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.

Calvert 22/Courtesy of the artist, Danila Tkachenko
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Ruin porn: the art world’s awkward obsession with abandoned Soviet architecture

Deserted fairgrounds, disused factories and forgotten military bases may look cool, but are we fetishising the remnants of such a cruel history?

Armenia, where one side of my family is from, was one of the first members of the USSR, annexed by Russia in 1922. A few years ago, when I visited this little country that perches precariously in the south of the Caucasus, I was struck most by its Soviet architecture.

Although its landscape is a hotchpotch of medieval Orthodox churches, a smattering of Persian-era domes, and brutalist concrete, it was the latter that particularly stuck out. From unfelled statues of Stalin to giant tower blocks spelling out the letters “CCCP” from a bird’s-eye view (well, half spelt-out – construction stopped partway through, with the fall of the Soviet Union), I’ve never forgotten it.

Perhaps it was so compelling because such stark physical symbols make recent history all the more tangible. A history still profoundly affecting the country of my ancestors (and all post-Soviet and communist states). But also, it just looked really cool.


Mixed air corps, Mongolia. Photo: Calvert 22/Courtesy of the artist, Eric Losito

It’s a bit passé now to mock the hipster obsession with reclaimed industrial detritus, exposed pipes and bare concrete. An aesthetic – that of a post-industrial wasteland, but a chic one – which has gripped western cities for years, and crept worldwide.

But it could be this tendency to find disused stuff visually intriguing, and a morbid fascination with cruel regimes, which has led to the art world’s obsession with abandoned Soviet architecture. A whole wave of artists and photographers have been poking around the eastern bloc’s architectural graveyard in recent years.

Late last year, we saw the hugely popular disused Soviet bus stop series by photographer Christopher Herwig, echoing photographer Sergey Novikov’s equally absorbing collection of abandoned Soviet cinemas from 2013.

Following Russian filmmaker and photographer Maria Morina’s “Atomic Cities” project four years ago, London-based artist Nadav Kander explored the “aesthetics of destruction” in his exhibition, Dust, in 2014, snapping “radioactive ruins” of secret cities on the border between Kazakhstan and Russia. The same year, Moscow photographers Sasha Mademuaselle and Sergey Kostromin travelled to the disputed region of Abkhazia, capturing fragments of its deserted infrastructure.


Fighter aviation regiment, Mongolia. Photo: Eric Losito
 

And photojournalist Anton Petrus’ now iconic pictures of Chernobyl’s abandoned amusement park have long been an internet favourite, as have numerous haunting images of Pripyet – the city famous for lying deserted following the nuclear disaster.

Jamie Rann, a lecturer in Russian at Oxford University, has written that the quality and technical accomplishment of most of this photography make the style more “ruin erotica” than “ruin porn” (the tag being used by some critics), but argues: “The enormous online popularity of this genre . . . combined with their voyeuristic, almost exploitative feel, certainly has something porny about it.”

The latest exploration of Soviet society’s skeletons can be found at the Power & Architecture season at London’s Calvert 22 Foundation. In an exhibition called Dead Space and Ruins, we see abandoned military bases and formerly mighty monuments, forgotten space ports freezing in the tundra, the ghost of an entire unused, unfinished city in Armenia lying derelict.



The unfinished "ghost city" built in Armenia to house earthquake survivors (water added by artist). Photo: Calvert 22/Courtesy of the artist, Vahram Aghasyan

The works are beautiful, but do they feed in to this zeitgeisty lust for Soviet ruins?

One of its curators, Will Strong, laments this trend. “I was keen that this didn’t become like a kind of ‘ruin lust’, ‘ruin porn’ thing; this slightly buzzwordy term that there is at the moment, this kind of fetishisation of dead space,” he tells me.

“This history is incredibly loaded, and it did not end in 1991. To sort of fetishise it in the very bourgeois western way of, ‘oh yeah, look at all this wonderful Soviet architecture, isn’t it fantastic?’ Obviously a lot of people who lived in that time hated it . . . a lot of people were very miserable under these regimes, so it’s important not to forget that.”


Gym at the Independent Radar Centre of Early Detection, Latvia. Photo: Eric Losito

He adds: “It’s more a point of reflection on how buildings were designed, what their legacy is, what their narrative is, and who the people are who live with that story. This show looks at the aftermaths of when utopia hasn’t been delivered.”

This view is echoed by the Moscow artist, Danila Tkachenko, whose work is featured in the exhibition. “It is rather a metaphor for the future, not the past,” he says. “It represents an image of a possible future. When there is a visualisation of this issue [utopia], it evokes a response in people; they see this utopia in their lives . . . There is disappointment in all utopias.”


The world's largest diesel submarine, in Russia's Samara region. Photo: Calvert 22/Courtesy of the artist, Danila Tkachenko

His Restricted Areas series explores great behemoths of European communism left to lie forgotten in the tundra of remote regions in and around Russia and Kazakhstan: the world’s largest diesel submarine, like a beached whale in the snow; a giant satellite, thatched with antennae, built to communicate with Soviet bases on other planets some day; the deserted flying saucer-like communist headquarters in a region of Bulgaria. The structures hover in blank, white space, making the photos appear black-and-white.


Deserted observatory, Kazakhstan's Almaty region. Photo: Danila Tkachenko
 

Anton Ginzburg is an artist who grew up in St Petersburg in the Eighties as the Soviet Union was disintegrating. He believes studies like his film, Turo, of disused modernist constructions in the post-Soviet bloc, appeal to people’s connection to history. After all, picking through the architectural carcasses of former societies isn’t exactly a new thing:

“Russian culture is still haunted by its Communist past, and constructivist architecture is a decaying shell for its ghosts. It is an active reminder of the recent history,” he reflects. “Perhaps [its appeal] is a mixture of memento mori, with its thrill of beauty and destruction, along with a Romantic tradition of contemplation of Greek and Roman ruins.”

(Anton Ginzburg Turo teaser from Visionaireworld on Vimeo.)

The Power & Architecture season is on at the Calvert 22 Foundation, London, from 10 June-9 October 2016. Entry is free.

Anoosh Chakelian is deputy web editor at the New Statesman.