Repairing Trauma in Niger

Barbara Margolies has taken a few leaps in her life. From elementaryschool teacher, to children’s book author, to intrepid world traveler. When you ask the Brooklyn-born mother of two how in 2003, at age 63, she began dedicating herself to helping African women suffering terrible physical and psychological wounds from obstetric complications, she shrugs. “Maybe because I’m crazy?”

Crazy or otherwise, Margolies’s philanthropic efforts have dramatically improved the lives of hundreds of young women in Niger, the West African nation where Margolies worked training English teachers through the U.S. State Department, and where she learned of a severe gynecological problem afflicting girls and women after childbirth in many poor countries, but disproportionately in impoverished Niger, where medical care is woefully inadequate.

There are fewer than 25 obstetrician/ gynecologists serving more than six and a half million women in Niger, according to the Ministry of Health, and one midwife for every 33,500. Niger has the world’s highest estimated risk of maternal mortality: one in seven. For these malnourished women, laboring through childbirth, sometimes for up to a week, without proper care can be a misery. During such painful, attenuated births, the baby’s head presses against the mother’s vaginal wall, the wall adjacent to both bladder and rectum, preventing blood-flow to the area, causing a breakdown of the surrounding tissue. This creates what amounts to a hole in the pelvis, known as an obstetric fistula.

Women who survive childbirth with fistulas are left with little or no control over bladder and bowels, their psychological trauma compounding the physical damage. Eighty-five percent of babies born to fistula patients are stillborn; on top of this loss, the women are frequently ostracized by their families and communities because of the odors associated with the leakage. (Nonobstetric fistulas are rare, but do occur, as in a 14-year-old who had been raped when she was 10, and a 20-year-old who was “cut” by a medicine man to make her more sexually pliant for her husband.)

“It blew my mind that this could happen, and still be happening in 2003,” Margolies says. “I thought, I cannot walk away and live with myself. I have to do something.”

Within a year, with the help of supporters in Niger and the U.S., she founded The International Organization for Women and Development, a non-profit based in Rockville Center, NY, with its primary goal to create a self-sustaining program to repair and rehabilitate fistula women in Niger. Three times a year, IOWD coordinates the transport of 20 to 25 volunteer surgeons, doctors and nurses from the U.S. to a hospital in Niger’s capital, Niamey, where dozens of fistula women live at any given time. There, the surgeons perform roughly 65 surgeries each visit and pass on their skills and knowledge to Nigerien surgeons. In four years, IOWD physicians have performed more than 1,000 surgeries, with an overall success rate of 80 percent.

Along with medical care, Margolies has launched an outreach program to educate patients and their husbands about the causes of fistula; a laparoscopic surgical program at the local maternity hospital; and a vocational initiative that encourages patients to support themselves financially by making jewelry, and surgical caps and bed sheets for the hospital wards. (More at

Some of the women, even when healed, continue to live in the hospital courtyard, says Margolies. Some have no place to go because their husbands have divorced them or taken up with other wives. Others are loath to return to their husbands and abandon the camaraderie and support they find at the hospital.

Margolies is quick to sing the praises of the volunteer doctors (a measure of her success is that there’s a five-year waiting list for surgeons lining up to serve), but modest about her own achievements. “I’m not anybody special,” she explains. “I’m just a normal Jewish lady who was fortunate enough to have experienced life in different parts of the world, and to know who I am.”