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Restore Dignity to Women in Mali

by IntraHealth International
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Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Restore Dignity to Women in Mali
Fistula surgeons at work in Kayes, Mali
Fistula surgeons at work in Kayes, Mali

Obstetric fistula is a devastating, disabling condition that often disproportionately affects the poorest women. The condition remains the least-supported cause of maternal morbidity, though it has drastic effects on women, families, and societies.

In Mali, fertility rates are high and use of modern contraceptive methods is low. These conditions combined with a prevalence of early marriage and low rates of facility-based births put up to 2,400 women at high risk for obstetric fistula each year.

Women living with untreated fistula are often shamed, isolated from their communities, and left to live in poverty. Fistula can be treated and often cured, but many women don’t know this—and fistula services and treatment are difficult to come by in Mali, especially for complex cases.

That’s why IntraHealth has worked to make fistula repair services available at more health facilities staffed with trained health workers empowered to diagnose, treat, and prevent the condition effectively.

“This is a sickness that is accompanied by a lot of suffering, but I was able to be healed. You shouldn’t let it keep you from living your life and doing your usual activities. Be patient. One day you can be healed.” -Awa D

Meanwhile, efforts to increase community knowledge around the condition reduced stigma related to fistula.

“Before, there were rumors and myths about fistula being a curse. A lot of people didn’t know it was related to childbirth, but thought it was witchcraft. Now, they know it’s a health issue.” -Demba T, Fistula Mali Project Director

These key strategies helped ensure the project’s success:

  1. IntraHealth developed a new mentorship approach to train surgical teams. Between June 2014 and April 2018, this approach built the capacity of 25 fistula surgeons who conducted over 1000 fistula repair surgeries in Mali throughout the course of the project.
  2. IntraHealth’s technical approach focused on strengthening the health system at all levels by working with Malian civil society organizations and NGOs.
  3. To ease the burden on hospitals with limited space, IntraHealth worked with local foundations to build and equip three new welcome centers for patients during the lengthy hospital stay required before and after surgery.

The lives of many women and girls suffering from fistula were transformed for the better due to these and other important interventions. Women were able to rejoin their communities and lead productive lives.

“I have regained my dignity,” says Oumou S. after receiving fistula repair surgery. “I never thought that it could end. But I am thankful.”

This project has come to an end, but the work is far from over. Visit IntraHealth’s website for more information on our continued work to support women and girls in Mali.

Oumou S (right) after a fistula repair surgery
Oumou S (right) after a fistula repair surgery
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Bintou and her husband
Bintou and her husband

Bintou is 49 years old.She was married at 16 and got pregnant with her first child at 18.

It was during her third pregnancy that she developed fistula. She labored for two days at the local community health center. Unable to give birth, she was eventually taken by ambulance to a larger facility in Dioila. Then she lost consciousness.

Unconscious and unable to push, the doctors performed a C-section but sadly her baby did not survive. Later, once Bintou regained consciousness and was trying to stand, she realized she was leaking urine.

For over a year afterwards she could barely walk, could only move around on all fours, and had trouble sleeping because of the irritation to her legs. She was so desperate she wanted to commit suicide.

In one way Bintou was fortunate: her husband stayed with her throughout it all. “He is the best man in the world,” she says. And her immediate family and closest friends did not reject her or discriminate against her, though she was unable to attend community gatherings such as weddings and other events.

She gave birth to two subsequent children which survived but the deliveries made her fistula worse. One of Bintou’s relatives eventually heard about a program helping heal women with fistula and told Bintou about it.

Bintou had lived with fistula for over 20 years before receiving repair surgery. Since receiving the surgery she has been fully accepted back into her community, in part because of the shop she and her husband opened (the only one in their community). She has four children and nine grandchildren and is extremely grateful for the treatment she received which enabled her to live the life she has today.

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Oumou with her brother and daughter
Oumou with her brother and daughter

Oumou went into labor on a Saturday. On Sunday, her husband’s brother took her to the health community center on a motor bike, about 2km away by very rough dirt roads. She spent the day and night at the health center but still couldn’t deliver. Eventually the health workers took her to a referral health center by ambulance. When she arrived, the midwives performed a C-section, but the baby was stillborn.

Oumou was soon released from the health center but fifteen days later urine began coming involuntarily. Oumou made her way back to the health center where they gave her medicines and told her the leaking would stop. But it didn’t stop.

When her husband discovered she had fistula, he abandoned her at her sister’s house. She was isolated though—no one but her sister would eat with her. She lost her baby, her husband, and her home. She had no hope. She was crying all the time.

Oumou eventually heard about a health center in Koulikoro that was offering repair surgeries to cure her condition. Oumou’s little brother (pictured above) helped her travel to Koulikoro.

Before visiting the health center in Koulikoro Oumou didn’t know what fistula was or anyone who had it. But at the health center she saw many other women suffering from the same condition. It was at this facility where Oumou’s fistula was repaired.

“I feel Happy because I am cured, totally cured. No more sickness. The job has been done. I am very grateful.”

Today Oumou knows her fistula was a result of trying to give birth for so long. She wants to tell women to keep going for prenatal consultations, and to get the care they need during pregnancy.

If she hears about other women who are suffering from fistula, she will be sure to talk to them and let them know they are not alone. She wil also let them know that there is hope—and a cure.

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Saiba (left), Malado (center), and Djeneba (right)
Saiba (left), Malado (center), and Djeneba (right)

Three days.

That’s how long Malado was in labor. That’s how long she was unable to give birth. She was only 16 years old and it was her first baby. Her body wasn’t ready.

This was in the 1960s in rural Mali, and there were no cars to take her from her village to a health facility—even today, it’s rare to see a car pass on these dirt roads. Finally someone helped her into a donkey-drawn cart and carried her to a clinic in the nearby town of Dioila.

“They had to force the baby out,” Malado says. Her newborn did not survive.

Aside from the emotional pain, the trauma to Malado’s body was extensive. When the health workers helped her stand up after the birth, she realized urine was leaking out of her—and it didn’t stop from then on. Nerve and muscle damage gave her such trouble walking that soon she had to use a cane to get around.

She didn’t know it yet, but less than a kilometer down the road, a young woman named Saiba was going through the same thing.

Saiba had been married at 15 and was now having her third child. A few days into her labor she still couldn’t deliver. So she too made her way to Dioila, where her baby was finally born – a stillbirth. A few days later, Saiba was leaking urine.

“I didn’t know what was happening to me,” Saiba says. “I would spend all day crying.”

No one knew what to make of Malado and Saiba’s situation. No one knew it had a name—obstetric fistula—or that it was a direct result of their childbirth injuries. Or that it could be cured. Eventually, no one else in their communities wanted to get close to them because of the smell, and so they became friends.

For the next 50 years, both women lived with the condition, changing and washing their clothes constantly and feeling as if they had lost all dignity. Their only comfort was each other.

Today thousands of women in Mali and throughout West Africa are still experiencing exactly what Malado and Saiba went through over fifty years ago. The World Health Organization estimates that every year some 50,000-100,000 women are affected by obstetric fistula worldwide. It’s difficult to confirm an exact number—no one knows how many more could be hiding or unable reach the care they need.

For most of these women, a simple surgical procedure is all it would take to heal them completely.

But in Mali, making these surgical procedures more widely available in such a vast country is tougher than it sounds. It requires boundless cooperation, determined partners, and great creativity.

Just over two years ago, during the first fistula repair campaign organized by IntraHealth’s Fistula Mali Project, a local health worker, matron Djénéba, heard a radio announcement about it. The ad called on women with Malado’s symptoms to come to the Koulikoro CSRef health center, where they would receive all the care they needed at no cost to them.

Djénéba told Malado, now 73, who quickly passed the news to Saiba, 75. And together they set off for Koulikoro.

Today, both Malado and Saiba are completely healed. They hold hands as they walk around the community, laughing and chatting with the matron.

“We consider it our role in the community now to tell every pregnant woman we see that she must go for prenatal care,” Malado says. “And that she must deliver in a health facility.”

At Koulikoro and other facilities that work with the project, officials are determined to keep providing these services, and encouraging women like Malado and Saiba to come forward.

“The women are there, just waiting to hear when there’s a campaign so they can come have their surgery,” says Abdourhamane, a gynecologist at the Koulikoro CSRef. “They stay in the shadows until then. This is an illness where people don’t show themselves. But there are still a lot of older women who’ve been living with obstetric fistula for years and years—and we still need to help them.

“When you give a woman her dignity back, that’s better than giving her millions of dollars.”

*A version of this report was originally published on ONE.


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Project trained local team of specialists
Project trained local team of specialists

In the last three months meaningful progress has been made to the tune of surgeries for 30 women, the training of a local team of specialists, and a commitment in writing by the regional governor to end the social stigma and discrimination associated with fistula. Fistula Mali’s support in the drafting of action plans, commitment to capacity building of local health workers, and community engagement made a profound impact on women like Madame, 36, from Sikasso.

“I am married and was pregnant with my ninth child. I worked successfully in agriculture. Needless to say, I could financially support my family with out depending on my husband. We lived a fullfilling life.

Many hours after I started labor, I ended up at the Sangnena Health Center. I spent many more hours there before being referred to the Sikasso CSRef where I finally had a stillbirth. 

Three days after discharge, I noticed urine was constantly dripping. Faced with this worrying situation, I returned to the Sangnena Health Center. They gave me a urinary catheter for 10 days which did not resolve the problem. Despite support from my family and friends, I felt unhappy and frustrated because I could not take care my field which generates my income and I became dependent on my husband.

My husband and I had heard the radio broadcasts about an american project that provided treatment for women suffering from urinary issues after difficult pregnancies. This information was then confirmed by the CSRef staff I spoke to in Sikasso. I went with my husband to the hospital during the fistula campaign and after an examination by the medical team, my fistula diagnosis was confirmed. I recieved treatment without paying a cent because all of this was supported by the project.

Thank God I no longer leak and there is no more suffering for me and my family. I take this occasion to thank everyone who contributed to the restoration of my health. I can’t wait to return to my life as it was before this condition and resume my role in the community. I would like to be more involved in maternal and child health in my community as I do not want anyone to suffer from this condition and the social exclusion that comes along with it.”

For many women fistula means not only physical hardship, but social isolation With your continued support we can help more women like Madame receive the care and treatment they need. 

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Organization Information

IntraHealth International

Location: Chapel Hill, NC - USA
Facebook: Facebook Page
Project Leader:
Emily Kiser
Development Officer
Chapel Hill, NC United States

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Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.

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