“Birkiko weighed 32kg when she arrived. Her hips and knees were flexed and unstabilized, says Dr. Melaku Abreha of the Fistula Center in Mekelle. Long-term immobility caused joint contractures.

Birchiko was pregnant (nine months) when the Tigray war began in 2020. She went into labor while people fled and military personnel blocked roads. She hid in the jungle for seven days, being unable reach a hospital. Her stillborn baby was delivered ultimately. She’s heartbroken.

Birchiko soon knew something was amiss. She was unable to control her pee and faeces. “I stopped drinking and eating to reduce leaks, but it didn’t work.” Birchiko didn’t know fistula was curable and felt helpless. When she was permitted to return home, she rented herself a room and grew increasingly reclusive.

When fighting stopped, her younger brother took her to the Fistula Centre in Mekelle, Tigray’s capital. Since July, she’s been a patient. Doctor Melaku has conducted three procedures to heal Birchiko’s fistula, but the prognosis is poor. He continues solemnly, “That baby might be her very last.” “She may never walk or have sex again”

Birchiko’s tragedy isn’t rare. Obstetric fistula arises when women have protracted and obstructed labor without professional emergency obstetric treatment. The baby’s head pressing on the mother’s pelvis cuts off the blood flow, causing tissue to atrophy and fall off. The fistula in between bladder and/or rectum produces uncontrolled urine or feces leakage. It affects the world’s weakest and most vulnerable women.

50,000 – 100,000 women who are pregnant have fistulas each year, and 90% of newborns die. Birchiko’s fistula brought isolation, humiliation, and rejection from family and communities.

Conflict heightens danger

Ethiopia has all the fistula-risk factors. During the violence, about 80% of Tigray’s health facilities were destroyed or damaged, medical supplies are few, and the referral system is flawed. Today, less than 30% of deliveries are supervised by a medical practitioner. Teenage females are prone to fistulas just because their systems may not be ready for motherhood.

Dr. Melaku believes fistula elimination efforts after Hamlin Fistula Center debuted in 2006 have degraded. He argues the conflict has impacted women’s socio-demographic features. Women were poor, illiterate, or rural before. Now, urban and educated women are affected. Sexual assault and malnutrition among pregnant women exacerbate the problems.”

Service and dignity restoration

Obstetric fistula can be prevented with proper maternal and neonatal care. In Ethiopia, UNFPA is developing the ability of midwives to provide essential newborn care and sending them to institutions with staff shortages to help eradicate fistula by 2030. More than 13.5 metric tonnes of reproductive health equipment and supplies, including life-saving maternity care drugs, have been provided to promote safe deliveries.

UNFPA also trains facilities that can provide free fistula surgery and works with fistula survivors as advocates. Birchiko is one of 24 acute fistula cases in Tigray that UNFPA is treating with Danish assistance.

Birchiko’s fistula was psychologically and physically excruciating, but she’s happy for a second chance and hopes to reopen her restaurant when she’s fully recovered. “I liked owning my own business in my hometown.”

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