet ball in his lower intestine. I guess there’s a lesson there: always have friends who work in emergency rooms, as they have the best stories.

No coyotes tonight. But there’s a long, lonesome, faraway train whistle or horn. Where?

Where in LA would there be a long, lonesome, faraway train whistle or horn?

It’s such a faraway sound. Lonesome hoboes watching the desert from an empty train car. Going where?

I met a woman recently who found human body parts in some bags while she
was hiking.

Technically, her dogs found them.

Then she found the dogs.

And then the sky was full of helicopters, as even in LA it’s unusual to have human hands and things left in bags near a hiking trail a few hundred yards from Brad Pitt’s house.

What is this place?

When I used to visit LA, I marvelled at the simple things, like gas stations and guest bedrooms.

I was a New Yorker.

And the gas stations took credit cards. At. The. Pumps.

What was this magic?

And people had Donald Judd beds in their living rooms, just slightly too small for actual sleeping – but, still, there’s your Donald Judd bed. In your living room at the top of the hill somewhere, with an ocean a dozen miles away but so clear you can see Catalina.

They drained the reservoir and now don’t know what to do with it.

Good old LA, confused by things like empty reservoirs in the middle of the city.

Maybe that’s where the lonesome train lives. And it only comes out at night, to make the sound of a lonesome train whistle, echoing from the empty concrete reservoir that’s left the city nonplussed.

“We’ve never had an empty reservoir in the city before.”

So . . . Do something great with it. I know, it’s a burden being given a huge gift of ­empty real estate in the middle of the city.

Tomorrow I’m meeting some more friends who’ve moved here from New York.

“We have a guest bedroom!” they crow.

A century ago, the Griffith Park planners planted redwoods across the street. And now the moon is waning but shining, far away but soft, through the redwoods.

No coyotes, but a waning moon through some towering redwoods is still really OK. As it’s a city that isn’t a city, and it’s my home.

Goodnight.

Moby’s memoir, “Porcelain”, is published by Faber & Faber

This article first appeared in the 26 May 2016 issue of the New Statesman, The Brexit odd squad