In Ethiopia, a country of nearly 77 million, there are reportedly fewer than 150 OB-GYN doctors. The result — according to A Walk to Beautiful, a new documentary that airs tonight on PBS — is that an increasing number of women, some of whom have been victims of sexual abuse or rape, unnecessarily suffer from a surgically repairable condition called fistula.
"There's a quick surgery," says Mary-Olive Smith, who spent more than two years in Ethiopia making the documentary. "People think we have a tendency to have too many Caesareans here, but it's the very thing that would save a person's life."
Smith says fistula is a hole between an organ and the outside world. It can strike anywhere, but when an obstetric fistula appears in pregnant women, it's mostly the result of being in labor for two to 10 days. Tissue in the anal and vaginal region can suffer small tears or even total disintegration, Smith says, and a third of women who experience fistula die from complications. "Many would prefer to die," she says. "The life they're left with is one of isolation and shame."
Because women with fistula are often actually leaking feces and urine, Smith says, they are shunned by husbands and family alike. A doctor in the film, Catherine Hamlin, describes one young Ethiopian woman whose husband kicked her out and whose mother isolated her in a shack behind the house. "The little girl is exhausted, dehydrated. She finally pushes out a dead baby. She wakes up to her worst horror . . . Her life is ruined. So they build her a little hut outside. There she will stay until death."
Fistula is so common in countries such as Ethiopia because girls marry young and give birth young. They also work long hours in the field and don't eat enough.
"They may get enough food for the kind of life we live, but when you are burning a few thousand calories a day carrying water and sticks . . . These girls are really working hard."
Smith says in all of Ethiopia, there is only one hospital that focuses on repairing fistula. The surgery is not necessarily that complicated, she says, and can be as simple as a one-hour procedure in which the hole is sewn up. But she says that women have lost entire sections of their vaginal wall and in some cases the entire bladder was destroyed.
Getting to the clinics can take days, involving an overnight walk and a days-long bus trip.
"The United Nations didn't even have a plan to deal with this until five years ago," Smith says. "Ultimately, we need the government to get involved. We need more roads, and we need more hospitals."