For days Adina’s son had lain dead inside her. In labour, his head had pushed forward every five minutes, but her small fourteen-year-old pelvis had obstructed his passage. Her sister, Tinadem, had been with her from the beginning but there was nothing she or anyone could do. Adina was giving birth in a remote village in the deserts of Ethiopia’s Tigray province many days walk from even a basic clinic – a caesarean was impossible. With no option she had responded to the contractions and for ten days kept pushing until she finally excreted a mass of dead tissue and her still born son. The damage to her body by the prolonged labour had been immense, dead tissue hung from her vagina and holes had been torn in her rectum and bladder – each opening the size of a fifty cent piece, this double Fistula (torn holes making a connection between two body cavities) constantly let urine and faeces seep into her damaged genitals.
For six weeks Adina lay afraid and ashamed in a hastily constructed shelter – her husband had cast her out because she smelled and was wet and unclean. Carrying her dead son had lead to severe sepsis and fever, while scar tissue had almost completely closed her vagina. On her back, the skin had given way to bedsores from lying in a urine soaked and faeces soiled bed. With her sister close to death, Tinadem had managed to beg bus fare for them both to travel to Addis Ababa. She had learned that in the capital there was a hospital and a doctor that may be able to save her sisters life. Somehow Tinadem had transported Adina for two days to the main road and then nursed her for another three days on the bus until they arrived, barefoot and in rags, in Addis Ababa.
One in twenty women across the world experience obstructed labour. In western countries it can be easily solved by caesarean section, but in the third world many die with children undelivered. Ethiopia has one of the highest maternal mortality rates in the world, while the number that dies of Sepsis from the dead baby inside them is unknown. If they survive these women are incontinent due to the Fistula in their bladder or rectum and unemployable except in the fields. They are put out of their homes, as the smell is unbearable, though sometimes not cruelly as mother and father do provide for them. Many others like Adina are completely ostracised, spurned as social outcasts they are treated worse than lepers. With no self-respect, they endure and simply exist without friends and family and in some cases spend years in tiny one room hovels dripping urine. To those that know of their plight these women are the Fistula pilgrims.