A Conversation with Dr. Andy Norman
Editor’s note: Maternal health, including the issue of fistula, will be the focus of the next Strong Women, Strong World luncheon (December 2013). Women of Vision is excited to partner with the Campaign to End Fistula. For more information, contact email@example.com.
Imagine you have a condition that no one around you understands, one that causes you to be cast out from your family, friends and community. Imagine having that condition when you are newly married, young, with so much life ahead of you. Imagine that it happened to you because you did not have access to basic medical care. In the developing world, most births are unattended by a trained medical professional or a lay midwife and take place in the home. In the United States, a ‘home birth’ is a choice women can make when medical care is still readily available for themselves or their babies should it be necessary. In most of the world, home births are the only choice, and often there are dire consequences.
I recently had the opportunity to sit down with my friend and mentor, Dr. Andy Norman, a gynecologist who has worked all over the world to bring hope and healing to women who suffer from the condition known as fistula. In addition to living and working in Nigeria for almost 13 years, he has worked and trained medical doctors and nurses as well as students in countries such as Ghana, Liberia, Cameroon, Bangladesh, and Zambia, just to name a few. I caught up with him just after he returned from a two-month stint in Kenya where he was doing gynecological surgery including fistula repairs. In his career he estimates that he has performed around 1000 fistula operations, and, given the scope of the problem, there is still plenty of work to do.
A fistula, as he explains, occurs when a woman (usually very young and often with her first child) labors too long without relief and the bones of the baby’s head push against the bones of her pelvis. This causes the soft tissues between the two to break down and form a hole between the bladder and/or rectum and the birth canal, causing a woman to leak uncontrollably and constantly. Not only is this physically disabling, but it can also be a social death sentence. Most of the time the baby doesn’t survive and often the woman is blamed by her husband or family, deemed ‘inadequate’ in addition to being ‘unclean’. Almost always this leads to divorce and social alienation. Because of her odor and because she has been cast off by her family, the woman becomes a pariah. She isn’t allowed to do tasks that are typically considered ‘clean’ such as carrying water or cooking. Other women want nothing to do with her. She will live alone and in despair for the rest of her life.
That is, unless she hears by word of mouth of a fistula hospital, or a surgeon like Dr. Norman who is skilled in treating her condition. When she goes to the hospital and meets other women in her same state for the first time she will experience what Dr. Norman has seen over and over again, a kind of “community of suffering” where she will learn that she is not the only one.
After Dr. Norman arrives at a hospital to do fistula repairs and train more staff physicians, it will only be a matter of days before crowds of women are lined up outside the walls, waiting for their opportunity for a surgery that may help them live again. Most women with this problem, however, will never make it to the hospital. They have never heard of a fistula or a fistula surgeon, and even if they have, they have no transportation, no money and no hope to get them there. So, as Dr. Norman explains, the key is not only in educating and treating the women who have fistulas, it’s preventing women from ever getting one.
As he discussed in a recent lecture to a group of physicians, even though the surgery is life-changing, the effects of preventing fistula in the first place are even more profound. The key to preventing fistula is ensuring access to maternal health services and having skilled attendance at births. Not surprisingly, these are the very same interventions that can prevent maternal deaths as well.
During his recent time in Kenya, Dr. Norman met a very young girl, married at an early age, who suffered with a fistula. Her family was aware of her problem and its consequences and brought her to the hospital where Dr. Norman was working. She had an uncomplicated surgery and stayed in the hospital for two weeks until her catheter was removed. Her family was responsible for providing her with sheets and food to eat while she was recovering. She worked on little projects and visited with the other women and girls while her body was healing. After two weeks, she stood up and for the first time in a long time she did not leak. She walked home with her family that same day. Now her journey, like so many other women, is just beginning. She faces a difficult physical recovery as well as a lifetime of social, emotional and spiritual rehabilitation. She must find meaningful work, reincorporate into society and recover her dignity.
I have assisted Dr. Norman with fistula repairs and I have cared for these women after their healing. I have watched them leave the hospital with renewed hope. I have felt good about the women we’ve helped. Dr. Norman, too, continues to do this work year after year because of the purpose he finds in it. He admits, though, there is much more to be done beyond the surgery. Priorities are educating women and their families, training medical personnel, upgrading emergency obstetric services, improving access, and using our own voices to spread the word. Bringing the problem of fistula into the light is a step towards safer childbirth for every woman in every part of the world.