In this episode, Alex talks with world renowned fistula expert, Dr Andrew Browning, Director of The Barbara May Foundation, about the plight of women affected by birth trauma in Africa and South East Asia. Andrew is an Australian trained obstetrician who has spent his entire professional career volunteering in Africa as a medical missionary specialising in obstetric fistula surgery. During his time in Africa, Andrew worked with the legendary Dr Catherine Hamlin in Ethiopia for 10 years before setting up the Barbara May Foundation in 2009.

Dr Andrew Browning: in Africa and with his family back in Australia

Over his career, Andrew has conducted over 11,000 fistula which has completely changed the lives of his patients. Since the Barbara May Foundation was set up, it has overseen the safe delivery of over 50,000 women, treated over 10,000 fistula patients and trained hundreds of midwives. Andrew works closely with both the World Health Organisation and the United Nationals and is regarded as the world expert in fistula surgery.

Andrew’s life changing fistula surgery work has completely changed the lives of his patients, and given his patients the opportunity to live a normal life.

What is a Fistula?

A fistula purely means a hole that is created by childbirth, usually when a baby becomes stuck during labour. About 5% of all pregnancies will result in a baby becoming stuck during labour otherwise referred to as an obstructive labour.

In countries like Australia, women who have an obstructive labour are routinely offered a casearan section which results in a safe delivery occurs. However, in countries where there is no maternal care and casearan sections aren’t available, an obstructive labour will not self-resolve so some women can remain in labour for up to 10 days.

This is Zahara, who developed a fistula after delivering a baby. She was forced to live in isolation in a mud hut on her family’s property. Surgery performed by Andrew gave Sahara her life back and she ha since returned to school and wants to study to become a midwife!

Invariably, the baby won’t survive a labour of this length and, sadly, the woman will deliver a stillborn child. It will then take around 2 days for the mother to regain consciousness. When the woman wakes, she will be incontinent from both her bladder and new bowel. Unfortunately, the prolonged pressure of the baby pressing on the mother’s pelvis usually results in a crushing of the tissues between the birth canal and the bladder or even the rectum. When these dead tissues come away, the woman will be left with a fistula.

Understandably, women affected by fistula will often develop depression with over 40% of the women Andrew has treated having attempted suicide before he operates on them. Their incontinence means they are usually rejected by their families and their husbands will often divorce them. They are therefore forced to live in isolation for the rest of their lives. Andrew estimates that there are over 2 million women awaiting treatment in Africa with this condition that need treatment.

How Is Fistula Preventable?

Fistula injuries used to be common in the Western world in the 1800’s but when access to safe maternal care was made available to pregnant women, it was no longer an issue.

One of Andrew’s key objectives in establishing The Barbara May Foundation was to build hospitals where women could access free maternal health care and casearan sections. 1 in 14 African women will die during their lifetime trying to deliver a baby and 96% of African women don’t access hospitals during their pregnancies as they either don’t live close enough or believe hospital care will cost money so stay home and face the prospect of either developing a fistula or dying in childbirth.

The Barbara May Foundation Hospital in Tanzania

How Will The Corona Pandemic Affect the Plight of Women Affected by Fistula?

With so many people losing jobs and facing uncertainty with their careers, donations to charities including The Barbara May Foundation have declined. And like many charities, the lack of funds means that the Foundation may not be able to continue delivering their maternal health services.

The greater concern is however the mental health of women awaiting surgery. The travel restrictions imposed as a result of COVID19 pandemic means Andrew is unable to return to Africa to operate on women who are desperately awaiting fistula surgery. Only weeks ago, Andrew had to cancel surgeries for women in South Sudan, many of whom were suicidal.

How Can You Help?

The Barbara May Foundation runs a very cost effective operation:

It costs just $1.50 to equip a TBA (or traditional birth attendant) with a delivery kit.

It costs just $200 to fund the safe delivery of a woman which includes all visits, patholog, testing, delivery and post natal testing and immunisation

It costs $400 to repair a fistula

Where To Find The Barbara May Foundation

If you would like more information about The Barbara May Foundation, you can visit their website or alternatively, check out their Facebook page.

And while we are all staying at home and not going out,why not think about directing your coffee money or thai takeaway budget towards supporting this vital work.

How To Listen

You can listen to Alex’s chat with Andrew via your favourite podcast app, or alternatively click on the link below.

Happy listening

Alex x