Campaign to End Fistula with special focus on Ethiopia – A walk to beautiful 1 Is there a role for ultrasound?

Introduction A scourge from time long past that we thought removed from the surface of the earth has affected humanity again, or more correctly, part of humanity. A misery so all-embracing that it is incomprehensible to people of the Western world is everyday reality for hundreds of thousands of young women in Africa and other parts of the developing world. A disease by the somewhat strange name of obstetric fistula (OF), also known as rectovaginal or vesicovaginal fistula,1 afflicts more than two million women in low-resource countries and the most remote parts of the world, while at the same time is totally absent in high-income countries.3 A fistula by definition is a false exit from cavities or tubular structures inside the body to the outside world or in-between internal structures that arises due to disease or physical damage. An obstetrical fistula is either a connection between the rectum and the vagina that allows stool to pass unhindered or a connection betwen the urinary bladder and the vagina that allows urine to pass. The term ‘obstetric’ derives from the fact that these fistulae are caused by tissue damage due to prolonged labour. To the vast majority in the West it is not even known. However, anyone who has ever visited a medical history museum will probably recall the horror by which one was struck when observing the instruments used for cutting up the (almost always dead) fetus in case of obstructed labour, and with little doubt, at the same occasion thought these doctors must have been some kind of monsters. Little did we know that the condition which called for the use of these cruel instruments still exists and affects thousands of birth-giving women, mainly in Sub-Saharan Africa and South Asia every day. Only the instruments, luckily, are no longer in use, but neither is the modern alternative available in these parts of the world. This very, very unlucky scenario causes the unbelievable suffering of millions of women through the complications of OF. Of course today in the West, treatment would involve the timely help of a midwife and, if necessary, a caesarian section performed by an obstetrical surgeon. With this prologue, I wish to emphasise that being a young girl or an adolescent woman living in rural areas of contemporary Africa may very likely mean exposure to several forms of negative discrimination that inevitably decreases odds for leading a prosperous and happy life. Obstetric fistula especially afflicts impoverished girls and women living in remote regions without adequate medical services. Affecting the most powerless members of society, it touches issues related to reproductive health and rights, gender equality, poverty and adolescence. Young Mother by Christian Pállson Nolsøe Campaign to End Fistula with special focus on Ethiopia – A walk to beautiful Is there a role for ultrasound?