Fashion Internationale de la Mode Africaine
It was a pleasure to return to Niamey, Niger, this trip by far the most fashionable, sponsored by internationally renowned designer Alphadi and his innovative wife Kadidja, along with United States Ambassador Bisa Williams and the First Lady of Niger, colleague Dr Malika Issoufou Mahamadou. Promoting health and wellness along with creativity, fashion, beauty and the power of the African Diaspora, Fashion Internationale de la Mode Africaine 2011 made a clear statement – Health is Beautiful.
The Fashion Internationale de la Mode Africaine whirlwind of creative genius is the brainchild of haute couture designer Alphadi, whose dedication to the promotion of African fashion transcends the political landmines and traditional dogma of Nigerien culture, sparking debate in his country and awe in the world of international fashion.
Committed to promoting health and wellness along with creativity and couture, FIMA 2011 invited 3 American physicians, Dr. Emily Nichols and her husband Dr. Jonel Daphnis – specialists in internal medicine and adult/pediatric emergency medicine, and myself – specialist in urogynecology and obstetric fistula repair. It was a pleasure to reconnect with colleague and expert fistula surgeon Dr. Abdoulaye Idrissa, connecting his work at the National Hospital in Niger with the newly minted Cure Hopital au Niger run by Dr. Gary Roark, and a tragedy to see the women suffering fistula waiting for surgical repair at the National Hospital no longer permitted to live on the hospital grounds, relocated instead to a garbage dump across the street from the hospital, camped out in a shared sisterhood of sorrow, resilience, patience and hope.
While these women gave permission to show their faces, the picture chosen is one that preserves anonymity, both for their privacy rights and to highlight the non-anonymous rag tents fenced with garbage in the background. In this place of filth and feral cats they have camaraderie, belonging and hope that was lost to them in their lives of exile as totally incontinent obstetric fistula sufferers living on the margins of their communities. As of my last mission to Niamey in 2005, these women were permitted to live on hospital grounds while waiting for surgery and after discharge from hospital while securing arrangements to return home. New hospital rules do not permit overnight stays unless you are in a hospital bed. With no half-way house option, these women now live across the street from the hospital, in sight of the side-entrance, in an open air garbage dump.
The prevalence of obstetric fistula is difficult to know with certainty, typically extrapolated from the maternal mortality data to which it is closely related. Niger, for many years running, lays claim to the worst maternal mortality rate on the planet, at 1:7 risk. Compare this to maternal mortality in developed nations at 1:4000, and the difference between the two is simply obscene.
Obstructed Labor, Death and Disability
One great contributor to maternal mortality is obstructed labor. Without ready access to trained clinicians during labor, or EmOC (emergency obstetric care), women in obstructed labors lasting for 3, 4, 5 days and some up to a week, have 2 possible outcomes- maternal death, or maternal survival with severe damage to bodily function, including vaginal fistula causing constant incontinence of urine or stool, severe foot drop from pelvic nerve compression, uterine infection resulting in infertility, and vaginal fibrosis precluding sexual function, usually in some combination of miseries and almost always associated with a stillborn infant. Can you imagine the trauma, depression and anxiety these women suffer?
In developed nations we call this obstructed labor “failure to progress”, preventing the stillborns, fistulas, nerve damage and vaginal destruction with cesarean section performed according to accepted standards of care. For women living in remote rural areas of poor nations, access to such care does not exist. Women labor alone, or with a local lay-midwife with no formal training.
Access to emergency obstetric (EmOC) care allows any woman of any age and condition to be delivered safely, to be able to count on her own survival and that of her baby. Reduce maternal mortality through EmOC and watch obstetric fistula disappear, watch neonatal survival improve, just as occurred in the States and Europe with the advent of ready access to Cesarean delivery made possible by the then novel application of Ether anesthesia in the late 1800’s. Some 200 years later, the pregnant women of Niger are living as did women worldwide in 1850, in fear of their lives and the lives of their unborn babies with every single pregnancy every single time.
Taking care of the women takes care of the children, takes care of the men, takes care of the community and creates a new future full of hope and possibility for the country. Right now, as this post occurs, the pregnant women of Niger would be safer in DR Congo, in Somalia, Sudan, Bangladesh, Pakistan or Afghanistan. And all of these women in all of these developing and middle income countries can only dream of the safety and optimal mother-child outcomes enjoyed by their sisters lucky enough to live in wealthy nations where antenatal care and routine access to EmOC has nearly obliterated the constant threat of pregnancy-related death and disability.
With this initial collaboration of Nigerien and American doctors, the First Lady of Niger, the US Embassy and the creative genius of the House of Alphadi FIMA 2011, we look forward to the day when the women of Niger can rest assured that they, their daughters and grand daughters will bring forth future generations in comfort, in safety, in health as a birthright for mother and child.
Content is copyright protected on date of online publication. Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org