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 Listen to the documentary "The Dutch Doctor and the River Spirit" (29'17") |
If the condition lasts for more than three hours, the tissues die, leaving an opening between the bladder and the vagina. As a result, the mother leaks urine continuously.
The prolonged labour can also create a hole between the bladder and the rectum – a recto vaginal fistula - causing faeces to leak into the woman's vagina. In 95 percent of the cases, the infant dies inside the mother.
History
The earliest recorded VVF case was found in a 4000-year-old Egyptian mummy. Fistulas occur in two to five out of every 1000 deliveries and were quite common in Europe and North America till the middle of the 20th century.
The first operation to repair a vesico vaginal fistula was described by a Dutchman, Hendrik van Roonhuizen, in 1663. In the 1850s, an American surgeon, James Marion Sims described and perfected a technique to repair fistulas.
The world's first fistula hospital was opened in New York City in 1860. It operated for nearly a century until a network of obstetric units had been established throughout the United States where emergency Caesarean sections could be performed on any woman who experienced obstructed labour. In Holland, the last obstetric fistula case occurred in 1952.
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Case study A 17-year-old woman who had already had two stillbirths went into labour in a remote rural area. After two days of labour, the infant's head appeared, but the mother had no more strength left and could not expel the baby. The family called the local midwife who was unable to assist her. The family hired a donkey to transport the woman to the nearest road. Since the infant's head was stuck between her legs, she could not sit down. One of her brothers had to mount the donkey and carry her in his arms for four hours. When they and the rest of the family reached the main road, they tried to flag down a taxi, but drivers generally don't stop to pick up sick people. Finally the family succeeded in getting a taxi. Because of her condition, the woman had to lie down in the back of the taxi with her head hanging out of one window and her legs out of the other. When she finally arrived at the hospital, the doctor managed to pull the infant out, but by then the baby had died. The woman survived, but she had developed an obstetric fistula. |
Cost
According to Dr Kees Waaldijk, one of the world's leading experts on VVF, "it will take at least 150 years to set up a similar network of obstetric units in Africa. I have calculated that 75,000 to 100,000 units would be needed
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| Dr Kees Waaldijk at work |
"It's hard to estimate how much it would cost. The building is the cheapest element. Each obstetric unit would also require at least three gynaecologists because they have to work in shifts, as well as anaesthetists, blood banks, etc. Obviously all of this would cost an enormous amount of money."
In Africa alone, between 1.5 and two million women suffer from the condition. No one knows how many women never reach a medical centre and die in the bush.
Tags: childbirth, Kees Waaldijk, Nigeria, vagina, Vesico Vaginal Fistula, VVF