SANA’A, Yemen – Shaima, 20, has experienced more than her share of suffering. Displaced by conflict, she was married off at 14, then endured pregnancy after pregnancy before her body was ready. She developed devastating complications in childbirth, including an obstetric fistula  – a traumatic injury that can have lifelong consequences.

On Wednesday, the world will observe the International Day to End Obstetric Fistula, which calls for action to end the marginalization and inequality that perpetuate this preventable injury.

Injury, isolation

An obstetric fistula is a hole in the birth canal caused by a prolonged, obstructed labour. Left untreated, it can cause incontinence, infections, pain and a host of other problems – including social isolation, stigma and depression.

Girls who are pregnant too early, such as child brides, are especially vulnerable to this affliction, as are women who are malnourished. Malnutrition and recourse to child marriage are both on the rise in Yemen, where grinding conflict has uprooted communities, increased extreme poverty and caused the health system to collapse.

After the conflict forced Shaima’s family to flee from Sa’ada to the capital city, Sana’a, her impoverished parents married her off.

“In our community, girls are married off at a young age, like 9 or 10,” Shaima told UNFPA. “For me, I was 14 and it was considered late. I did not have a choice but to marry the first one who offered to take me. So, I wedded a widower.”

Her husband was in his 30s. Shaima was pregnant by the time she was 15, but she suffered a miscarriage.

She quickly became pregnant again, but her husband could not afford to send her to a hospital during childbirth. A neighbour helped her deliver at home, but the process was prolonged and excruciating. She developed an obstetric fistula.

And then she became pregnant once more. Again, she delivered at home. The condition worsened, as did her pain.

“Reborn”

Shaima is not alone.

More than 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are estimated  to be living with fistula, and some 50,000 to 100,000 new cases develop annually. Yet the condition is almost entirely preventable with access to emergency obstetric care – in particular, Caesarean section.

UNFPA works around the world to help expand access to sexual and reproductive health care, including emergency obstetric care. UNFPA also supports surgical repairs for fistula survivors, and helps reintegrate survivors back into the community.

In Yemen, UNFPA has supported the establishment of two fistula units, including one at Al Thawara Hospital in Sana’a, where 28 fistula surgeries were successfully treated, free of charge, in recent months.

And in the south, 90 percent of fistula surgeries were undertaken with support from UNFPA. UNFPA has also created and strengthened a network of community volunteers, midwives, reproductive health workers and fistula experts from most of the governorates to help fistula survivors receive the services they need.

Shaima was one of these women.

After enduring months of pain, her family was finally able to send her to a local hospital. From there, she was referred to Al Thawara Hospital, where she successfully underwent fistula repair surgery.

“Now my pain is gone. I feel as if I am reborn," she said.

THAPANGTHONG, Lao People’s Democratic Republic – “Just lie still and relax. Breathe slowly,” midwife Khoun Keobouttavong told Out, 30. Out was laying on the floor of her small stilt house in the southern Thapangthong District of the Lao People’s Democratic Republic.

Ms. Keobouttavong pressed a fetal stethoscope into Out’s belly. Out was about six months pregnant.

“The heart is beating well,” she told Out, smiling.

Ms. Keobouttavong is the only midwife covering the district, which includes eight villages and hundreds of residents.

Though she has a small clinic, she spends much of her time making house calls – when road conditions allow.

“For women who live in the main village, they can visit the clinic, but for those outside, there are obstacles,” she explained. “The roads are not good.”

There are also widespread misconceptions about the care she provides.

“There is a perception that antenatal care is not essential,” she said. “The previous generation gave birth at home, most often with the help of a traditional midwife [without professional training]. So sometimes they simply do not come.”

This makes it difficult to achieve one of her primary goals: reducing maternal mortality among the rural women here.

According to the most recent UN data, out of every 100,000 live births in the country, 197 women die of pregnancy-related causes – much higher than the regional average. Only about 40 per cent of births are attended by a skilled health professional, like a midwife or doctor.

Midwives trained to meet rural needs

There are now some 1,700 trained midwives working across the rural parts country, part of a 2012 government initiative to improve maternal health. UNFPA has supported these efforts, helping to develop a midwifery curriculum, training midwifery instructors and equipping midwifery schools.

Still, these midwives face a range of challenges – not only poor roads, but communication barriers as well. The country has dozens of ethnic groups, each with their own language and customs.

Grinding poverty also limits rural women’s access to care.

“They need to tend to rice crops and take care of children,” Ms. Keobouttavong said, explaining that many women do not have the time or resources to seek health care.

Out had to squeeze her check-up into a busy day of farm work. Afterward, she returned to the rice fields, and also cared for her two young children.

She told UNFPA that, to meet the family’s needs, she also forages for food every day. “I catch fish or frogs to eat or cut some bamboo, as we do not have money to buy food,” she said.

Family planning, up-to-date midwifery guidance

Khamkong, 21, is seven months pregnant. Like Out, she is a rice farmer.

She is aware pregnancies can be deadly, but comforted knowing that skilled care is available.

“I do feel very nervous because it is my first baby, and in the village where I am from, one woman died,” she told UNFPA. “I feel good having the midwife close by. I know she will take good care of me.”

The government is also looking to improve women’s health by increasing access to family planning.

Contraceptives reduce the incidence of dangerous pregnancy-related complications. Family planning also empowers women to stay in the classroom and workforce, helping them break the cycle of poverty.

“Family planning has a far-reaching social and economic impact,” said UNFPA’s representative in Lao PDR, Frederika Meijer.

UNFPA has supported the country’s family planning efforts since 1995, including by training health workers to provide contraceptive counselling and services. UNFPA has often been the sole provider of contraceptives to the government health system.

UNFPA is also working to keep midwifery care up-to-date. Last year, UNFPA released a mobile phone app for midwives, which contains the most recent clinical guidance as well as instructional videos.

A role model

For her part, Ms. Keobouttavong says that, although she is sometimes overwhelmed with the workload, she happy to see an increase in women seeking her services.

She hopes to set an example for the next generation.

She, too, grew up in the area, she explained. She was the only woman in her village to ever graduate from secondary school.

“I have some girls who want to talk to me about my education and some of the parents see that maybe it’s good for their daughters to stay in school. People see what I have done and so they have begun to think, maybe I can do that too,” she said.

– Ruth Carr

KOLLA TEMBEIN, Ethiopia – Not long ago, the sight of a 10-year-old bride was a common occurrence in Ethiopia’s Kolla Tembein District, said Daniel Hagos, the district’s chief administrator.  But the community’s women and girls are mobilizing to change things – and they are seeing enormous success.

“We are getting remarkable results in the fight against child marriage,” said Atsede Girmay, one of the volunteers in this effort.

Child marriage is a global phenomenon, one that leaves girls vulnerable to abuse and health problems, including potentially deadly pregnancy complications .

In Kolla Tembein, the practice is deep-rooted, with many people believing that girls should marry while they are young and “pure”.

But three years ago, community groups began working with UNFPA to raise awareness of the harms of child marriage. Then through the UNFPA-UNICEF Global Programme to Accelerate Action to End Child Marriage, efforts were targeted towards three localities in the district where child marriage was most prevalent.

Central to their approach is empowering women and girls to stand up and take action themselves.

Women take action

The programme works with women’s volunteer networks called Women’s Development Groups. The volunteers received information about the consequences of child marriage, as well as related issues such as gender equality, the importance of ending female genital mutilation (FGM), and the benefits of maternal health care.

Some volunteers, like Ms. Atsede, were selected to become a facilitator for the broader community. Ms. Atsede received a teaching manual and training to engage people on the subject of child marriage.

Now, every Sunday, she meets with 35 adolescent girls and their families to discuss the issue.

“We teach how child marriage isolates a girl, how it will force her to drop out of school, and how it will end in serious health hazards such as obstetric fistula,” Ms. Atsede explained.

Because girls who leave school are more likely to be married off, and because many child brides are forced to drop out, the Women’s Development Groups also work closely with the local schools. If a girl drops out, the volunteers speak with her family to convince them of the importance of education over early marriage. If necessary, they refer cases of child marriage to local authorities.

Empowering girls

In schools, girls’ clubs are also helping to end child marriage. The clubs meet every two weeks with a specially trained mentor, who explains the harms of child marriage.

The girls also receive other information, including the basics of sexual and reproductive health and how to prevent sexually transmitted infections. They also gain life skills such as financial literacy skills.

The idea is to empower girls to not only reject child marriage, but to minimize their vulnerability by improving their prospects for the future.

Merhawit Mezgebe, 18, is a 10th grader, and has been attending this programme for the past two years. Like other girls in the club, she has opened a savings account and is eager to plan for her future.

“I want to use my savings to finance my college studies without bothering my parents,” she said, smiling. 

The girls are also helping to stamp out child marriage in their communities, she added.

When members of the club hear about possible child marriages taking place, they report it back to their mentor, who works with authorities to take action.

Ahead of the curve

In 2014, Ethiopia committed to end child marriage by 2025.

But Mr. Daniel says Kolla Tembein is on track to meet this goal even earlier. “My district will attain the commitment the country made to end child marriage before the set target date,” he said.

In the three high-risk localities where the programme is being implemented, some 1,200 unmarried girls were reached through school programmes like the girls’ clubs. Community outreach efforts engaged another 1,200 girls who were already married.

Thanks to such efforts, Mr. Daniel says, there have not been any cases of child marriage reported in those localities in the past last three years, and the dropout rate among female students has fallen to almost zero.

The programme now is set to expand to the rest of the district.

– Abraham Gelaw

Chinhoyi, Zimbabwe - Nyasha Musandu (name changed to protect identity) was just 12 years old when she was forced into child marriage three years ago. At 13 she fell pregnant, suffering a still birth and double fistula; a debilitating condition caused by a four-day labour rendering her completely incontinent. Although scarred from the trauma of child marriage and teenage pregnancy, Nyasha’s hope has been restored and she has begun healing after receiving free fistula repair surgery under the UNFPA-led Campaign to End Fistula.

Fistula occurs mostly among women and girls living in extreme poverty, such as Nyasha whose parents died when she was very young. She was only 12 years old when her sister sold her into a child marriage to a much older man. “She owed him $20 and she could not pay so he took me as his wife.”

One year later, at the age of 13, Nyasha fell pregnant and her husband threw her out. She was sent to live with her blind grandmother in Chimanimani in Zimbabwe’s Eastern Highlands, Manicaland Province. During a gruelling four-day labour at her grandmother’s rural homestead, Nyasha suffered a still birth and developed fistula. “The child was dead, I was leaking urine and feces all the time and no one wanted me anymore,” said Nyasha.

This birth injury is more likely to afflict girls like Nyasha who become pregnant while still physically immature, as their underdeveloped bodies are unable to cope with the trauma of labour. Women and girls with fistula are often unable to participate in society, ostracized by their families and communities driving them further into poverty.

However, Nyasha has avoided this lifelong plight receiving free fistula repair surgery after Child Line Zimbabwe connected her to Women and Health Alliance International (WAHA), UNFPA’s partner in the Campaign to End Fistula, which has repaired over 300 women to date through five repair camps at Chinhoyi Provincial Hospital under the Health Development Fund, supported by the governments of Ireland, Sweden, the United Kingdom and the European Union.

Nyasha was scheduled to receive two fistula repair surgeries as she had both a fistula to the bladder and to the bowel.

Nyasha is now safe in the protection of Child Line Zimbabwe who have placed her with a foster family. She is healing and has high hopes of returning to school. “I am now fully recovered and I wish to go back and finish to school if I can get enough help.”

By Victoria Walshe (with reporting by WAHA)
 

The story was first published on UNFPA Zimbabwe website.

MAIDUGURI, Nigeria – “One week after I delivered my second child, I realized that there was an issue,” Aisha told UNFPA from her hospital bed in Maiduguri, in north-east Nigeria. She had developed an obstetric fistula, a devastating childbirth injury that can derail a woman’s whole life.

Obstetric fistula occurs during prolonged, obstructed labour. The obstruction can create a hole between the vaginal wall and the bladder or rectum, leading to incontinence – and often stigma, shame or even rejection from families and communities.

“I am now worried to mix with people,” Aisha said. “I am so disturbed by this. I love my husband but he is so disturbed too.”

Obstetric fistula is a major public health problem in Nigeria.

According to a 2010 report by EngenderHealth, an estimated 400,000 Nigerian women and girls suffer from fistula, and approximately 12,000 new cases occur annually.

This injury afflicts society’s poorest and most marginalized – those without access to emergency obstetric medicine.

The humanitarian crisis in the north-east has exacerbated these conditions; a significant majority of the country’s fistula cases take place in the north.

A broken system

Aisha was 12 years old when she got married, and 14 by the time she delivered her second child.

Her situation is not uncommon.

Women and girls in the region face high rates of child marriage and early pregnancy, which is part of the problem. Pregnant adolescents have a higher risk of experiencing fistula because their bodies may not be ready for motherhood.

“Early childbirth, a lack of skilled birth attendants, unavailability of comprehensive emergency obstetric care services and poor access to family planning are the main factors contributing to obstetric fistula,” said Dr. Diene Keita, UNFPA’s Representative in Nigeria. “All of these factors are very prominent in the north-east.”

Fistula is preventable – with speedy access to medical care such as Caesarean section – and it is treatable with surgery.

“Opportunities for fistula repair surgery exist in North-East Nigeria,” Dr. Keita said. “However, due to the ongoing conflict, health facilities in rural areas have been destroyed or damaged, and the referral system to operating hospitals and the outreach programme, to make women aware of the surgery, are broken.”

Beyond reach

A fistula surgery costs roughly $300 to $420, which puts it beyond the reach of most of those afflicted.

And because the condition only affects vulnerable women and girls, and is not considered life-threatening, it is often not prioritized.

Every year, UNFPA’s Campaign to End Fistula supports approximately 1,200 fistula repair surgeries in Nigeria.

“We see that the surgery is very important,” said Asabe Christopher Mshelia, a nurse-midwife in the fistula unit of Maiduguri State Specialist Hospital, where UNFPA is supporting upgrades. “Not only for the individual woman but also as a pull factor for other women and girls to seek help. If a woman goes back to her community after a successful surgery, the good news travels and inspires others to come forward.”

UNFPA is also working to improve access to emergency obstetric care in emergency settings. And the government has also adopted policies to help prevent and eliminate this injury.

But much more remains to be done.

Today, Aisha is on the waitlist for a repair surgery at the Maiduguri State Specialist Hospital. Despite her troubles, she is confident about the future.

“I want to go back to my husband and have more children after the surgery,” she told UNFPA. “But I might advise my younger sisters to wait with marriage and children because I learned here that being a young mother can cause this issue of fistula.”

– Anne Wittenberg

Batouri, Cameroon – Amina was married when she was just a child. Soon after, she became pregnant, and, at only 13 years old, she went into labour. As is the case with many girls her age, Amina’s body was not mature enough to bear a child, and she suffered an obstructed labour, an excruciating condition that could have killed her.

Fortunately, both she and her baby survived the childbirth, but the ordeal left Amina with a devastating injury known as an obstetric fistula, a hole in the birth canal that leaves women incontinent and vulnerable to a raft of medical problems.

This condition afflicts the world’s most vulnerable women and girls, and it makes their lives immeasurably harder: Many are abandoned by their families and ostracized by their communities.

More than 20,000 women are estimated to be living with obstetric fistula in Cameroon, and some 2,000 new cases occur every year. Yet it is almost entirely preventable. In fact, it has been essentially eliminated in industrialized countries through the availability of emergency obstetric care.

A 10-day campaign held in early July – a collaboration between UNFPA, the United Nations Population Fund, the health ministry, the Orange Foundation – reached out to survivors with free repair surgeries, training for health workers, and information to help community members make sure fistula does not happen in the first place.

Free fistula surgeries

Amina, now 20, was one of 33 women to receive free fistula repair surgeries during the campaign, which brought four Cameroonian specialists to Batouri, in the eastern part of the country. The doctors conducted three to four operations per day, followed by post-operation observation lasting 14-21 days.

It was a rare opportunity for women in the East Region, who otherwise would have to travel up to 700 kilometres through rough terrain to reach the N’gaoundéré fistula repair centre, which was established by UNFPA and the MTN Foundation in 2013.

But many more women must be reached, experts acknowledge.

“It would be illusory to think that the current rate of repairs can reduce the pool of women with fistula who are waiting for surgery,” said Barbara Sow, UNFPA’s Representative in Cameroon.

For greater impact, UNFPA and its partners are working to increase the number of health centres able to deliver care to fistula survivors.

This is why the doctors participating in the 10-day campaign also trained health workers at the Catholic Hospital of Batouri, including three physicians, two anaesthesiologists and 10 nurses.

Now that they have a qualified team in the region, women will no longer need to travel to N’gaoundéré for care.

Beyond surgery

But fistula survivors also have needs beyond surgery. Because of their exclusion by the community, most women have been forced to abandon their jobs and livelihoods. "When I had fistula, people wouldn't buy the food I was selling because of the bad odour of urine and the leaking," recalled one woman who received the repair surgery.

UNFPA and Orange will provide 60 fistula survivors with seed funding for small businesses and other income-generating activities.

And UNFPA is working to spread the word in communities that fistula can be prevented from happening in the first place, by ensuring women give birth under the care of a skilled birth attendant – such as a midwife, nurse or doctor – who can respond should complications arise.

It is especially important to get these messages to men, “since they hold decision-making power over their wives,” said Dr. Sow.

UNFPA-trained advocates are speaking about the issue in so-called husband’s clubs, groups of men who meet regularly to discuss family matters. And the message seems to be having an effect, experts say.

“Prevention is better than the cure,” Dr. Sow said.

– Olive Bonga

The story was first published on UNFPA website.

“In my community, it is difficult not to see adolescent girls aged 15 to 16 years pregnant or as young mothers”, says 18-year-old Lucia Aiuba Amade from Quelimane in Mozambique's province Zambezia.

Childbirth at an early age is associated with greater health risks for the young mother. In fact, complications of pregnancy and childbirth are the leading cause of death in young women aged 15 to 19 years.

Teenage pregnancy often force girls to drop out of school, and expose them to the risk to develop a fistula.

Lucia is one of 783 mentors trained under “Rapariga Biz” - the first joint United Nations programme on sexual and reproductive health and rights for teenage girls in Mozambique led by the government with technical assistance by UNFPA, the United Nations Population Fund, UN's educational and scientific organization UNESCO, UN's children's agency UNICEF and UN's women's agency UN-WOMEN, funded by the Swedish International Development Assistance (SIDA).

In Mozambique, an estimated 2,300 new cases of fistula occur every year. This is largely due to the high rates of teenage pregnancy and early marriage. According to a survey by the Ministry of Health, 46 per cent of girls between 15 and 19 years are pregnant or mothers and 48 per cent of girls are married before 18 years.

Rapariga Biz aims to reach 1 million girls and young women of 10-24 years from 2016 to 2020 to address the pressing sexual and reproductive situation of girls and young women in the provinces of Nampula and Zambezia.

Mentors prevent fistula
“Our communities lack information about fistula, and the girls and young women are the ones to bear the consequences. Those living with fistula are isolated and discriminated against. We can help prevent this child birth complication under Rapariga Biz,” says Lucia Aiuba Amade.

Each mentor is leading a session with some 30 girls between 10-14 years or 15-19 years each week for six months in a safe space in the community identified by the girls and young women themselves.

In the first year, Rapariga Biz has reached a total of 23,518 women and girls.

In the safe space, they learn and discuss about life skills, solidarity, human rights, including the right to live free of violence and child marriage, sexual reproductive health, the consequences of early pregnancy and how to prevent it.

Fistula has a dedicated session: “We need to ensure that the girls and young women understand the causes and consequences of fistula to empower them to make informed choices and delay the first pregnancy,” says 22-year-old Amina Carlos Antonio.

Promoting the rights of teenage girls

“The key to eliminate fistula is prevention, specifically through prevention of child marriage and teenage pregnancy which sits at the heart of our efforts as UNFPA targeting the most vulnerable girls and young women. It is essentially about their rights to health and life,” says Bettina Maas, UNFPA Representative in Mozambique.

The ability to control the own fertility is fundamental to the empowerment and equality of women and girls. Apart from the preventive efforts, UNFPA is supporting Mozambique's Government in ensuring the availability of treatment and social reintegration for fistula survivors.

Mangochi District, Malawi – A phone call changed Nachilango Bisolomo’s life.

For 46 years, she had suffered from an obstetric fistula, a stigmatizing injury caused by childbirth complications. Fistula causes incontinence and can also lead to infections, chronic pain and other problems.

“Everywhere I sat, I left a mark, and people would come to see, and talk so much about my condition. I was helpless and could not do anything about this,” she told UNFPA.

Like many fistula survivors, she felt embarrassed and alienated.  “My life has been hell,” she said.

But then one day, Ms. Bisolomo’s son-in-law was at the Monkey-bay Community Hospital in Mangochi District, and he saw a ward full of women wrapped in 'chitenje', a fabric worn around the waist.

The women explained that they were fistula survivors. The hospital was holding an obstetric fistula "camp," and repairing fistulas free of charge.

He immediately phoned his mother-in-law.

Ms. Bisolomo quickly travelled the 300 km from Dedza District, and the next day, she underwent the surgery.

When she was wheeled out of the operating room, her niece, Anastanzia Paulo, cried tears of joy.

Ms. Bisolomo's long ordeal was coming to an end.

“One who has been punished”
Ms. Bisolomo was born Nasiwelo Bisolomo. She married early, and was pregnant by 18.

She had no idea that adolescent pregnancy increases one’s risks. Childbearing before the pelvis is fully developed can lead to prolonged and obstructed labour, the complication that causes an obstetric fistula.

At the time, Ms. Bisolomo lived over 100 km from the nearest hospital, so she gave birth at home. The labour was horrendous and long, and, tragically, her baby died in the process. Afterward, she was left with a fistula.

The loss was devastating – as was life with her condition.

She even changed her name to Nachilango, meaning “one who has been punished.”

“I accepted that I will be like this for the rest of my life,” she said.
Still, in some ways, Ms. Bisolomo was fortunate.

Many women with fistula are abandoned by their families and persecuted by their community. But Ms. Bisolomo’s family life was just beginning.

She and her husband managed to successfully have another baby, Natumani, who is now 45 years old. Her husband stayed with her until he died in 2012.

Then Ms. Bisolomo learned about the fistula camp, an initiative supported by UNFPA and organized by Mangochi District Hospital.

Forty-one women received care at the camp. Some were referred elsewhere for more specialized operations; over half were repaired and discharged.

“It took us almost three hours in the theatre to have her repaired,” Gonjezo Kumpatsa, one of the medical clinicians, said about Ms. Bisolomo. “It was a complicated condition, coupled with her age, but we are hopeful she will be healed.”

Treatment and prevention
Surviors like Ms. Bisolomo are now helping to spread the word that fistula treatment is available.

“We are able to mobilize more patients through the treated patients, who act as our ambassadors,” said Lydia Kasiya, a nurse and midwife technician.

Ms. Bisolomo plans to keep her name to send a message to other women.

“I don’t intend to change my name when I go back, despite being healed,” she said from her hospital bed, “because I want to still be an example to many that this condition can be cured.”

Since 2011, UNFPA, the Freedom From Fistula Foundation and AMREF Health Africa have supported the government in providing fistula treatment in Lilongwe and Mangochi.

Last year, fistula camps were held in Chikwawa, Mulanje and Mangochi districts, including at the Bwaila fistula centre.

But fistula repair services are not enough.

The condition is easily prevented through access to emergency obstetric care – usually in the form of a Caesarean section. In fact, the condition is so preventable that it has been essentially eliminated in industrialized countries.

UNFPA supports midwifery trainings, health centres and reproductive health supplies to bolster the availability of emergency obstetric care in remote areas around the world.

Meanwhile, Ms. Bisolomo’s family is determined to convince more women to seek proper health care.

“I am sure people will ask who this amazing traditional healer is,” said Ms. Paulo, “but I will tell them it’s the hospital, and it is a condition that can be cured.”

– Henry Chimbali

The story was first published on UNFPA website.

Abra sits quietly as she remembers the journey of her life. For 24 years, she has known suffering and great emotional pain. One day and one event changed the course of her life for over two decades.

On that day, many years ago, Abra went into labor. It was her fifth child, and she had managed all of her previous labors by herself at home. But this time was different. After struggling with the pain and pressure, she was taken to the hospital for a caesarian section. “There was no hope,” Abra remembers sadly. “Even the doctor lost hope.” The struggle was devastating. The baby died, and Abra remained in a coma for five days.

Abra dances her way into the hospital’s Dress Ceremony.

When she awoke, she learned that her husband had decided to leave her. Then, a few days later, she realized she was incontinent. The condition that Abra suffered from is known as VVF (vesicovaginal fistula). It is an injury caused by obstructed labor, and it results in a continual leakage of urine, feces, or both. Unfortunately, it is a condition that is much too common in developing countries, where women have little access to medical care.

The condition exacts a terrible emotional toll, as well. Abra was ostracized by her family, friends, and community. “Everybody in our area knows about my sickness,” Abra says quietly with downcast eyes. “All of them know.”

Over the years, people often mistreated Abra. They made signs and yelled insults at her. When she stood up, they often checked her clothes to see if they were wet. For a few years, she was able to stay with some relatives. However, when they died, she was on her own in the bush, secluded from the world. She was isolated from every kind of help and support – physical, mental, and emotional.

Abra says she only got through this time with God’s help. “In those times of challenges and pain, I did weep most of the time. I didn’t have anybody to come to my rescue. I spent most of my time in my hidden place, where I wept.” She struggled with depression that made it difficult for her to eat, and she longed for the day her suffering would come to an end. “So the only option is to wait for God’s time when I will join him after death, and it will be the end of everything. This was all I could tell myself before the ship came,” she says sadly.

Then, in 2010, Mercy Ships sailed into the port of Lomé, Togo. The arrival of the hospital ship brought hope for Abra – something she had not felt for a long time. Soon she was received a free successful surgery. After spending a few weeks in the ship’s hospital, Abra was able to go home.

She felt like a new woman, but her joy was short-lived. Tragically, a few weeks later, Abra was the victim of a brutal rape that ruined the surgical repair. She was back in the same nightmare she had experienced for two decades. “When my sickness came back, I was confused and lost,” Abra explains. Sadly, the ship had already left, and she had nowhere to turn.

Abra took refuge with her brother, who required her to be the housekeeper for the entire family. The work was very difficult for her. When she was unable to complete all the tasks, she was driven out of the home. She was only allowed to re-enter the house at certain hours to sleep. She had to awake every morning at 4:00 to leave the house and had to wait until late in the evening to return. She was not allowed to use the kitchen or even take a cup to drink from. She could not share in any of the food. Her brother’s family wanted to make sure she suffered because they were uncomfortable with her sickness.

No one can take Abra’s smile away. She is filled with joy.

Abra struggles to hold back tears as she recalls those days. “My brother did not agree with me. According to him, I’m telling a lie – I am not sick because I didn’t lose weight.” She quietly says a prayer and pauses before continuing, “My brother mistreated me. He mistreated me to the point that I got seriously sick.” The pain of her brother’s rebukes and abuse almost destroyed Abra’s spirit.

Finally, she found reprieve with her aunt. “She told me I smelled like a dead corpse before joining her. But the hands of God are upon me. Today I am here. I am still alive today,” she says.

Less than a year later, Abra’s daughter contacted her, telling her the wonderful news that Mercy Ships had returned! “For me, Mercy Ships has been sent from God to me, and I know that the ship is here to heal, I was hopeful. I didn’t know other people, too, have this sickness, I thought I was alone. But now, I know that I’m not the only one. I’m confident, and God is with me.”

Now, Abra has healed from her second surgery with Mercy Ships. She is living with her daughter and has been accepted back into the family. “I feel better now. No, rather, great! And I thank the Lord for the life of the medical team. May the Lord bless them, strengthen them, and give them long life. They will be blessed. God will reward them for ever and ever.”

Abra’s face radiates with happiness as she adds simply, “I have joy in me!”

Written by Nicole Pribbernow. Edited by Nancy Predaina. Photos by Debra Bell. Courtesy: Mercy Ships.

Abra sits quietly as she remembers the journey of her life. For 24 years, she has known suffering and great emotional pain. One day and one event changed the course of her life for over two decades.

On that day, many years ago, Abra went into labor. It was her fifth child, and she had managed all of her previous labors by herself at home. But this time was different. After struggling with the pain and pressure, she was taken to the hospital for a caesarian section. “There was no hope,” Abra remembers sadly. “Even the doctor lost hope.” The struggle was devastating. The baby died, and Abra remained in a coma for five days.

Abra dances her way into the hospital’s Dress Ceremony.

When she awoke, she learned that her husband had decided to leave her. Then, a few days later, she realized she was incontinent. The condition that Abra suffered from is known as VVF (vesicovaginal fistula). It is an injury caused by obstructed labor, and it results in a continual leakage of urine, feces, or both. Unfortunately, it is a condition that is much too common in developing countries, where women have little access to medical care.

The condition exacts a terrible emotional toll, as well. Abra was ostracized by her family, friends, and community. “Everybody in our area knows about my sickness,” Abra says quietly with downcast eyes. “All of them know.”

Over the years, people often mistreated Abra. They made signs and yelled insults at her. When she stood up, they often checked her clothes to see if they were wet. For a few years, she was able to stay with some relatives. However, when they died, she was on her own in the bush, secluded from the world. She was isolated from every kind of help and support – physical, mental, and emotional.

Abra says she only got through this time with God’s help. “In those times of challenges and pain, I did weep most of the time. I didn’t have anybody to come to my rescue. I spent most of my time in my hidden place, where I wept.” She struggled with depression that made it difficult for her to eat, and she longed for the day her suffering would come to an end. “So the only option is to wait for God’s time when I will join him after death, and it will be the end of everything. This was all I could tell myself before the ship came,” she says sadly.

Then, in 2010, Mercy Ships sailed into the port of Lomé, Togo. The arrival of the hospital ship brought hope for Abra – something she had not felt for a long time. Soon she was received a free successful surgery. After spending a few weeks in the ship’s hospital, Abra was able to go home.

She felt like a new woman, but her joy was short-lived. Tragically, a few weeks later, Abra was the victim of a brutal rape that ruined the surgical repair. She was back in the same nightmare she had experienced for two decades. “When my sickness came back, I was confused and lost,” Abra explains. Sadly, the ship had already left, and she had nowhere to turn.

Abra took refuge with her brother, who required her to be the housekeeper for the entire family. The work was very difficult for her. When she was unable to complete all the tasks, she was driven out of the home. She was only allowed to re-enter the house at certain hours to sleep. She had to awake every morning at 4:00 to leave the house and had to wait until late in the evening to return. She was not allowed to use the kitchen or even take a cup to drink from. She could not share in any of the food. Her brother’s family wanted to make sure she suffered because they were uncomfortable with her sickness.

No one can take Abra’s smile away. She is filled with joy.

Abra struggles to hold back tears as she recalls those days. “My brother did not agree with me. According to him, I’m telling a lie – I am not sick because I didn’t lose weight.” She quietly says a prayer and pauses before continuing, “My brother mistreated me. He mistreated me to the point that I got seriously sick.” The pain of her brother’s rebukes and abuse almost destroyed Abra’s spirit.

Finally, she found reprieve with her aunt. “She told me I smelled like a dead corpse before joining her. But the hands of God are upon me. Today I am here. I am still alive today,” she says.

Less than a year later, Abra’s daughter contacted her, telling her the wonderful news that Mercy Ships had returned! “For me, Mercy Ships has been sent from God to me, and I know that the ship is here to heal, I was hopeful. I didn’t know other people, too, have this sickness, I thought I was alone. But now, I know that I’m not the only one. I’m confident, and God is with me.”

Now, Abra has healed from her second surgery with Mercy Ships. She is living with her daughter and has been accepted back into the family. “I feel better now. No, rather, great! And I thank the Lord for the life of the medical team. May the Lord bless them, strengthen them, and give them long life. They will be blessed. God will reward them for ever and ever.”

Abra’s face radiates with happiness as she adds simply, “I have joy in me!”

Written by Nicole Pribbernow. Edited by Nancy Predaina. Photos by Debra Bell. Courtesy: Mercy Ships.