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Laurie Zephyrin
MD, MPH '06, MBA
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Prevention of Obstetric Fistulas in Eritrea
Eritrea is an East African country with a population of approximately 4.4 million people. More than half of the population lives far from cities and hospital care. Pregnant women can be in labor for days, resulting in high maternal and fetal death and a high incidence of obstetric fistulas, abnormally large openings that connect the vagina to the bowel and/or bladder. This results in continuous leakage between the bladder and vagina or bladder and rectum, or both.
This is a major medical and social problem for women, resulting in divorce, isolation from family and poverty, in addition to a myriad of debilitating physical complications. Access to surgical services is critical to achieving the Millennium Development Goal of improving maternal health. Obstetrical fistulas are a preventable condition. As a practicing obstetrician/gynecologist currently at Columbia University, this is not a condition that I or my colleagues see today in the U.S. In most developed countries, fistulas were eradicated in the late nineteenth century with increased access to caesarean sections and forceps deliveries.
Seeing firsthand the impact of fistulas on these women has further strengthened my commitment to improving health care for the most vulnerable women. These women are strong, resilient and hopeful. They travel many miles for the possibility of a cure. The Eritrean Women's Project, started by Dr. Mary Lake Polan, has been traveling to Eritrea for the last seven years, training Eritrean OB/GYNs to perform complicated surgeries for women with obstetric fistulas. The importance of trained experts leading these surgical missions is clear. However, prevention of these fistulas is the ultimate goal. I have had the opportunity to work with the Eritrean Women's Project, UNFPA and the Eritrean Ministry of Health on prevention of obstetric fistulas. One of the key drivers is lack of human resources. There are fewer than ten obstetricians and gynecologists in the entire country of Eritrea. We are tackling this by developing obstetrical training missions for the current OB/GYNs. This allows an exchange of skills between Eritrean and U.S. OB/GYNs. In addition, the Ministry of Health is moving forward in developing the first postgraduate obstetrics and gynecology training program in Eritrea.
It is exciting to be a part of this process. Imagine, in the next decade, we can more than double the capacity of skilled OB/GYNs practicing in the outskirts of Eritrea. It is an exciting time to work in Eritrea and be a part of this goal with the Ministry of Health. I look forward to seeing the impact of our work in improving health care access to some of the world's most vulnerable women.
Laurie Zephyrin is Assistant Professor of Clinical Obstetrics and Gynecology, Clinical Population and Family Health and Clinical Health Policy and Management, Columbia University Medical Center, Columbia University Mailman School of Public Health.
