UPHS Physicians Travel to Eritrea, Africa
to
Treat Obstetric Fistula
Obstetric fistula, a condition endemic to many
countries in Africa and Southeast Asia, is the
result of childbirth injuries that damage the
vagina, rectum, or tissues of the urinary tract.
As a result, these patients constantly and uncontrollably
leak urine, feces, or both.
The origins of obstetric fistula reside in prolonged,
obstructed labor in which the fetal head impacts
on the soft tissues of the pelvis. Vascular injury
and pressure necrosis ensue, predisposing to fistula
formation. Since the baby usually dies during
the delivery, these young women are often left
childless and abandoned by their husbands and
communities. They suffer in silent shame, living
as outcasts in their society.
The estimated incidence of obstetric fistula
in nations comprising the “fistula belt”
-- in sub-Saharan Africa from Mali to Eritrea,
ranges from 0.2 to 0.3 percent of all deliveries,
up to 100,000 new cases per year. Due to underreporting
of the condition, the scope of the problem could
be much worse than these figures indicate.
Samantha
Butts, MD, an ob/gyn and fertility
specialist at the University of Pennsylvania
Health System, notes, “Intertwined with
the incidence of obstetric fistula are extremely
high rates of maternal and perinatal mortality
in countries in the fistula belt. These public
health problems have multiple facets, but there
is one that stands out: the lack of timely access
to well-trained medical care for women during
labor.”
Throughout the past two years, Mark
Morgan, MD, a gynecologic oncologist and director
of the Division of Urogynecology and Pelvic Reconstructive
Surgery at the University of Pennsylvania Health
System, has made five trips to Eritrea in East
Africa to treat women with the devastating problems
that can result from obstetric fistula. Dr. Morgan’s
trips have been sponsored in part by the United
Nations and he has worked with physicians from
the Stanford University Eritrean Women’s
Project. This project is working to create awareness
of obstetric fistula and organizes teams of physicians
who travel to Eritrea to perform and teach fistula
repair techniques.
Since his first trip with the Stanford physicians,
Dr. Morgan has led several teams of Penn physicians
to Eritrea, including Dr. Butts, urogynecologist
Lily
Arya, MD, and several other staff members
from Penn’s Department
of Obstetrics and Gynecology. During a typical
mission, team members will screen 50 to 100 patients
and perform 30 to 40 operations within a ten-day
period.
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