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In Koulikoro, Malian Women with Fistula Find Compassion and Solidarity

I watched one health worker carefully chase mosquitoes from underneath the bed nets, so the women using them could rest.

As I listened to the obstetric health histories of the women who came to the Koulikoro referral health center in Mali last month, I got a brief introduction to how obstetric fistula has affected their lives.

Each one had come to the facility hoping to undergo a successful repair surgery to heal her fistula (a childbirth injury that can occur during obstructed or prolonged labor). And their accounts revealed some unmistakable parallels:

Sali is 27 years old and developed obstetric fistula during her second pregnancy. After laboring for three days, she received an emergency cesarean to remove her stillborn child. She’s lived with a fistula for nine years and has lingering incontinence after receiving two previous fistula repair operations. Of two total pregnancies, she has only one living child.

Their stories reflect a health system that offers inadequate access to high-quality perinatal care.

Korotimi is 43 years old and developed obstetric fistula after 24 hours of labor during her third pregnancy. She’s lived with a fistula for 10 years and has lingering incontinence after two previous repair operations. Of seven total pregnancies, she has two living children.

Doussouba is 61 years old and developed obstetric fistula during her eighth pregnancy after laboring at home for three days. She’s lived with incontinence for more than 20 years. Of eight total pregnancies, she has three living children. This will be her first fistula repair operation.

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Their stories reflect a health system that offers inadequate access to high-quality perinatal care. National estimates reveal there is only one midwife or obstetric nurse for every 10,175 Malians.

But their narratives also uncovered a much larger systemic problem—how to provide the multifaceted support necessary for these women, who’ve fallen through the cracks of a struggling health system and been left to endure the debilitating consequences.

Their most obvious and immediate need is for physical healing. But the logistics of offering surgical repair for obstetric fistulas can seem overwhelming. Many different levels of health providers are needed, including community health agents to educate and recruit clients, and serve as companions and advocates for the women throughout their hospitalization. Nurses must place IV lines, administer fluids and medications, provide 24-hour monitoring to screen for postoperative complications, and attend to clients’ daily needs. Specially trained surgeons must locate and repair the compromised tissue, restructuring anatomy when necessary.

If the women needed something, one of the health workers would jump in and do it. And it didn't stop at physical healing.

There are also laboratory technicians, pharmacists, nursing assistants, anesthetists, surgical aids, physicians, and orderlies who play equally critical roles in the physical care of these women throughout the process.

As a visiting student nurse, I flitted in and out of the different phases of patient care during the campaign, lending a helping hand where I could, often just observing in awe the prowess of the providers. As I watched the fistula repair team work together like a well-oiled machine, it quickly became clear to me that a common resolve motivated each and every one of them. It didn’t matter what their official role was—if something needed to be done for the women, one of the team members would jump in and do it. And it didn’t stop at physical healing.

I saw a surgical aid calm an anxious client with words of reassurance.I saw an anesthetist protect the dignity of a woman by taking the time to clean urine off her legs before helping with her transfer.

I saw a nurse chasing mosquitoes out from underneath bed nets so the women using them could sleep without being disturbed.

These health workers were united in their goal of serving women in need and playing their part in the holistic healing that was underway. This multidisciplinary and multilayered approach from the health care team was my first glimpse of solidarity during my time with the fistula campaign, but it would not be my last.

Ingrid Marzuola worked as a visiting University of North Carolina School of Nursing Global Health Scholar at the Koulikoro referral health center during IntraHealth International’s third fistula repair campaign at this site, through IntraHealth’s US Agency for International Development-funded Fistula Mali Project.

IntraHealth’s End Shame: Restore Dignity campaign helps women in Mali reclaim their dignity and well-being by providing holistic care for those with fistula. We train and coordinate with health workers to provide the surgical procedure that can cure fistula, and provide the social, psychological, and economic skills and resources women need to rejoin their communities. Learn more