Niger and fistulas and hope

I don't ordinarily read the Wall Street Journal. It's one of the periodicals that isn't available for free online, and I've never felt such a deep need to read it that it seemed worth the price to me.

But I'm reconsidering, mainly because of an article by Roger Thurow that appeared in yesterday's WSJ. I came across it only through a fluke--on rare occasions, in an attempt to entice me into buying it, a free copy of the WSJ simply appears on my doorstep, and that's what happened yesterday.

Perhaps they know exactly what they're doing, because this particular article was enough to make me think I should be reading the paper regularly. The title, "Married at 11, a teen in Niger returns to school," gives little hint of the depth within.

I assume that most readers here are not subscribers, so I am going to summarize the article for you. It deals with another sad fact of sexual and reproductive life for Moslem women in the area of the southern Sahara--the first, of course, being what is sometimes euphemistically referred to as female circumcision, but is more correctly known as female genital mutilation. The second is the prevalence of early marriage, pregnancy, and fistulas, common in an area stretching from Eritrea to Mali.

Yes, these topics are sickening and sad, but so are the realities of these women's lives. But the story is not without hope, as you will see.

What's a fistula, and why are they so common in these countries? This article highlights Niger, where girls are typically married even before the arrival of puberty, although they don't ordinarily live with their husbands until after reaching puberty (the girls, that is--not the husbands, who are typically older). At that time sexual relations commence, often leading to very early pregnancies. In addition, the girls drop out of school on marriage, which means they leave primary school, never to return.

Many teens' bodies haven't yet matured enough to deliver vaginally, but in all of Niger, only 10 medical centers are capable of performing Caesarean sections. A fistula is caused by unrelieved, protracted labor. The pressure of the baby pushing for days causes a hole to tear in the wall between the bladder and vagina. This results in uncontrollable leaking of urine.

These restrained words convey an almost unimaginable but unforunately commonplace horror--girls barely emerged from childhood themselves, enduring painful and lengthy labors, and ending up with a defect that causes them to become outcasts.

More than one million young women with the condition are scattered throughout the so-called fistula belt...Because of their severe incontinence and smell, many have been ostracized by their families and villages and live by themselves or with fellow fistula sufferers.

Horrible, tragic.

But, strangely enough, this ends up being a story of incredible courage and heroism on the part many people--and, especially, of familial love.

The author follows the story of a young girl in Niger named Anafghat Ayoub. Hers is the usual tale of extremely early marriage, dropping out of school in the third grade, and very early pregnancy. Her husband had left for work in Libya, her mother was dead, and her father was a poor goat herder with several daughters younger than she. Here is what happened when Anafghat was ready to deliver:

After three days in labor, Mr. Mahomed [Anafghat's father] knew he needed help. He scraped together money from friends and relatives to hire a car to take them to the nearest town with medicine and maternity nurses. For about 60 miles they bounced over rutted dirt roads [imagine this journey, after three days of exhausting and unproductive labor!]. Once there, the nurses said they weren't equipped to handle her delivery. Mr. Mahomed hired another car, for $40--a fortune for a goat herder. It took them to Niamey, the nation's capital, more than 100 miles away down a paved road pocked with potholes.

So the same father who had married her off at such a tender age (for the brideprice of a precious camel--a camel that ended up either lost or stolen, by the way) is the father who now was willing to go through fire to save her.

At the hospital, doctors performed a forceps delivery of her stillborn child. Anafghat lived, but she now had a fistula "the size of a baseball," and an infection, which the doctors staved off. But they could do nothing about the fistula.

Anafghat stayed at the hospital for four months, awaiting the arrival of a team of American doctors, who have been to Niger six times already to help women like Anafghat. When they finally arrived there, she endured a three-hour repair surgery, performed by a volunteer surgeon from Johns Hopkins. She has since recovered nicely.

During her recuperation, Anafghat noticed a woman from Niger who was a medical student making the rounds with the American doctors. Anafghat, the goatherder's daughter from the rural village, was extremely taken with her, saying: I want to live in Niamey, be a doctor and be an important woman. And she extracted a promise from her chastened father that she would be allowed to return to school, unheard of for a woman (or, rather, girl) in her situation.

And so she has returned to school, and she's doing very, very well. According to the school's director: The others call her "the college student" because she is so smart and older...

Anafghat is back living in the small round hut with her family. She and her father say she has no plans to return to her husband and she will stay with her family until she advances to the higher school. And she wants to make sure her younger sisters follow her. Mr. Mahomed sat on one of the beds stirring a bowl of rice, surrounded by all of his daughters.

He says he will keep his promises to Anafghat. "Even if one of my daughters asks to get married while they are still in school," he says, "I will refuse."

I have to say that this story--which is much longer and more detailed than I've excerpted here--moved me to tears; first of rage, and then of inspiration. People like this will be the ones to build the foundation of a better future for the women of the area, if allowed. There is great hope that this movement will grow. Hear what Sabou Ibrahim, director of the National Hospital, has to say:

A fistula woman who is repaired and goes back to her village brings many changes...All the women get together and they talk about the risk of having a child so young."

Before, I suppose these "fistula women" stayed away, shunned by all. Now they can go back and spread the word, and have a good chance of preventing this from happening to others.

The more people see it is in their own interest to decline to follow a traditional cultural dictate which has led in the past to so many blasted lives, the more people will feel comfortable doing so. Then the practice (and the fistulas) will disappear from these societies--and not a moment too soon.

ADDENDUM: I wanted to include a link to the agency sponsoring the American doctors, the International Organization for Women and Development, Inc., founded by Barbara and Ira Margolies of Rockville Center, NY, and also to give them a donation. But I couldn't find a webite for the group. This was the closest I could come, a feature on one of the doctors. If anyone can get any better information on this organization than I was able to find, please post it in the comments section. Thanks.

ADDENDUM TO ADDENDUM: Reader Marianne has found the website, which is here. And this is the donations page. Thanks so much, Marianne!