As the world celebrates International Women's Day on March 8, thousands of women around the world continue to suffer from a medical condition that, left untreated, can cause social stigmatisation and life-threatening complications.
Between 4,000-5,000 women in Pakistan continue to fall victim to obstetric fistulas every year. They occur as a result of complications during labour, when the child's head gets stuck in the birth canal. This can lead to a tear in the delicate wall between the birth canal and the bladder or rectum. As a result, affected womenuncontrollably leak urine, blood or faeces. The condition often causes the woman to lose her child - and her dignity. Unskilled surgeons operating on women can also cause fistulas to form.
Obstetric fistulas were largely eradicated in the West decades ago - but continue to plague women in many impoverished parts of South Asia and Africa.
"Knowing that something you did has changed someone's life forever - nothing beats that feeling" - Dr Saboohi Mehdi, surgeon, fistula specialist
Despite the dire state of maternal health in Pakistan - where nearly 30,000 women lose their lives in pregnancy-related complications every year - expenditure on public health constitutes a mere 0.7 percent of gross domestic product, according to statistics from the World Bank. Accordingly, awareness of the disease is relatively low, and only about 30 surgeons in the entire country are equipped to treat such cases.
'Worse than death'
Fistulas are most common among women living in rural Pakistan, where childbirth is often assisted by unskilled midwives because health facilities are few and far between. The highest incidence of fistula cases occur in Pakistan's sparsely populated Balochistan province, followed by Khyber Pakhtunkhwa in the country's northwest.
"Living with this disease is worse than death," said Abida, a mother from the northwestern city of Peshawar who developed a fistula after the birth of her fifth child. Women living with fistula not only have to live with the unease of being perpetually wet - which can lead to infection and nerve damage - but are, in many cases, also ostracised from society.
"For the longest time, my mother-in-law did not allow me to touch my children. I did not pray for almost a year," she said. "There was this constant feeling of being dirty, being inferior." In some extreme cases, fistula patients are locked away in separate lodgings, not allowed to socialise or eat with others or believed to be possessed by the supernatural. Some husbands abandon their wives because of their condition.
Dr Saboohi Mehdi is one of Pakistan's few surgeons specialising in fistulas [Sarah Munir/Al Jazeera]
"There is such limited awareness about this disease. Usually, by the time patients come to us, they are so physically and mentally tormented that it breaks my heart," said Dr Saboohi Mehdi, a fistula surgeon who has treated countless women over the past four years.
"The saddest part is that this condition is completely treatable. Most patients are denied treatment because those around them are clueless about the problem," she added. A simple surgical treatment, costing anywhere between $150 to $400, can usually repair a fistula.
Mehdi works at Koohi Goth hospital in Karachi, Pakistan's only primary healthcare facility that offers treatment for fistula. Set up by Dr Sher Shah Syed in 2005, the hospital spans 16 acres of his private land on the outskirts of Karachi, and has so far treated more than 10,000 women free of charge - thanks to private donations and funding from international aid organisations.
"It is a shame that we boast of our nuclear strength, but our women are still dying in labour," said Syed. "Fistula is a poor person's disease, and who cares about the poor in this country?" Since the disease primarily affects low-income families, many doctors are reluctant to enter this field.
"I went into labour in the middle of the night. But no ambulance would come to our area at that time due to fear of getting killed. By the time I made it to the hospital in the morning, my child had died and I had developed a fistula" - Aasia, fistula patient
The doctors working at the Koohi Goth hospital earn a monthly wage of just $300-$400, despite knowing that performing a single surgery could earn them more than twice that amount at a private hospital. But, Mehdi explained with a smile: "Knowing that something you did has changed someone's life forever - nothing beats that feeling."
Women from all over Pakistan flock to the Koohi Goth hospital in search of a miracle. Aasia, a resident of Balochistan's strife-ridden Washuk district, is one of them. "I went into labour in the middle of the night. But no ambulance would come to our area at that time due to fear of getting killed," she said. "By the time I made it to the hospital in the morning, my child had died and I had developed a fistula."
When Aasia and her husband heard of Syed and the hospital, they immediately set off for Karachi. Because her fistula was not detected early, she has had to undergo five surgeries, and hopes to return to her family after a successful sixth operation.
Nearly every patient occupying the hospital's 200 beds have similarly heartbreaking tales. Along with medical treatment, the hospital also provides the women with rehabilitation services to help them become healthy, participating members of society. The patients are taught how to stitch, sew and embroider and are even given a sewing machine upon discharge. "These things help women value themselves and restores their sense of self-esteem," explained Mehdi.
Along with curing fistula, Syed also emphasises prevention. For this, the hospital also runs a midwifery and state-of-the-art nursing school where young women are trained to provide quality healthcare and contribute to the family income. Syed has also trained teams from hospitals in other cities to treat fistula, though Koohi Goth remains the country's only specialist facility.
Despite Pakistan's deep maternal health problems, Mehdi is optimistic. "The rate of reporting of fistula cases has improved significantly in the past couple of years," she said. "Now, patients are seeking help a lot sooner. There has been a downward shift in the number of those patients who had been suffering for years."
Things are on the right track, Syed believes, but there's still a long way to go. "The dream is very simple. The only thing that is needed is political will," he said. But in a country like Pakistan, that may be a lot to ask for.