The Economic Community of West African States (ECOWAS) has committed US$245,000 to support surgeries and reintegration for obstetric fistula—a childbirth injury that creates a hole between a woman's vagina and or rectum.

Benedict Roberts, head of the ECOWAS National Office in Liberia, said women experiencing urine and stool leakage due to obstetric fistula will be identified, treated, and receive livelihood training such as tailoring, pastry making, cosmetology, and soap-making that prepares them for reintegration back into their communities.
“When they finish, we give them a small financial package along with the skills they learn to start as their own empowerment,” he said.

Obstetric fistula is a global health issue, with poorer countries being mostly affected. According to the United Nations, an estimated half a million women and girls are living with the condition, with thousands of new cases occurring each year. Most of these are in Asia and Sub-Saharan Africa.

Victims face severe stigma, neglect, and abandonment from their families and communities, leading to trauma and significant psychological impacts on their mental and social well-being. The constant leakage of urine or feces results in severe infections and chronic pain. The malodor associated with fistula makes it extremely difficult for these women to work or participate in social activities, further exacerbating their poverty and social isolation.

In Liberia, the leading risk factors are common, including teenage pregnancy, lack of proper obstetric care, low-skilled birth attendants, and rape. Underdevelopment, rebuilding from the 14-year conflict, and the Ebola crisis have created a critical gap in the country's healthcare system, according to the World Health Organization (WHO).

The fistula treatment and rehabilitation center at Phebe Hospital in Suakoko, Bong County, which was supported with aUS$3.5 million grant from Zonta International through UNFPA, is currently closed due to a lack of funding. Once a beacon for women suffering from obstetric fistula, women were allowed to stay in the dorm and trained in basic skills until full recovery. 

Ruth Walker, Ministry of Health (MOH), Fistula Coordinator, said since the UNFPA support halted in 2018, there has been no fistula care in Liberia, and the government is patiently waiting for ECOWAS to start the project. 

Finance is not the only hurdle to fistula care in Liberia—data is another issue. The Health Management Information System (HMIS) at the Ministry of Health has no record of fistula indicators, surgeries conducted, or the victims, says Walker. 

However, she said a technical working group was established with the support of UNFPA to create the fistula element in the HMIS, which will serve as fistula indicators. 
In an email, Calixte Hessou, UNFPA Programme Specialist, said the indicators were from the UNFPA metadata on maternal health, adding that UNFPA is also supporting the training of physicians as urogynecologists with an emphasis on obstetric fistula.

While the Ministry of Health is awaiting the commencement of the ECOWAS project, Dignity Liberia, an NGO dedicated to restoring hope to women with fistula and their communities through education, healing, and prevention, has constructed a maternal waiting home for 'at-risk pregnant women' in Goyah's Town, Todee District, rural Montserrado County.
Kathi Gutierrez, President at Dignity: Liberia, said the patient could be a woman who previously had a fistula. It can be a woman who is having her first child and is too young to have a baby. It can be someone who has developed gestational diabetes and high blood pressure. 

“If you are pregnant and having a normal pregnancy, you would still be welcome to stay at home, but we are trying to identify the women who are high-risk and would not do well in a village setting,” Gutierrez said. “However, she noted that only women who register as regular patients, attend at least three prenatal visits to monitor their pregnancy, and closely detect risk factors will be eligible to stay at home. Each time they visit the clinic, they will be required to bring a cup of rice, which will be used to prepare meals for them during their stay at home after the 28th week of pregnancy.

“If a pregnant woman in labor shows up at the home and is not one of our patients, we will not receive her,” Gutierrez said. “She will have to go to the hospital. We can call an ambulance for her, but she will be responsible for paying.”
"According to what is necessary, there will be certain tests that they will need to pay. Also, we will collect $20 before delivery to pay for their delivery. Currently, there will be no deliveries at the Maternity Waiting Home. However, patients will be transferred to CH Rennie Hospital in Kakata, Margibi County, for delivery.”

In 2025, Dignity: Liberia will begin the process of building an adjoining women’s clinic. Once the clinic is completed, all deliveries will be done on-site. “We will have resident doctors on call who will be able to handle C-sections.”

Obstetric fistula and other reproductive health conditions are mentioned in the draft revised Public Health Law that is before the Liberian Senate. If passed, the Ministry of Health will adopt regulations to ensure access to quality and acceptable sexual and reproductive health and family planning services, information, and education.

​​By David A. Yates and Simeon S Wiakanty

Obstetric fistula impacts about 1,200 Liberian women annually. It is a severe tear between a woman's birth canal and her bladder or her rectum, typically resulting from obstructed labor or from sexual assault. On average, Liberian fistula patients are seventeen years old and have had their fistula for five years. Without prevention or treatment of fistulas, they can expect lifelong suffering from physical pain, social shame, and chronic symptoms such as incontinence. 
The host Partner for this humanitarian project is the Rotary Club of Monrovia. The Rotary Club of Loveland, CO is the primary international partner. Dignity:Liberia board member and Rotarian, Becky Mueller Huner, R.N., is scheduled to speak at the Georgetown, TX Rotary Club about this project at its December Meeting. 
DIGNITY:LIBERIADignity:Liberia is a nonprofit, 501c3 organization with ten years of experience providing maternal care, specifically the prevention and treatment of obstetric fistula. Its board members either grew up in Liberia or have developed close ties to the country as adults. Dignity:Liberia is also a registered Liberian NGO. The organization partners with the local medical and business communities, and those working closest with fistula survivors. Dignity:Liberia's fundraising campaign, The Big Push, also continues.
Dignity:Liberia
Kathi Gutierrez
Founder, President and Executive Director
(816) 217-8751
348877@email4pr.com
https://www.dignityliberia.org

Kerri and I had a wonderful time at the Medical Missions 101 Gathering.  We met many wonderful people who have served on medical missions to different countries and learned about how their organizations provide direct help or provide assistance to organizations such as Dignity:Liberia.  We attended presentations on various topics which included discussions on making sure well-intended efforts don't cause harm.  We were pleased to note that Dignity:Liberia already follows much of the advice we heard.  We picked up a couple of copies of a Health Education handbook that stresses health promotion and prevention.  We shared with others what we have accomplished over the last six years, and the news that our maternity waiting home is getting closer to becoming a reality.  It was a very worthwhile way to spend the day.