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FAQs

Effective Altruism
What is effective altruism?

Effective altruism is an approach to philanthropic giving that focuses on maximizing the good from one’s charitable donations. This evidence-based approach first identifies issues where the next dollar spent could have the greatest impact on human welfare, and then supports the most effective charities tackling these issues. 

In his book, The Life You Can Save, Princeton ethicist Peter Singer asserts charities operating effectively in low-resource countries—where poverty and its effects are most pronounced—are best positioned to make the largest impact.

Since 2014, The Life You Can Save organization has recommended Fistula Foundation as one of its Top Charities that it believes provides the greatest good for funds spent. Named after Singer’s seminal book, this watchdog organization is one of  the nonprofit sector’s most authoritative voices on Effective Altruism.

From a health metrics standpoint, healing a woman with fistula is a highly effective intervention—comparing favorably with vaccines and bed nets. Obstetric fistula is one of humanity’s most disabling injuries, but it can be cured by a surgery that costs $586.

Background resources

 

How We Work
How much does it cost to treat obstetric fistula?

The average cost per patient is $586 USD. This includes surgery, postoperative care and physical rehabilitation. This price estimate is based on data reported to Fistula Foundation by our grantees across Africa and Asia. Costs and hospitalization can, however, be far greater for more complicated surgeries such as treating dual vaginal and rectal fistulas. You can learn more about how we determine the average cost of care on Our Strategy page

How did Fistula Foundation start?

Fistula Foundation was founded in 2000 as an all volunteer organization to support the pioneering Addis Ababa Fistula Hospital in Ethiopia.

Our success between 2004 and 2008 enabled us to dramatically expand our mission in 2009  to fight fistula globally. As a result of this rapid expansion, we have now supported fistula treatment in 32 countries at sites on two continents, Africa and Asia. We fund more obstetric fistula surgeries globally than any other organization.

Why we don’t focus on prevention?

There were a number of worthy approaches we could have pursued in the fight against fistula, including midwifery training, contraceptive provision, and eliminating child marriage. But one path—providing curative fistula surgery—stood out from these approaches with two clear advantages: 

  • the unmet need to treat women already  injured with fistula is profound
  • the marginal difference surgery can provide is truly life-changing.

This enormous return on investment is precisely why Fistula Foundation focuses solely on delivering fistula repair surgery. With each surgery we provide, we know that we’re helping change one woman’s world forever. And we know that the ripple effect of her restored health—on both her family and community—is profound. Learn more about Our Strategy

How does Fistula Foundation choose its partners?

We do our homework upfront and only invite funding requests from the very best hospitals and doctors, some of whom operate in the world’s toughest neighborhoods. We never lose sight of the fact that we’re not buying widgets—we’re selecting surgeons to perform intricate, vaginal surgery on horribly injured women.  Cost is not the key variable; the quality and training of the medical team is.  

We vet potential partners through a careful process that draws on the expertise of the Foundation’s Program Development team, Board of Directors, and Grants Review Committee. We also rely on our relationships with Direct Relief and an international network of fistula surgeons who help advise on the reputations of local doctors and the needs that exist in different regions.

What type of projects does Fistula Foundation fund?

Wherever possible, we work to empower dedicated local doctors in developing countries. In addition to paying for the direct cost of surgeries, we fund activities that remove critical bottlenecks to treatment. These include the training of surgeons, the building of hospitals and operating rooms dedicated to fistula surgery, community outreach to let women know where they can get treated, and “mobile” fistula clinics to provide treatment in rural areas where no hospitals exist.

We also fund solutions targeted to the specific needs of a partner. For example, in Senegal, we funded a fleet of motorcycle ambulances to transport patients to care facilities over difficult terrain, while in Uganda, we funded the construction of a water tank to secure a source of clean water for surgery and recovery.

Learn more about our Investment Areas

How does Fistula Foundation make sure my donation is used as intended?

We are committed to getting as much money as possible to our trusted partners in the field, because that’s where women’s lives are changed. 

To ensure funding goes to the most respected local doctors and hospitals in Africa and Asia, Fistula Foundation issues grants on an invitation-only basis. Learn about  our partner selection process

Surgeons and hospitals that receive funding from Fistula Foundation are required to provide quarterly progress reports detailing their project activities and costs, surgical outcomes, and any challenges encountered. Fistula Foundation only releases funds once a partner’s report has been reviewed by our Medical Advisor and Program Development staff.

How long does it take for a partner to receive funding?

We work fast, because it helps our partners more if they receive their funding quickly. Following a few protocol procedures including Board approval and the signing of a grant agreement, we usually are able to turn around and dispense funds in a few days time if needed.

This means that if dedicated surgeons in developing countries come to us for help, we can respond immediately. For example, when Dr. Denis Mukwege, founder of the Panzi Hospital, desperately needed funds after a major donor pulled out, we could respond in a heartbeat. Panzi Hospital remains the leading treatment center for victims of sexual violence in the Congo, including surgery treatment of fistulas.

How do you find out about new funding opportunities?

We fund projects on an invitation-only basis, and we’re constantly on the lookout. We are in frequent conversation with our international network of surgeons and partner organizations.

Does Fistula Foundation provide funding for the Hamlin Fistula Hospitals in Ethiopia?

Fistula Foundation began as a fundraising organization for Hamlin Hospitals and is honored to have provided over $10 million USD in support of Hamlin. Today Fistula Foundation no longer solicits earmarked funds for Hamlin Hospitals, which now runs its own fundraising operations in the U.S., Hamlin Fistula USA. Hamlin Hospitals also has partner organizations in Australia, the UK, the Netherlands, Germany, Sweden, New Zealand and Japan.

How do you determine the $586 USD cost for fistula repair surgery?

Fistula Foundation arrives at an average cost for one surgery based on aggregate data from impact and financial reports received from partners we fund across Africa and Asia. Actual surgical costs vary depending on the local economies where our partners work. Costs for more complicated surgeries, such as treating dual vaginal and rectal fistula, can be greater. Learn more about the cost of care on Our Strategy page

Making a Gift
Are my donations to Fistula Foundation tax deductible?

Yes. Click here to view our official letter stating our tax-exempt status

Supporters in the UK and Australia can provide tax exempt gifts through the following Fistula Foundation’s The Life You Can Save web pages:

Supporters in Canada can make tax-exempt gifts through Fistula Foundation’s RC Forward web page.

Is there any way I can have a photo or stay in touch with the woman I have assisted?

Sorry, no. We understand your desire to find out more about your specific donation, but because of resource limitations, we are unable to keep photographs of each woman helped or to manage donor correspondence.

How can I donate in honor of someone?

If you are making a gift online by credit card, there is an option on our donation form to dedicate your gift in someone’s honor. If you check this box and tell us the person’s email address, we’ll send them an email letting them know about your gift.

Where can I send my donation?

Online: You can easily make a donation online by visiting the Donate page on our website.

By Mail: Personal checks, cashier’s checks or money orders, made payable to Fistula Foundation, may be mailed to:

Fistula Foundation
1922 The Alameda, Suite 302
San Jose, CA 95126

By Phone: Fistula Foundation accepts Visa, American Express, MasterCard and Discover.

Staff are available to take your call Monday – Friday, 9am to 5pm Pacific. Please call our office at:

  • (866) 756-3700 (toll-free in the U.S.)
  • +1 (408) 249-9596
Is my information secure when I submit it on your website?

We are committed to providing you a safe means of communicating your sensitive information. Our website complies with industry standards for Secure Sockets Layer (SSL) data encryption to ensure your personal data is safely and securely transmitted across the web.

We do not share your contact information. See Privacy policy

How do I modify a recurring donation?

You can change your credit card information or the amount of your monthly gift by creating a new subscription. We’ll take care of removing the old information.

If you do not want to update your information online, or have a question about your gift, please call our offices at (866) 756-3700 (toll free in the USA) or +1 (408) 249-9596, and we would be happy to help you in person. Or you may send an email to kimberly@fistulafoundation.org

I would like to host a fundraiser. What resources are available?

Fundraising is a great way to get involved with the fight against obstetric fistula. We’ve got lots of tips and resources available on our How to Help page

I am a Financial Adviser and am looking for information.

Fistula Foundation welcomes inquiries from professional advisers. We are eager to help you assist your clients in fulfilling their philanthropic plans.

  • Fistula Foundation’s U.S. Tax Identification Number is 77-0547201.
  • To send gifts of securities and/or arrange wire transfer gifts, please contact Kimberly Adinolfi, Senior Development Manager for Fistula Foundation at kimberly@fistulafoundation.org or (408) 249-9596.
  • If you are an executor or an attorney representing an estate, please contact Jesse Dubow at  jesse@fistulafoundation.org or (408) 249-9596.

 

Obstetric Fistula
What is a fistula?

A fistula is a hole. 

An obstetric fistula of the kind that occurs in many developing countries is a hole between a woman’s vagina and one or more of her internal organs. This hole develops over many days of obstructed labor, when a mother is unable to access emergency maternal care. Contrary to a common misconception, this injury is not due to the ripping of tissue, rather it is due to the pressure of the baby’s head being pushed against the mother’s pelvic bone by uterine contractions during labor. This pressure can cut off the supply of oxygenated blood. Deprived of oxygen, the tissue becomes “necrotic” or dead. When this dead tissue falls away, it leaves behind holes in the vagina, bladder and sometimes the rectum. These holes result in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their foul smell.

Traumatic fistula is the result of sexual violence. The injury can occur through rape or women being butchered from the inside with bayonets, wood or even rifles. The aim of sexual violence is to destroy the women and the community within which the sufferer lives. Once committed, the survivor, her husband, children and extended family become traumatized and humiliated. Panzi Hospital in Congo is a pioneer in treating victims of traumatic fistula, and Fistula Foundation is proud to support their work. Learn more about their work on our DRC country page

The Institute for Health Metrics and Evaluation (IHME) compares the burden of different health conditions through a relative-weight metric. A weight of 0 means perfect health, and a weight of 1 means death. The IHME rates Vesico-vaginal fistula (incontinence of urine) at 0.342, putting it on par with complete hearing loss and drug-resistant tuberculosis. It rates recto-vaginal fistula (incontinence of feces) at 0.501—on par with terminal cancer.

What are the root causes of fistula?

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but cannot access to emergency medical care, such as a C-section. It is a symptom of deep, intractable poverty and the low status of women and girls.

In poor countries, many children are malnourished, which can stunt their growth. If a young mother’s pelvis is not fully mature, she is at an increased risk of experiencing an obstructed labor—and with it, devastating childbirth injuries like obstetric fistula. The practice of early marriage and young pregnancy can additionally compound this risk. Child marriage remains a worldwide issue, affecting millions of girls around the globe.

Another key cause of fistula is a critical lack of doctors and medical facilities. In poor, rural regions of Africa and Asia, fewer than 6 out of 10 women give birth with a medical professional present.

Does obstetric fistula occur in wealthy countries?

Even though obstructed labor occurs in approximately 5% of all child births worldwide, obstetric fistula has largely been eradicated in wealthy countries, thanks to the advent of the Cesarean section in the early 1900s. 

Today, fistula persists in low-income countries where women have limited access to emergency obstetric care. It continues to destroy women’s lives at an alarming rate in poor, rural regions of Africa and Asia, where  fewer than 6 out of 10 women give birth with a medical professional present. Learn about where we work

Can obstetric fistula be cured?

Yes. An obstetric fistula can be closed with corrective surgery. If the operation is performed by a skilled surgeon, a woman with fistula  can very often return to a normal life, with her continence and hope restored.

Launched in 2012 by Fistula Foundation, Direct Relief and UNFPA, the Global Fistula Map is the single most comprehensive source for understanding worldwide availability of treatment for women living with fistula. The map relies on self-reported data from treatment partners, but counts only 60,280 surgeries completed between 2012 and 2015 – about 20,000 per year.

I heard that fistulas are a result of female genital cutting. Is this true?

While harmful traditional practices such as female genital cutting (FGC) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients have been victims of FGC, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGC does not “cause” a fistula.

FGC can, however, make treatment of an obstetric fistula more complicated, because the scar tissue resulting from FGC can make fistula repair surgery more difficult.

How many women does this problem affect?

A peer-reviewed analysis, published in December 2013 by a team at the London School of Hygiene and Tropical Medicine, estimates there are over one million women suffering with obstetric fistula. Because many women with fistula sustained their injury as young women — many still in their early twenties or even late teens — they are likely to live with their condition for decades if it is left untreated. Yet surveys done for the Global Fistula Map estimate that fewer than 20,000 surgeries are performed per year.

Where is fistula prevalent?

Women are susceptible to developing fistulas in low-income countries with poor access to emergency maternal care. Today fistula remains prevalent in poor, rural regions of sub-Saharan Africa and parts of Asia. With the advent of the C-section in the early 1900s, the condition was largely eliminated in wealthy countries such as the United States. 

To learn more about the regions where Fistula Foundation works, please see our Country Directory

Can obstetric fistula be prevented?

Any woman with obstructed labor who has access to competent emergency obstetric care, including a Cesarean section, will not develop a fistula.

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