Q: The Lutheran: What is an obstetrical fistula?
A: Mark Jacobson: It's a hole between the vaginal wall and the bladder or the rectum caused by prolonged, obstructed labor putting pressure on tissue so it lacks blood supply and dies. This causes incontinence of urine, stool or sometimes both. Sufferers also have a much higher risk of urinary tract infections.
Such holes can't heal naturally. They require delicate operations on very disrupted, scarred tissue--operations that can last one to two hours or, in more complicated cases, as long as four hours. Selian has done these repairs for four years now, and is one of only three hospitals in Tanzania with the skills to regularly do this operation.
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