The Pine Cone's sixth story of the week

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'The chief thought it was mind-boggling that people from California would do this'

- Peninsula residents join international effort to rescue fistula women


Published: October 22, 2010

IN 2007, during a trip to the impoverished, landlocked African nation of Niger, Pebble Beach resident Rita Steele had a chance encounter that changed her life and set her on a personal journey to help relieve the misery of a medical condition afflicting millions of women and teenage girls in Sub-Saharan Africa.

“We were in Niger to set up ‘microcredit’ programs to facilitate economic growth in rural areas,” Steele recalled. “And then I saw all these women living in shacks by the side of the road.”

When she asked who they were, she was told they were shunned and forced to live on their own because they have obstetric fistulas, which are practically unknown in the West but leave millions of young mothers in undeveloped parts of the world in lifelong misery.

“They marry when the girls’ bodies aren’t finished growing,” Steele said. And, with no access to a doctor or hospital, many of these girls have great difficulty delivering babies through their immature pelvises — a heartbreaking situation that goes on for days and often results in death for mother and baby. But if she is lucky enough to live through it, the mother’s childbirth agony can be compounded when her organs rupture, allowing urine or feces to leak into her vagina.

“It’s something that’s completely preventable and usually also curable with a $450 surgery,” Steele said. But in a culture that has little medical knowledge, not to mention doctors or hospitals, the women are simply left untreated. Soon, they start to stink and develop sores and are cast out by their families.

“It’s one of the most horrible things I’ve ever seen,” Steele said. “And there are 130,000 new cases a year.”

When she returned from the 2007 trip, Steele told her husband, Shelby, a research fellow at Stanford University’s Hoover Institution, that she wanted to help the women she had seen, and the millions more like them.

“I had retired from being a psychologist after 28 years, and the more I researched the problem of obstetric fistulas, the more I wanted to do,” she told The Pine Cone. “It seemed like the perfect cause for me, because it had a solution.”

She wasn’t the first person to embrace the cause. An aid group, the Worldwide Fistula Fund, founded in 1995 by St. Louis doctor and anthropologist Lewis Wall, has made headway against the problem in places such as Ethiopia and Nigeria, backed with contributions of about $500,000 per year. A doctor from Grand Rapids, Mich., Steve Arrowsmith, makes frequent trips to Africa to perform fistula surgeries.

An Australian couple, Reg and Catherine Hamlin, pioneered the cause when they founded a fistula hospital in Ethiopia in 1974.

“Catherine Hamlin is St. Catherine at this point, for the fistula campaign,” Steele said. “She’s been absolutely selfless.”

Musician Dave Matthews has been a big supporter. And a moving column by Nicholas Kristoff, published in the New York Times in June 2005, helped raise international awareness about obstetric fistulas. But there is still so much to do.

‘20 minutes to fix’

“The best estimates are that 3.5 million women have the condition, with more than 100,000 new cases per year, and the worldwide surgical capacity to treat fistula cases is 10,000 per year,” Dr. Wall told The Pine Cone. “There’s an enormous backlog.”

To illustrate the tragic simplicity of the fistula epidemic, he told of a 67-year-old woman he operated on in the nation of Liberia several years ago.

“She had a fistula from giving birth to her third child when she was 32,” Wall said. “When we got her into surgery, we found that she had a hole the size of a matchstick between her bladder and her vagina. It took 20 minutes to fix.” But the woman had suffered for 35 years.

His organization, the WFF, has joined with religious groups and health advocates to lobby Congress to set up a fistula repair fund — which they see as a moral imperative and as good medical diplomacy.

“We’ve been working with Dr. Wall, the NAACP, Southern Baptists and other groups to help craft language for the U.S. government to establish a medical school to partner with African doctors to set up fistula repair centers,” said Daphne Price of the Religious Action Center of Reform Judaism. She estimates it will take $10 billion to eradicate fistulas in 10 years — a lot of money, she acknowledges, but “this is a project that is targeted, narrow and achievable, and it has such an impact on women’s lives, and their families and their communities.”

Acting locally

While those ambitious plans may or may not come to fruition, there is still plenty that people in communities such as the Monterey Peninsula can do, Steele said. Three years ago, she created the Monterey Peninsula Friends of the WFF, and started raising money from her friends and acquaintances. In 2008, the group launched a pilot project in the isolated Nigerian community of Bankilare, population 100,000.

“Without a guide, you could never find it, but we trained village volunteers, and we set up transportation, by donkey if nothing else was available, to get these girls to a hospital,” Steele said. “It was a big success, and we’ve had no new maternal deaths and no new fistula cases that we’re aware of in Bankilare.”

But it was the tip of the iceberg, and her next step was to expand her group’s ambitions. Since November 2009, it has raised $82,250. Of that, more than $31,000 will be matched by Matthews.

“We want to prevent and treat obstetric fistulas all over Africa,” Steele said.

And not only does Western medicine redeem the lives of fistula women who would otherwise barely scrape together a miserable existence, only to die neglected, young and alone, the effort can also transform an entire culture.

“Most of the women have no idea there’s a fix for a fistula, which they see as God’s punishment,” Steele said. “All of a sudden, God’s curse is reversed by surgery. This is their introduction to Western medicine.”

Once cured, the women are eagerly accepted back into their families. And when word spreads about the miraculous cures, the happiness spreads, too.

“One day, in November 2008, we were told the chief wanted to see us,” Steele recalled. “He wanted to thank us. It was mind-boggling to him that some people from California would want to do this.”

To learn more about the international effort to eradicate obstetric fistulas, go to To get involved in the local group, which includes Rita Steele, Judy Beville, Lois Mayol, Jane McCoy, Mia Hamwey, Peggy Alspaugh, Mary Ann Garner, Sandra Dewey and Annette Welton, email Steele at