By Roshni Lodhia, Photographer
I once heard an obstetric fistula surgeon describe fistula survivors as “heroes.” After meeting patients from East Africa, I wholeheartedly agree. When you meet a woman with fistula, you are meeting a fighter.
Obstetric fistula is a childbirth injury that occurs when a woman has a prolonged, obstructed labor but is unable to access emergency obstetric care. As a result, the woman can develop a fistula—a hole between her vagina and her bladder or rectum. Perineal tears are another type of childbirth injury, similar to fistula. If left untreated, a fistula or perineal tear will cause a woman to leak urine, stool, or both for the rest of her life.
At least one million women suffer needlessly from these devastating conditions across sub-Saharan Africa and Asia. The only cure for either condition is surgery.
I’m a photographer who works with Fistula Foundation, the global leader in treating fistula and other childbirth injuries that leave women incontinent and shunned by their communities. Over the course of my work with the Foundation, I’ve been able to capture the photos and stories of patients from Kenya, Nigeria, and Tanzania. It’s a humbling experience, and I’ve learned many lessons from these women. They are lessons that everyone could learn from.
Lesson 1: Keep Going
Fistula patients are the most resilient women on Earth. Their suffering is extreme. They endure days of obstructed labor, often give birth to lifeless children—children whose arrival was supposed to elevate their status in their home and community—leak uncontrollably, and are shamed and shunned by their husbands and families because of their bad smell.
It’s too much for anyone to handle. But they keep going. They don’t give up. Instead, despite the adversity they face, they choose to fight for their health—often for years on end. (According to Fistula Foundation, women who are found and treated by its global network of partners wait an average of five years to access treatment for fistula.)
I have spent hours getting to know fistula patients, photographing them, and interviewing them to learn their stories. These women continue to choose hope, joy, and resilience. They are truly remarkable women.
Most of us will never face half of the difficulties they face, but we can emulate their strength and grace in the presence of hardship.
Lesson 2: Choose Joy
I often spend time sitting on a patient’s bed, just chatting. Or I hang out with patients outside a hospital while they soak up the sun or braid each other’s hair. They share stories to encourage each other, they worship together in song, and they laugh.
During a recent shoot in Tanzania, I met Reveliana, a woman who has lived with fistula for 27 years. She shared something heart-warming. The day that she entered the fistula ward and saw other women with fistula was the day—after nearly three decades—when she knew she was not alone. She told me, “Even before I got surgery, I knew I would be cured, because I realized for the first time in my life that there are others like me.”
When a woman has fistula, her struggles aren’t limited to urinary incontinence. More often than not, she must contend with an unforgiving society, accusations of witchcraft, and rejection from community members; in many cases, she faces divorce and single motherhood. Yet I’ve seen firsthand how women persevere, and how they choose to live joyfully.
Through their interactions with each other, these women teach me lessons about unity, solidarity, perseverance, and gratitude. Their time at the hospital marks the turn of a page. Their life is changing before their eyes. There’s no use looking back when hope for a healthy future is right in front of them.
Lesson 3: Celebrate Life
I have a quote from Ralph Waldo Emerson attached to my email signature, and it describes how I want to live my life. The quote reads, “The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”
The surgeons and other healthcare providers who heal women with fistula embody this sentiment of usefulness and honor. They also know how to celebrate life.
Both Dr. Sunday Lengmang and Dr. Agyema Jemima of Evangel Vesico-Vaginal Fistula Center in Jos, Nigeria, left a lasting impression on me. They enter the fistula ward with big grins. They listen attentively to the patients and, when appropriate, crack jokes that lighten the atmosphere. It’s clear that treating fistula patients is more than just a job for them. They seek to enable transformation for each woman in the ward. They are there because they are driven by the conviction to eradicate the scourge of fistula in Nigeria.
Their joyful attitude catches on in the ward. It sparks hope and provides new opportunities for the women they serve. They work tirelessly so that women who come into their care can conquer fistula, and celebrate the start of their new life.