"I was chief trauma surgeon for many years in a clinic in Germany. I’ve been a war surgeon in Cambodia and I've done reconstructive surgery on leprosy patients, and believe me, fistula is the most difficult surgery I've ever encountered in my life. It's like operating on the sole of a foot through the top of a high boot." Dr. Kees Waaldijk, MD PhD, President, The International Society of Fistula Surgeons (ISOFS)

Obstetric fistula is a vast problem affecting hundreds of thousands of the world's poorest women. The Fistula Foundation plays a vital role in helping these women and eradicating fistula worldwide. We provide funding to the very best organizations helping in the places where the need for obstetric fistula surgery treatment is greatest. We focus on three things: patients, doctors and facilities. And we have a strong track record of identifying, assessing and partnering with the most respected, productive and effective hospitals and dedicated local doctors. One of our key strengths is our ability to move quickly and help provide funding for what is needed to advance care on the ground.

More Local, Skilled Fistula Surgeons Are Needed

A major obstacle to providing fistula treatment throughout the world is the lack of suitably trained surgeons. Not only does a fistula repair surgery require more training than some other corrective surgeries, but the global pool of trained fistula surgeons is much more limited. This is, in part, because obstetric fistula has long ceased to be a problem in the developed world. With vast improvements in maternal health care and, in particular, widespread access to caesarean section deliveries, obstructed labor in the developed world is nowadays routinely taken care of before a fistula can develop. In the absence of women with fistulas, surgeons in the developed world rarely have any experience in treating the condition and so the number of qualified developed world fistula surgeons is very small. With the ratio of physicians per capita in the developing world often a fiftieth or a hundredth of the ratios in richer nations there is obviously also a lack of local fistula surgeons in Africa and Asia. Training local health workers is a key solution. Not only does training local surgeons help overcome an immediate bottleneck to providing treatment, but it also can be a culturally appropriate and long-term, sustainable solution.

More Ways to Increase Treatment

Sometimes, though, the key to increasing treatment is not training, but the provision of equipped facilities. Sometimes it is informing fistula sufferers in the community of the existence and location of free fistula services and paying for their transport. Sometimes it is simply funding surgeon salaries and supplies. But whatever the specific local bottlenecks to treatment are, the stakes and urgency in overcoming them are great.