Healthcare Disparities in Ecuador – Obstetric Fistulas

By: Allison Crawford, BSN, RN

The summer I graduated from nursing school, I went on a surgical mission trip to San Pedro, Ecuador. The group of Ob-Gyn’s I went with had been providing training for physicians and midwives yearly to improve the quality of emergency obstetric care in rural Ecuador.

As a newly graduated nurse, this specialized type of nursing care was totally new to me and over the 10 days I learned how to perform the duties of a circulating, scrub and recovery room nurse – all with extremely limited Spanish, thank goodness for our amazing translators! The surgeries we performed ranged from caesarean sections and simple repairs of uterine prolapse to more complicated obstetrical fistula repairs. I had read about these types of fistulas in my women’s health textbook but I had never experienced it firsthand.

A vesico-vaginal fistula (VVF), which is a hole or abnormal tissue connection between the bladder and vagina, results from an obstructed labor that is left unrelieved and unattended.

In rural Ecuador and many other developing countries there are few hospitals, few doctors and poor transportation systems and so obstructed labor often results in infant and/or maternal mortality. If the mother survives she is likely to develop an obstetric fistula that will have devastating impact on the rest of her life. She will be incontinent of urine and a social outcast unless she is able to have the fistula surgically repaired. Truly obstetrical fistulas are a symptom of poverty and are preventable injuries when a woman can gain access to emergency obstetric care, such as a caesarean section.

We were able to provide ten of these life changing surgeries during our short trip and train Ecuadoran medical professionals to competently perform this procedure. It was such an honor to play a small part in giving those young women back their dignity through the hope and healing that followed their surgery.

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