My First Encounter with a Fistula Patient

Celestina Opened My Eyes to the Horror of Fistula—and Shaped My Life’s Work

By Lindsey Pollaczek, vice president of programs

When Celestina went into labor in her village, located along Lake Tanganika in Tanzania, she struggled to gather the bus fare that she needed to get to a district hospital. Three days later, she finally arrived at the facility. By then, her baby was stillborn. She returned home, and realized that she was leaking urine uncontrollably. 

Celestina was devastated. She thought this problem was hers alone. No one in her village understood her condition, and they abandoned her. She lived with fistula for nearly 10 years before a community health volunteer found her and told her that free treatment was available. Unfortunately, as before, the hospital facility was far from home—nearly 300 miles away. Eventually, she scraped together the funds needed to reach Bugando Medical Center, in northern Tanzania. 

A Fateful Encounter

Celestina was the first woman I met who suffered from obstetric fistula. I met her in 2008, during her stay at Bugando. Meeting her was a defining moment in my life. It profoundly moved me, and shaped the trajectory of my life’s work.

Until I set foot in that hospital ward, I knew next to nothing about obstetric fistula. At the time, I was working for Direct Relief, while waiting to go into the Peace Corps. It was my first-ever visit to Africa. For most of my trip through western Tanzania, I traveled with a seasoned medical advisor. But in this instance, I traveled to Bugando alone. The solo visit gave me ample time to listen and learn, and to reckon with the complex issues in front of me. 

People enter and exit Bugando Medical Center in Mwanza, Tanzania

Understanding the Problem

In general, there are three main barriers to fistula care: poverty, inadequate healthcare systems, and the stigma and misunderstanding that are associated with fistula. Celestina’s story was marked by all of these factors.

It would take me many more years to fully grasp the complexity of fistula. But during my time with Celestina, I began to think about the vast inequities that contribute to the prevalence of this condition. 

Not only is this a treatable injury, but it’s also preventable. It no longer exists in higher-income countries, where women have access to emergency obstetric care—to a C-section in particular. For Celestina, as for every woman who develops obstetric fistula, care came too late.

A fistula patient named Pili walks home in Mkata village, Tanzania.

Age Was All We Shared

Celestina didn’t know her age, but a doctor at the hospital—the highly respected Dr. Gumodoka, a distinguished fistula surgeon—thought that she and I were about the same age. I was 25 years old at the time. 

It was hard for me to believe: Our life experiences were vastly different. I was just a few years out of college, and working at my first job. Celestina had already given birth eight times. And her most recent childbirth had left her with a condition that hardly anyone in the world knew anything about. 

I felt profound sadness for her loss and injury. I felt enraged that she was living with this devastating condition. As I would later learn, there are nearly one million women who suffer as Celestina was suffering. Most of them are poor, young women who live in rural parts of Africa and Asia. They have little voice or agency to improve their health and quality of life. 

But through my work, I had the power to stand up, speak up, and enable women like Celestina to access the care they needed.

Becoming Part of the Solution

Celestina opened my eyes to the horror of this condition, and started me on a path that led to my employment at Fistula Foundation—an organization that embodies my compassion for women who needlessly suffer from fistula.

A year after my visit to Tanzania, I worked with the United Nations Population Fund and Fistula Foundation to create the Global Fistula Map—an effort to help the global community understand the landscape of fistula care and accelerate progress toward expanding fistula treatment. 

It was during this time that I met Kate Grant, Fistula Foundation’s fiercely passionate CEO. Later, she would hire me to launch the Fistula Foundation Treatment Network (FFTN) in Kenya in 2014. 

Lindsey Pollaczek visits Gynocare Women’s and Fistula Hospital in Eldoret, Kenya, in 2016.

It was an ambitious initiative that has massively moved the needle on fistula care in the country. Since launching FFTN in Kenya, we’ve brought together nine hospitals, five community organizations, a dozen surgeons, and an army of community health workers. Through this network, our partners have delivered life-changing repair surgery to more than 9,000 Kenyan women. 

Toward a Fistula-Free Future

We now have fistula treatment networks in Zambia and the Democratic Republic of Congo. In addition, we support individual hospital facilities and outreach partners throughout Africa and Asia. In total, we work with 67 partners, supporting more than 100 hospitals in 25 countries. Together with our partners, we aim to treat 10,000 women in 2022.

It’s been a remarkable journey. The landscape has changed, and more women are receiving treatment every year, thanks to our generous donors and our dedicated partners. Still, we know from our colleagues in the field that the need for fistula care remains immense. The problem is far from solved. Too many women like Celestina suffer from fistula today, and too many others are at risk of developing this condition tomorrow.

Fistula Foundation envisions a world in which this injury is no longer a threat to any woman, anywhere. 

With your support, we are working to make that vision a reality. We must be bold, ambitious, and unapologetic. We must keep pushing ahead—because, if not us, who? And, if not now, when?

Published on August 3, 2022

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