A fistula clinic repairs lives in Uganda.

AJN t November 2007 t Vol. 107, No. 11 http://www.nursingcenter.com Ostracized by husbands, families, and communities, these women and girls endure isolation and extreme hardship. “They are so ashamed,” Sister Maura said. “They think it’s their fault, that they did something gnes stood in the doorway, clutching her walking stick. Urine dripped from beneath the brightly colored cloth wrapped around her waist, puddling at her feet on the cement. She made her way down the steps by twisting her body, a compensation for bilateral footdrop. When she reached the grass she tossed aside her walking stick and took four proud steps unassisted. Agnes is one of an estimated 2 million women and girls in developing countries who suffer from obstetric fistula, a devastating complication of obstructed labor. I met the 16-year-old in July at the Kitovu Health Care Complex in Masaka, Uganda, a rural area of subsistence farming at the edge of Lake Victoria just south of the equator. It’s the site of a fistula clinic established by Sister Maura Lynch, a nun and surgeon who came to Uganda 20 years ago with the Medical Missions of Mary. Obstetric fistula is unheard of in the developed world, where women have access to skilled obstetric care. In countries like Uganda, where according to the World Health Organization only 39% of births are attended by a skilled birth attendant, obstructed labor may go on for days. A prolonged labor compresses the tissues of the vagina, and also the bladder or rectum or both, between the baby’s skull and the mother’s pelvis, causing hypoxia and necrosis. The result is a hole, leaving the woman unable to control the passage of urine or feces. (Temporary paralysis and footdrop can also result from sustained pressure against the sciatic nerve during obstructed labor.) A Fistula Clinic Repairs Lives in Uganda