One of the most dangerous things a woman can do in much of the world is become pregnant, and the risks caught up with a Kenyan named Alice Wanjiru a decade ago.
Then 20 years old and pregnant for the first time, she suffered a childbirth injury called an obstetric fistula, caused by prolonged labor without access to a C-section to end it. This left her with a hole in the tissue between her rectum and her vagina, and for 10 years she endured the humiliation of continually leaking stool through her genital tract.
“I could never get fully clean, for there was always some stool left,” she told me. “The other women would say, ‘She is the woman who stinks.’ I would ask God, ‘Why me? Why can’t I be like other women?’”
Wanjiru bathed herself several times a day, fasted from morning until evening so there wouldn’t be much in her digestive tract during the day, and always wore a sanitary pad. Doctors misdiagnosed her, sex was a nightmare and her husband abandoned her after harshly accusing her of having poor hygiene.
Shamed by the continuous odor, she withdrew from friends and stayed home from church and other gatherings. She endured her shame in solitude, year after year.
Perhaps one million or two million women worldwide are enduring fistulas and leak stool or, more commonly, urine through their vaginas. These are typically impoverished women in poor countries where home births are the norm, who couldn’t get to a doctor in time for a needed C-section.
This used to happen in the United States as well: In the 19th century, Manhattan had a fistula hospital for such women. But C-sections and emergency obstetric services became widely available, fistulas became rare and the hospital was torn down in the 1890s — to make way for the Waldorf Astoria hotel.
The torment of fistula is incalculable. I interviewed Wanjiru and other patients at the Jamaa Mission Hospital in Nairobi, and tears flowed with nearly every recounting. Women blamed themselves or sometimes thought that they had been cursed by God.
Yet there is an inexpensive solution. Wanjiru’s problem was finally diagnosed as a fistula, and she underwent a surgery that repaired the injury and ended the incontinence.
“I am healed!” she declared proudly. The surgery was, she said, the happiest day of her life.
I’m on my annual “win a trip” journey, in which I take a university student or recent graduate — this year it’s Trisha Mukherjee of Columbia University — on a global reporting trip. At a time when many Americans seem skeptical of our ability to make a difference, Trisha and I are looking at ways to address global health problems. Fistula surgery is an example of an almost miraculous intervention that transforms lives.
Wanjiru was able to get her surgery with the help of the Fistula Foundation, an American-based organization that supports fistula repairs in more than 30 countries. The foundation has financed more than 100,000 surgeries, and the average cost per surgery is just $619.
The Fistula Foundation is one of the nonprofits in my 2024 holiday giving guide, and I’m grateful to readers for donating more than $3 million in the last few weeks to the groups I suggested through my giving website, KristofImpact.org. Credit card fees are covered, so that 100 cents on the dollar goes to the organizations — and the upshot is that more women are able to recover their lives with a free surgery.
We also need to do more to prevent fistulas, perineal tears and prolapses, all childbirth injuries that can be as damaging psychologically as physically. Prevention will come about by improving emergency obstetric services, a path that will also reduce deaths in childbirth.
As I interview patients, I keep thinking of the needless mortification of a million or more women when we know how to fix these injuries quite inexpensively.
One 19-year-old woman told me that when she was leaking urine, she thought of suicide. Every time she sat down, she would leave a wet spot behind. “It was shameful,” she said. “And I couldn’t speak about it.”
After surgery, she said: “I got my life back. I can do anything again.”
Fistula patients suffer so much for so long because they are mostly poor, rural and female, a trifecta of marginalization. But I’ve seen significant progress over the years, in part because of the Fistula Foundation’s role in training surgeons and building a network of hospitals around the world.
There’s a misperception that journalism about global poverty is depressing and soul-sucking. Yes, you see wretchedness, but you also see unimaginable joy as obstacles are overcome and people recover their footing.
A fistula ward is one of the happiest places you can imagine. Some women beam nonstop because they are no longer leaking. Others are awaiting surgery and daring to hope that they can rejoin society and find purpose.
Gladys Kerubo Makori began leaking stool after a prolonged labor when she was a 22-year-old in 2007. Cleaning herself was difficult, because she had no running water at home and had to go to a river to fetch water. It took almost 17 years, but almost a year ago she finally got corrective surgery through the Fistula Foundation.
In the months since, she has made it her mission to help other women with fistulas. She has found six other patients and brought them in for treatment.
Like many of you, I’m frustrated by the state of the world and of my nation. There are many problems we can’t fix, but let’s not forget those areas where we can make a life-changing difference. We have a chance together to light a path forward and lift up women who have almost lost hope. I invite you to join this effort.
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