International Day to End Obstetric Fistula (IDEOF), May 23 each year, can be a solemn time to reflect on the ongoing burden of fistula worldwide, a condition where women experience incontinence due to an abnormal opening between the genital and urinary tract or rectum.¹ It can also be a time to celebrate truly life-changing events, such as successful fistula repair and reintegration into society. Such is the case for one woman, Massiamy Conde, who lived with obstetric fistula in Guinea for over twenty years.

There are an estimated one million cases of fistula globally, and thousands of new cases each year.^{2, 3} Major causes of fistula include prolonged or obstructed labor, surgical error (most often during cesarean section), and trauma (such as sexual violence).⁴ Women who experience fistula suffer incontinence and with it, shame, social isolation, and health issues.⁵

MOMENTUM Safe Surgery in Family Planning and Obstetrics has been active in Guinea since 2022. Guinea has one of the highest maternal mortality rates in the world, 550 maternal deaths per 100,000 live births,⁶ attributed to the inadequate provision of emergency obstetric and neonatal care services. In this context, MOMENTUM is working to address key gaps in the capacity of surgical teams to deliver safe surgical obstetric care, and to prevent and treat fistula. The project routinely schedules fistula repair sessions in project-supported regions.

MOMENTUM also works with local community leaders and radio stations to share information about fistula, encouraging women to come to a health post, health center, or district hospital to determine eligibility for repair. For example, MOMENTUM organized a fistula repair session in Labe in December 2023. This session coincided with an advocacy campaign for free fistula care in Guinea, also led by MOMENTUM. Massiamy provided a painful testimonial at the launch of this advocacy campaign. She spoke about living with obstetric fistula for decades, bringing attendees to tears as she recounted the physiological, psychological, and social consequences of the condition. During this testimony, she made a plea for treatment.

While Massiamy had been referred to the Labe repair session, doctors there determined that she required surgical treatment of severe bladder stones first and would need to take advantage of a subsequent repair session to treat her fistula. Over 60 women, including Massiamy, were referred to the Kindia Regional Hospital for examination and diagnosis.

Of these, thirty-five were diagnosed with fistula and received surgical fistula repairs in Kindia with MOMENTUM support in April and May 2024.

Happily, one of these women was Massiamy.

The next stage of the journey involves community reintegration. Upon discharge from surgery, MOMENTUM offers women the opportunity to enroll in a social immersion program with host families, who provide them with support to gradually reintegrate into routines in society. This model, which was designed by EngenderHealth, has been documented to support positive outcomes for women who have had fistula.⁷

Women post-repair live with a volunteer host family for two to three weeks, while the family involves them in activities such as cooking, eating meals together, shopping, and participating in social events. The families provide a supportive, caring environment as women recuperate physically and emotionally after periods of social isolation that have sometimes lasted for years due to stigmatization. Massiamy enrolled in such a program in Kindia before returning to her village.

During their stay, host families are honored through special visits from their mayors or mayoral representatives and have been interviewed by rural radio stations. These broadcasts help sensitize communities and combat the stigmatization of women with fistula.

Massiamy’s successful surgical fistula repair, coupled with a caring and supportive social immersion experience, is where this story ends. But, after being socially isolated for many years, Massiamy Conde is once again a full participant in society. She has reclaimed her life with dignity.