Obstructed labour can happen to any woman, regardless of geographical location. However, it is only in the developing world that it leads to devastating injuries such as obstetric fistula.
This, according to Barbara Margolies, the executive director and founder of the International Organisation for Women in Development (IOWD), leaves a global treatment gap to eradicate tragic childbirth injuries.
Margolies, a retired American educator, is in Rwanda where she leads a team of American doctors three times a year as part of her organisation's efforts to share technical expertise with local healthcare providers in assisting women with obstetric fistula.
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"We have seen (first hand) the toll these horrific injuries take on women during my travels to Rwanda since 2015," she told The New Times in an exclusive interview.
"Their lives are devoid of dignity, and that is motivation enough for us to come here (Rwanda) and share our experience, and support as well as working with Rwandan healthcare providers to impart this knowledge."
According to the World Health Organization, obstetric fistula occurs when women go through prolonged labour without medical care, and a hole develops between the birth canal and either the bladder or the rectum.
Without maternal healthcare and treatment, it is one of the most ghastly and debilitating injuries that childbirth can cause, affecting an estimated two women and girls every year.
Margolies pointed out that her voluntary team has so far forged partnerships with different hospitals in Rwanda, including Kibagabaga Hospital, where the team conducts daily operations for patients with the disease.
"We do this at no cost in partnership with the hospital. We also offer equipment that can be used to assist these patients in their daily activities.
"It is a tragedy for any mother to live like this, with urine and excreta coming from their organs."
The unseen suffering
The women afflicted by obstetric fistula face systemic gender discrimination and social marginalisation, according to Viviane Umutesi, who works at Kibagabaga Hospital.
"This suffering must stop. We must revere the mother as much as we revere motherhood, and this is by investing in maternal healthcare. Women, not just here in Rwanda, should have access to qualified midwives and other health workers while they are trying to give life to another human being."
Umutesi added: "They (women) with fistulas are often ostracised by their communities, abandoned even by their close family. Adding to this trauma, in the majority of births that result in a fistula, the baby will likely die.
"In some cases, they will not even talk openly about the situation due to the stigma around it."
Umutesi shared similar sentiments with Dr Abhi Tangada, who pointed out that many women with obstetric fistula are waiting to undergo corrective surgery.
She said that meeting this need is crucial to alleviating suffering, restoring communities where these women live, and creating a fistula-free landscape for future generations.
"The solution for me is three-fold; timely access to high-quality emergency obstetric and newborn care, trained professionals with midwifery skills at childbirth, and universal access to modern contraception."
Tangada is part of IOWD's urogynecological mission and says she has been to Rwanda about three times for the mission.
"They offer Rwandan medical students valuable clinical training. Working with skilled urogynecologists, we gain expertise in procedures, patient education, and complication management," said Samy Hirwa, a medical student at the University of Rwanda, who has part of the training programme.
He added: "This hands-on experience prepares us to provide high-quality urological/gynaecological care.
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"They also facilitate professional mentorship. We learn updated techniques from experienced urogynecologists committed to building local capacity. This guidance allows us to address community needs effectively as future healthcare providers, sustainably improving urological healthcare in Rwanda."
Since 2015, IOWD fistula teams say they have examined thousands of patients and performed surgical procedures. The paediatric urology team has done more than 100 surgeries while the obstetrical gynaecological team has chalked up more than 500 vaginal births, 300 Caesarean section deliveries, and about 100 gynaecological surgeries.
There are no official figures in Rwanda indicating the number of women affected by fistula, but the country has met the United Nations Millennium Development Goal (MDG 5) of reducing the number of women who die during pregnancy, or shortly after giving birth.
With a maternal mortality rate of 1,007 per 100,000 live births in 2000, childbirth was a perilous journey for many women in Rwanda. The number dropped to 259 in 2020, putting the country on the charts of top performers in Rwanda.
