Echoes from the horn of Africa – #BeBoldForChange

The sun was high and intense you would think it was about midday or 1pm but it was only 10 am in the morning in this part of the world. We couldn’t help but notice the beautiful scenery of acres and acres of landscape as we drove by. “Yep”, my friend said. “Stella welcome to Ethiopia - my beautiful country” Beautiful indeed I responded, nodding my head with a broad smile. In no time my mind was miles away - wondering about the many devastating stories that we have heard about obstetric fistula and what was instore for us at our destination. As we approached the village one did not need to be reminded or to be told about the culture of the people in this area as it was all so glaring. We could see the herdsmen afield behind the grazing livestock and women and young girls and even children carrying very heavy clay pots and jugs of water on their heads and behind their shoulders heading home coming back from the farms or streams.

After about 2 hours of country ride our vehicle pulled up next to a small thatched hut that looks like a local community centre. I could tell we have arrived our destination. A man in wrapped clothing that seemed to have been made of sheepskin came out and with a broad smile shaking hands with our driver said what I believed to be welcome. We greeted each other as he directed us into the hut. As we entered the hut, I couldn’t help but perceive a kind of pungent smell. I looked at my friend as she looked at me, “Are you smelling what I am smelling?”. We nodded our heads in confirmation. The sad faces of the women and young girls seated on locally made stools with long dresses said it all as they stared at us. I made the first move towards one of the ladies. “Salamnu”, I said to her - meaning how are you? Salamnu is one of the few words I have mastered in Amharic, the main language in Ethiopia. The young lady smiled back at me as to acknowledge my greetings and my little knowledge of the local language. This gesture lightened up the atmosphere in the room as we all giggled.

Through an interpreter, I said she looks so young asked her how old she was and what brought her to the community centre that day. “My name is Bizunesh and I am 15 years old. I was told by this elder in my community that some people from the city were coming to talk to girls and women suffering from my condition so I came along to listen and see if they could help me and be my voice to the world”. Bizunesh suffers from obstetric fistula – one of the most serious and tragic childbirth injuries. It is a hole between the birth canal and bladder or rectum caused by prolonged, obstructed labour (that can often last for six to seven days!!!) without access to timely, high-quality medical treatment. It leaves women leaking urine, faeces or both, and often leads to chronic medical problems, depression, social isolation and deepening poverty. Worst of all the women usually give birth to still babies. I moved even closer to this young lady - as a matter of fact, a child as she is only 15 years old for crying out loud. I stooped

next to her, my head tilted towards her left side as I tried to contain the smell, my one hand on her upper back robbing in gentle to console her as she went on to tell her story, tears running down from her eyes. Bizunesh has been married off at a tender age of 14 years by her parents in exchange for money to help solve the poverty situation in the family and shortly after that had become pregnant from her husband who is 35 years old. At this tender age, very often the body is not quite ready for child bearing so labour can go on for very long hours or for days and since there is very little or no maternal health care in these remote areas the child is finally born but dead (still birth). As if the dead of the baby is not enough trauma for the young girl, it is the devastating after-effect of the process that her body has been left into and her life turned into thereafter which is so gruesome. She has become incontinent as her body excretory function is uncontrollable and so urine and faeces leak constantly down her inner thigh to her feet. Hence the constant smell. She will wet and soil their marital bed her husband will not be able to withstand her and therefore send her packing to her parents. Even her family and siblings will not be able to withstand her as they see this as a curse to the family and may scare suitors away that may come for her other sisters’ hand in marriage. Eventually this young child runs away from home into the bushes to start a solitary life as a social outcast from her community.

My head was spinning in dismay as I went from one patient to the next. The story was not different and I constantly had rush out to get some breath of fresh air and hide to wipe my tears. I had never heard anything like this. Why any human being go through such a situation was a question I murmured to myself as I stared into the sky into the blazing sun. I walked back into the hut pretending I was alright. With my friends and the interpreter we sat down and listened to the old man who helped in locating these ladies from the bushes and brought to us. “My friends” he went on “I want to really thank you for taking the time out to come and visit this community and listen first hand from these young ladies. I hope that you could be their voices to the wider world and share their stories so that they can get help to treat this illness that they have. We have heard about fistula centres in the capital city of Addis Ababa were these girls can get treatment. But the city is so far away. The villagers cannot afford the money to pay for transportation to the city as it may have to sell about 3 to 4 cows to be able to raise the money that they need for travel to the capital city of Addis Ababa to sort treatment.” Nodding our heads in despair we could only breathe a sigh of relief that this was over. We walked out from the hut towards our car. It was going to be a long journey back to the capital city my silent voice murmured.

As we drove off it will be 10 minutes before anyone would utter a word, perhaps absorbing as I did all what we had listened to in the last two hours. I could hear the voice of this particular young lady in my mind “…. I had to run to the bush as no one will come close to me as I smell horribly….”. Sitting in front of the car I turned to my friend at the rear seat and told her this has just boosted my resolve to campaign against child marriage and obstetric fistula. “I will join you she said”. Fistula is preventable and treatable, I added, and so no one should be left to suffer in this kind of condition.Obstetric fistula is a stark outcome of gender inequalities, human rights denial and poor access to reproductive health servicesincluding maternal and new-born care, and an indication of high levels of maternal death and disability

According to the United Nations Population Fund (UNFPA), gender based violence undermines the health, dignity, security and autonomy of its victims, yet it remains shrouded in a culture of silence. Victims of violence such as girls involved in child/early marriages can suffer sexual and reproductive health consequences such as obstetric fistula. Statistics from UNFPA also indicates that obstetricfistula. Statistics from UNFPA also indicates that obstetric fistula affects an estimated 50,000 to 100,000 women around the world every year and is particularly common in sub-Saharan Africa, where populations face challenges to obtaining quality health care.

A study by Haregewoin and Emebet in 2003 shows that in Ethiopia, 80% of women (and in some parts of the country up to 100%) are mutilated, as a means of women’s loyalty to culture and faith.In some cases fistula has been known to be a long-term effect of FGM. The World Health Organization also estimates that at least 8,000 Ethiopian women develop new fistulas every year.

The stories of these young ladies were like spears going through my heart. I am a woman and know what labour pain is like for a few hours but talking of labour pains for days and having a still-birth after all that one has gone through is not acceptable for a preventable and treatable condition.

As we celebrate this International Women’s day on March 8th 2017 I encourage every woman to step up and make their voices heard for change #BeBoldForChangeBecause we are the change that we need. We alone are responsible for our destiny and if we don’t do it for ourselves no one will. Let us vow to do the little that we can to bring some social justice to these women here in Ethiopia and all other women suffering with obstetric fistula in sub-Saharan Africa were this condition is prevalent.