Improving the Lives of Ethiopian Women with Fistula: An Interview with Dr. Gladstone

One of the nurses and the fistula patients in her group, taken at the final group meeting, which is a celebration. Photo courtesy of Dr. Gladstone.

When Dr. Tracy R.G. Gladstone visited Ethiopia’s Gondar Fistula Center in 2015, her goal was to train medical providers to address depression and anxiety in women with obstetric fistula: a hole in the tissues that separate a woman’s vagina, bladder and rectum. Fistula develop during obstructed childbirth when a timely caesarian section is not performed. 

“Over the past several years I’ve seen growing recognition of obstetric fistula as a medical issue—non-Governmental Organizations (NGOs) have begun bringing mobile health units into rural areas to provide free repair surgery to women who need it—but not as much attention has been paid to pre- or post- surgical psychological health,” Gladstone, Associate Director and Senior Research scientist at the Wellesley Centers for Women, told Lilith.

Nonetheless, as the connection between physical and emotional health is better understood, Ethiopian medical workers have become increasingly receptive to learning concrete strategies to help women deal with their post-traumatic stress and other psychological problems the condition triggers.

That said, obstetric fistula remains a serious problem throughout much of sub-Saharan Africa and Asia, though it is almost never seen in North America. It is estimated that 39,000 Ethiopian women suffer from fistula.  According to The Fistula Foundation, the country has just one physician per 10,000 people. What’s more, 41 percent of Ethiopian women are illiterate and female life expectancy is 67.4 years.

Gladstone became interested in the psychological issues surrounding fistula in 2010, after her pre-teen daughter, Sarah, read Sheryl WuDunn and Nichola Kristof’s book, Half the Sky. Sarah, Tracy Gladstone reports, was so incensed by what she’d read that she decided to raise money for fistula repair as a Bat Mitzvah project. Since then, Sarah has raised more than $10,000 for the effort.

In tandem with Sarah, Tracy Gladstone has created the COFFEE Project: Cognitive Behavioral Therapy with Obstetric Fistula for Education and Empowerment. She recently spoke to Eleanor J. Bader about her work.