Champion of Choice

A true story of fistula in Ethiopia

Fistula Hospital in Addis Ababa

Excerpt from Champion of Choice: The Life and Legacy of Women’s Advocate Nafis Sadik
by Cathleen Miller

Zadia Birru*
Addis Ababa, Ethiopia

[*A pseudonym has been used to protect this girl’s privacy.]

Probably no other rite of passage is capable of changing a woman’s life like giving birth–an event that can alternately propel her into the joys of motherhood, provide caretakers for her old age, earn her the respect of a community, ensure her place on a nation’s throne, offer undeniable proof of an illicit affair, trap her in a miserable marriage, maim her for life, or kill her.

No group knows this better than the patients lying here in the hospital ward in Addis Ababa, a room that is so clean that upon entry, the viewer has the momentary feeling of being snow-blinded. The whitewashed walls and ceiling gleam, reflecting the sparkling sunshine that flows through polished windows. Two facing rows of hospital beds covered in sky blue blankets line either side of a central divider. This hygienic atmosphere presents a refreshing contrast to the patients lying in those beds, all of whom have dwelled–some for as many as fifty years–in the constant filth of their own bodily waste as a result of giving birth.

I see them recovering in the ward and walking around the lovely parklike grounds, all draped in handknit shawls, the contribution of a ladies’ church group from Australia. Most of the patients are mere girls, like Zadia Birru. She doesn’t know her age, but she looks about thirteen or fourteen. If she had been born in different circumstances, this classic beauty could have easily been a model. With her dark wavy hair pulled into a French braid, her face possesses an elfin charm, a gracefully curving jaw line, large expressive dark eyes, a full-lipped heart-shaped mouth and a beauty mark that highlights her café-au-lait colored skin. Her smile sparkles, transforming her face like sun bursting through clouds.

Zadia’s tiny frame measures around four foot eight; draped in a pale blue cotton nightgown and a handknit shawl of primary-colored squares, her body hunches with pain. Through the opening of her gown I can see that her breasts have stretch marks, a detail that seems strangely out of place on such a waif-like girl. But when I hear her story, I learn the reason for the telltale puckered lines.

Zadia had never been to school when her parents arranged her marriage to a farmer from their community. She doesn’t know how old she was when she wed her husband, but they had been married for three years before she started her period. In the beginning their relationship was good, but during the fourth year–with no access to birth control–she learned she was going to have a baby. This was when her husband began seeing someone else. The couple quarreled constantly, and when Zadia was four months pregnant, he left her.

The child bride returned to live with her parents in the village of Aju. When it came time for her delivery, she was in labor for two days at home with unbearable back pain because the baby was unable to pass through her tiny pelvis. When she started getting weak, her father decided to take her to the hospital. The family loaded her onto a bench and walked two hours, carrying the child to a district health center. Precariously balanced aboard the plank, she thrashed about in labor.

At the health center Zadia finally gave birth to a stillborn son. Later she learned that ironically his death had allowed him to be born. The fetus, which cannot withstand the rigors of days of obstructed labor, detaches from the placenta and dies. At this point the bones soften, and the baby shrinks enough so that it can pass through the birth canal.

Zadia herself nearly died and was unconscious in the hospital for fifteen days. When she came to, she learned that the stressful delivery had ripped a hole between her vagina and bladder, a condition called obstetric fistula, which permits waste to leak uncontrollably into the vagina. Like an infant herself, she was constantly soiled and reeked with the stench of urine. At this point her doctor referred her to the Fistula Hospital.

Unfortunately Zadia’s experience is not a rare occurrence in Africa, where one in twelve births results in the mother’s death. Although the choice to marry has been enshrined as a human right since 1948, in much of Africa half-starved girls as young as six are married off by their families. The poverty-stricken parents look at them as a commodity to be traded for livestock or other goods. In most cases they feel they’re doing their daughters a favor to try and place them in stable homes where they’ll be provided for. And when these girls become pregnant–as they immediately do without birth control–their young bodies are too small and frail to withstand the rigors of childbirth.

This combination of events results in an untold number of cases of obstetric fistula per year, but thousands and thousands of victims have come forward for treatment. The force of delivery on these slight, malnourished bodies can rip the fragile birth canal and tear holes between the girls’ rectum or bladder, allowing feces and urine to flow uncontrollably into their vagina. In the vast majority of cases the husband divorces the girl because she is unclean and unfit for sex. Zadia was one of the lucky ones whose family was willing to take her back. In many instances the family refuses, and the girl–whose only crime was obeying her parents and then her husband–is turned out into the street with no home, left to live in daily humiliation as a social outcast who scavenges for food like an animal.

I hear similar stories to Zadia’s from the other patients: a childhood marriage, an early pregnancy that results in a fistula and stillborn delivery, followed by divorce….

© Cathleen Miller, 2013

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