By Wezi Tjaronda WINDHOEK Ten young women from Otjozondjupa, Kavango and the Northern Regions had their dignity restored after undergoing plastic surgery to close obstetric fistulae they have had for months, and some for years, thanks to a volunteer from the United States. Obstetric fistula is an abnormal opening between a woman’s vagina and bladder and/or rectum, through which her urine and/or faeces continually leak. It is caused by complications which arise during childbirth when blood supply to the tissues of the vagina and the bladder and/or rectum is cut off during prolonged obstructed labour. The tissues die and a hole forms through which urine and/or faeces pass uncontrollably. Chief Medical Officer at Rundu State Hospital, Dr Yuri Yangazov told New Era yesterday that some of the women have lived with the condition for months while others have had it for years. He said the women who live in poverty and cannot afford medical aid will now live in dignity. Dr Yangazov said obstetric fistula is caused by obstructed labour, especially when the baby is big and the pelvis is small. He said the women were recovering well and he was happy that they would live their normal lives again. Repairing fistulae is an expensive exercise as it requires specialized equipment, but in this case, Yangazov said, the specialist came at his cost and used his own equipment. Permanent Secretary of Ministry of Health and Social Services, Dr Kalumbi Shangula, said yesterday the condition is quite common among Namibian women, especially where there is no proper obstetric care. Shangula could not, however, give statistics on how many women are affected in Namibia. Now and then, added Shangula, Namibian surgeons perform surgery on fistula survivors. Sometimes specialists from Germany, Holland and the United States, who belong to an organization of international volunteers, are invited to assist, according to Yangazov. “It is a good thing that was done, especially considering that this is for poor people,” he added. In November, Yangazov said a group of surgeons from Germany will be performing plastic surgery in Oshakati on a number of patients who were identified in 2005. Women who develop fistulae are often embarrassed as they are not only unable to control their bodily functions resulting in the fact that they are continually soiled and wet and they smell, but they can also become infertile and paralysed in the muscles of the lower legs, and may require the use of crutches. Some are also abandoned by their husbands, rejected by their communities and forced to live an isolated existence. Eradicated in Western countries at the end of the 19th century when Caesarean section became widely available, obstetric fistula continues to plague women throughout the developing world. It is estimated that there are 100ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 000 new fistula cases each year, but the international capacity to treat fistula remains at only 6ÃÆ’Æ‘ÀÃ…ÃÆ”šÃ‚ 500 per year. The World Health Organization has called fistula “the single most dramatic aftermath of neglected childbirth” because fistula victims also suffer profound psychological trauma resulting from their utter loss of status and dignity. More rarely, female circumcision, poorly performed abortions or pelvic fractures can cause the injury. Primary risk factors are early and/or closely-spaced pregnancies and lack of access to emergency obstetric care. A study conducted in Nigeria, for instance, found that 55 percent of the victims were under 19 years of age, and 94 percent gave birth at home or in poorly equipped local clinics. When available at all, Caesarean sections and other medical interventions are usually not performed until after tissue damage has already been done. According to the WHO, over two million women currently live with fistula injuries throughout the world but mainly in parts of sub-Saharan Africa and Asia. Mostly susceptible to fistula are adolescents because their pelvises are not fully developed. These can be avoided by delaying the age of first pregnancy, cessation of traditional harmful practices and timely access to maternal and obstetric care.