April 2, 2007

African Women Face Postpartum Risks

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Each year, 50,000 to 100,000 women develop a condition called fistula after prolonged childbirth, a post-natal result that hardly occurs in the United States any longer but continues to be a severe problem in many developing nations. Last Saturday, Dr. Karolynn Echols ’89 came to speak about her experience treating fistula in West Africa and how it inspired her to create Medicine in Action (MIA), a non-profit healthcare organization focused on underserved women’s health issues. Dr. Echols was the keynote speaker for Skee-Week 2007, sponsored by the Mu Upsilon chapter of Alpha Kappa Alpha.

Obstetric fistula results from complications during labor when pressure from the unborn child’s head cuts off blood flow to tissues in the mother’s pelvic region. The tissue dies and eventually erodes away, leaving a hole between the rectum and vagina (vesicovaginal fistula) or between the rectum and vagina (rectovaginal fistula). In about 90 percent of cases, the babies are stillborn and their mothers suffer from chronic incontinence.

In Niger, many of these women seek refuge in the courtyard of the National Hospital, where Echols worked with patients affected by fistula.

“There are some women who have been in the courtyard for 20 years,” said Echols.

Fistula patients are frequently abandoned by their husbands and ostracized by their communities.

“These poor women are walking around leaking urine and/or stool and it becomes a serious problem,” Echols said.

This problem is preventable by cesarean section, but it is difficult for many women living in remote villages to receive that kind of procedure. The corrective surgery costs about $300, which some are unable to afford.

Harmful traditional practices such as Gishiri-cutting create other problems.

“In the Hausa tribe, when they can’t get the head out of the pelvis, they actually take a knife and start making cuts,” said Echols. “These cuts can puncture the bladder, urethra, rectum or other surrounding tissues. If the women do not die from this, it’s still a huge problem to fix.”

Other practices include the insertion of salt into the vagina, believed to cleanse substances that are preventing the fistula from healing, which in turn creates additional problems.

Echols got her start in her third year of medical school by taking an infectious disease elective in Cameroon.

“I was able to see some of the problems that they had,” said Echols. “I wasn’t really able to help then because I was still learning, but I was able to see how I could try to help in the future. That’s how I started my journey.”

Echols’ interest in global health issues eventually led her to become involved with the International Organization for Women’s Development. Started in August 2003 as a nonprofit organization to bring volunteer surgeons to operate on women suffering from fistula in Niger, there have been 17 missions in total and close to 500 surgeries performed, with a surgical success rate of about 80 percent.

The December 2003 mission was a landmark success for IOWD. At first, male surgeons from Niger were skeptical about working with a group of all-female physicians.

“At first they didn’t show up to the O.R.,” Echols said. “But after ten days they were ready to have us come back for another visit. Now we have a lot of female physicians going over and basically changed the attitudes of some of the cultural beliefs over there. And that’s the key. You can’t tell them that the things they’re thinking or feeling are wrong, you have to show and let them make up their own minds.”

Echols co-founded MIA in the spring of 2006 with Dr. Deborah Chong, whom she met during their residency together at Jackson Memorial Hospital in Miami. The organization is dedicated to providing quality health care to underprivileged individuals in Jamaica, with a focus on women’s healthcare issues.

“There have been three missions so far, and we’ve performed about successful 45 gynecological surgeries. We’ve already seen over 1,000 patients,” said Echols.

However, more physicians, equipment and funding are needed to support the facilities in Jamaica. Echols would love to see more help from the Cornell community as well.

“Service is more than just donating money,” said Andrea Nixon, community service chair of Alpha Kappa Alpha. “It’s about doing community service and building a bond with the community.”

Alpha Kappa Alpha plans to continue its fundraising efforts.

“In the future, we hope to continue our support by raising money and awareness about this issue,” said Laschelle Stewart, secretary of Alpha Kappa Alpha. “We’d love to have [Dr. Echols] back.”

Said Echols of volunteer work, “It makes you more globally sensitive. It makes you more sensitive to your neighbors, friends and family; it makes everybody a better person. It helps you persevere.”