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Grace Nana after her initial fistulae repair in a new dress.

The life of Grace is a typical one of needless suffering endured. She was born into a poor home in a rural area of South Eastern Nigeria. There was no father and her mother was a subsistence farmer. Grace had some education and was literate, quite bright and vivacious. At the age of fourteen, she was used by an older man and became pregnant and was of course abandoned. Grace was an attractive young woman but tiny at around 4’6”. She was thin, malnourished and anemic. During her pregnancy, she lived with her mother in their village in South Eastern Nigeria, West Africa.

Like most young pregnant women living in these circumstances, she had no access to prenatal care and was not seen by anyone with medical or midwifery training, not even a traditional birth attendant (TBA), the untrained but experienced women in the villages who do deliveries. Grace was anemic throughout her pregnancy, most likely due to malaria and a lack of adequate food; she also likely had a worm infestation. Grace went into labour at term alone, without support, pain relief or nourishment.

Not surprisingly, she ran into trouble very quickly. Being small, her pelvis was small, and there was not enough room for the baby’s head to descend through the birth canal. Soon Grace was in obstructed labour, and she needed essential obstetrics including a caesarean section. However, there was no money for transport to the local district hospital. She continued to stay at her home, without help, for what was now unrelieved obstructed labour.

After four days, Grace was still undelivered. Her baby had died and her uterus and bladder had ruptured, she was severely dehydrated and barely alive. A TBA was called who tried a few drastic but futile maneuvers to deliver the infant. Later, a passing village woman helped Grace to deliver the macerated baby.

A few days after, Grace developed both vesico-vaginal and recto-vaginal fistulae and was now incontinent of urine and faeces. A local native doctor tried to solve these problems by inserting herbs into the vagina. When this failed, some well-meaning women tried to “dry her out” by pouring boiling water over her vulva. This compounded the problem by causing extensive burns to the inside of Grace’s legs. Grace was now close to death.

At last, the villagers managed to contact one of the Medical Missionaries of Mary at a mission hospital some distance away. Grace was taken to the hospital, resuscitated, and her burns dressed. Her condition improved a little, but the relatives, seeing what had happened to Grace, decided to take her back to the village to die. There she lay on her face in great pain, covered in flies for weeks.

Sometime later, one of the sisters went to see how she was. On arrival in the village the sister was literally attracted to a small house by the awful smell. There she found Grace in a pitiful state. She was taken to another of their mission hospitals much further away which specializes in the treatment of obstetric fistulae. In addition to these awful problems, Grace was found to be crippled as she had developed foot drop, also caused by the prolonged obstructed labour which damaged the nerves supplying the leg muscles.

Over the next three years, Grace had a number of painful operations; including a colostomy, skin grafts, and physiotherapy, to close the fistulae. Grace was undernourished, anemic and sometimes difficult to handle, perhaps like many teenagers. However, Grace had much to contend with, not only physically, but also mentally in the knowledge that she would never have another baby. She was trained to help out at the hospital as a ward maid and was sent back to school.

Unfortunately, she again came under the influence of an older man, and she ran away. About a year later Grace returned to the hospital in a sad state having been very obviously sexually abused, as the fistula had broken down requiring further surgery. The surgery was successful, and she was given a new job running a small stand selling drinks and fruit to visitors. She was now much happier and healthier.

In the late fall of 2002, Grace, now near 22 years of age, developed a bout of fever (malaria) which is not uncommon for most Africans. She asked if she could go home and stay with her mother, and a week later Grace died. Likely the cause was her general debilitated condition, including the anemia which was never fully resolved and the complications and the long term consequences of the fistula.

Someone remarked that Grace had had a “rough life”, but perhaps it is more accurate to say that Grace had had no life at all. Grace was neglected from her very beginning and had little chance. One of the sisters, an obstetrician with some forty years of experience helping mothers in Africa, said to me once when we were faced with another maternal death, “You know, Rob, I fully believe that no matter what a woman might have done during her past life, if she dies in giving birth, she goes straight to God.” I knew Grace well, and I am sure that Grace is in heaven and has been reunited with her baby.

From a presentation given by Dr. R. L. Walley

• Each year hundreds of thousands of women like Grace become maternal deaths that are preventable.
• Maternal Deaths occur during or shortly after delivery due to lack of access to emergency obstetrical services.
• Women in developing countries are more than 100 times likely to become a maternal death than their sisters in industrialized countries.
• Over 2 million women suffer from a preventable childbirth injury called “Obstetric Fistulae” in developing countries.
• 50,000 new cases are added each year.
• Obstetric Fistula is the result of long obstructed labour causing damage to the rectum and bladder. They become incontinent.
• Women with Obstetric Fistulae are ostracized and abandoned by their families and society.
• Many women suffer alone.

How Can You Help:

 Educate others about the preventable tragedies mothers face in developing countries.

 Support MaterCare in delivering essential obstetrics to women who need it most.