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.

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The rise of anti-Semitism in Donald Trump's America

On Monday, a Jewish cemetery was desecrated. 

Anti-Semitism is once again on the rise in America. Since January alone, there have been 67 bomb threats against Jewish Community Centres in around 27 states around the country. On Monday, a Jewish cemetery in St Louis, Missouri was desecrated, with over 100 headstones overturned. There has been a large increase in online anti-Semitic threats and hate speechSwastikas have been spray painted on the streets of New York.

Trump's poorly-executed "Muslim Ban" has closed the United States to people from seven majority-Muslim countries, including refugees from Syria, Iraq, Yemen and Somalia. But the divisive "them" and "us" rhetoric of the White House has had repercussions for other groups as well. 

Jewish people have not explicitly been the focus of any kind of executive order (after complaints about his lack of action, Trump called anti-Semitism "horrible"). Nevertheless, the new administrations appears to be implicitly pandering to anti-Jewish sentiment.

Take, for example, the official White House tribute issued on Holocaust Memorial Day in January. It failed to directly mention Jewish people at all. Jewish groups, including those representing Republicans, criticised the omission. Trump's chief of staff Reince Priebus defended the statement, saying: "I mean, everyone’s suffering in the Holocaust, including, obviously, all of the Jewish people.”

Superficially, one could attribute this to ignorance. But how politicians phrase their words matters. It is a common tendency of anti-Semites to play down, ignore or reject the idea that the Holocaust was targeted at Jews. It is hard to believe that no one within the White House would have been aware of the kind of dog whistle this omission sent to the extreme right. 

That White House staff includes Trump's chief strategist, Steve Bannon, who was the executive chairman of Breitbart, viewed widely as the online news outlet of the "alt right".

Timing also matters. The decision to shut US doors to Syrian and and Iraqi refugees was announced on Holocaust Memorial Day. The irony of an order singling people out for their faith wasn't lost on Jewish groups, who know all too well how many German Jews fleeing the Nazis were turned away from other shores. 

Trump's response time sent a message too. When a Hasidic Jewish reporter asked Trump about the growing anti-Semitism at his press conference on 16 February, he responded as if it was a personal attack, calling the question "very insulting" and telling him to sit down. Despite tweeting vociferously about Saturday Night Live and his daughter’s clothing line being dropped by a department store, Trump only managed to issue a statement condemning anti-Semitism on Tuesday.

David Samuels is a prominent Jewish writer living in Brooklyn, New York. He told me: "American Jews are threatened by rising anti-Semitism on both the right and left, which FBI statistics show to be more serious and more deadly than any animus directed towards Muslims or any other religious group.

"I feel sad that this is now my country, not because I am Jewish but because anti-Semitism is a degenerative thought-virus that makes people crazy by promising to explain everything that happens in the world with reference to a single prime mover - the Jews.

"Because anti-Semitism is a conspiracy theory, and not a form of social prejudice, it is fatal to rational thinking, in a way that simple racial or religious prejudice - including prejudice against Jews - is not."

Whatever the intentions of the Trump administration, the reaction in the country at large shows it is playing with fire. Americans must hope that Trump, who has three Jewish grandchildren, will come to his senses and rid his support base of any who seek to use the presidency to infect the country with their diabolical ideology. 

Lola Adesioye is a British writer based in New York. Follow her @LolaAdesioye.