DANJA, Niger — THEY straggle in by foot, donkey cart or bus: humiliated women and girls with their heads downcast, feeling ashamed and cursed, trailing stink and urine.
Some were married off at 12 or 13 years old and became pregnant before their malnourished bodies were ready. All suffered a devastating childbirth injury called an obstetric fistula that has left them incontinent, leaking urine and sometimes feces through their vaginas. Most have been sent away by their husbands, and many have endured years of mockery and ostracism as well as painful sores on their legs from the steady trickle of urine.
They come to this remote nook of Niger in West Africa because they've heard that a new hospital may be able to cure them and end their humiliation. And they are right — thanks, in part, to you as Times readers.
There is nothing more wrenching than to see a teenage girl shamed by a fistula, and I've written before about the dreams of a couple of surgeons to build this fistula center here in Danja. Times readers responded by contributing more than $500,000 to the Worldwide Fistula Fund to make the hospital a reality. Last year, the Danja Fistula Center opened.
This is my annual win-a-trip journey, in which I take a university student along on a reporting trip to shine a spotlight on global poverty. So with my student winner, Erin Luhmann of the University of Wisconsin, I dropped in on Danja to see what you as readers have accomplished here. What we found underscored that while helping others is a complicated, uncertain enterprise, there are times when a modest donation can be transformative.
The first patient we met is Hadiza Soulaye; with an impish smile, she still seems a child. Hadiza said she never went to school and doesn't know her birth date, but she said that her family married her off at about 11 or 12. She knows that it was before she began to menstruate. She was not consulted but became the second wife of her own uncle.
A year later, she was pregnant. Hadiza had no prenatal care, and a traditional birth attendant couldn't help when she suffered three days of obstructed labor. By the time Hadiza was taken to a hospital for a Caesarean delivery, the baby was dead and she had suffered internal injuries including a hole, or fistula, between her bladder and vagina.
"I didn't know what had happened," she remembered. "I just knew that I couldn't control my pee, and I started crying."
Hadiza found herself shunned. Her husband ejected her from the house, and other villagers regarded her as unclean so that no one would eat food that she prepared or allow her to fetch water from the well when others were around. Villagers mocked her: "They would laugh at me and point to my dress," which was constantly wet with urine.
She endured several years of this ostracism. Worldwide, there are some two million fistula sufferers, sitting in their homes feeling ashamed, lonely and hopeless.
A few months ago, Hadiza heard about the Danja Fistula Center and showed up to see if someone could help. Dr. Steve Arrowsmith, a urologist from Michigan who helped plan this center and has repaired more fistulas than any other American, operated on Hadiza and repaired the damage. He warned her not to have sex for six months to give the repair time to heal.
It typically costs $500 to $1,000 to repair a fistula and turn these women's lives around. There is no one more joyous than a woman who has undergone this surgery successfully, and Hadiza was thrilled to return to her village.
Yet life is complicated. When she returned home — dry and cured — her husband summoned her to his bed.
"I didn't have a choice," she says. "I was his wife."
The husband tore open the fistula, and she began leaking urine once more. He then threw her out of the house again, so now Hadiza is back at the hospital. She vows that this time, if she can be patched up, she will never return to her husband.
As in Hadiza's case, a fistula is often a result of a child marriage. Here in Niger, about three-quarters of girls are married before the age of 18.
"Some of these ladies here have never had a period," Dr. Arrowsmith noted. "They became pregnant the first time they ovulated, and then their uterus was destroyed."
Aside from repairing fistulas, the Danja center also conducts outreach to improve maternal health and encourage women to deliver in clinics. It has set up a system so that taxi drivers are guaranteed payment when they take a woman in labor to a hospital.
The Danja Fistula Center is also conducting research on how best to treat patients. One approach pioneered here may allow fistula hospitals to move patients out of recovery wards in half the time, effectively doubling capacity.
The fistula center was conceived by Dr. Arrowsmith and Dr. Lewis Wall, an obstetrics professor at Washington University in St. Louis, and it partners with Serving in Mission, an American Christian charity with long experience here in Danja. It also gets backing from the Fistula Foundation, based in the United States. But, in line with the original vision, the Danja Fistula Center is run by Africans, with Dr. Arrowsmith training Dr. Itengré Ouedraogo, a surgeon from Burkina Faso, to be medical director.
Fistulas may be a grim topic, but this center you readers have helped to build is a warm and inspiring place. Women who have suffered for years find hope here, and they proudly display skills they are learning, such as knitting or sewing, that they can use to earn a living afterward. As they await surgery, their dormitories echo with giggles and girl talk. They are courageous and indomitable, and now full of hope as well.
This fistula center continues to exist on a shoestring, struggling for operating funds. But the exuberance of the patients is contagious, and I wanted readers to know that your generosity has built a city of joy. These women may arrive miserable and shamed, but they leave proud, heads held high. And in a complicated world of trouble, that's a reason to celebrate.
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