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Ngoma District, Rwanda—Angelique Tumukunde was 19 years old, and on the day of her first child’s birth, things did not go well. Her labor was difficult and prolonged. No amount of pushing helped. Exhausted and in pain, Angelique went to the nearest health center, where providers explained that she faced serious complications.
She was rushed to the Nyagatare District Hospital for an emergency cesarean delivery. But it was too late: her baby boy, stuck in the birth canal for too long, had died from asphyxia. "I felt so sad. I was shocked like any other mother who has lost her baby," she said.
As Angelique lay in her hospital bed, recovering from the surgery, a new misery ensued. She was leaking urine. The bedding was wet and the smell was unbearable. Not only had prolonged, obstructed labor claimed the life of her baby, but it had also damaged the wall separating Angelique’s bladder from the birth canal. The result was fistula, a devastating wound she would endure for the next 5 years.
Obstetric fistula is a degrading, preventable tragedy affecting 50,000 to 100,000 women worldwide every year. It leaves women incontinent, ashamed and isolated. Most women with obstetric fistula suffer from loss of self-esteem, loss of self-worth and depression. Angelique experienced all of that. She even considered suicide.
“My husband abandoned me and married another woman,” she said. “I could neither go to church nor to the market because people told me I smelled bad. I decided to go back home [to the village] to live with my parents.”
In developing countries, women with fistula do not have access to reliable, high-quality fistula repair services. There are few surgeons with the necessary specialized skills, few operating rooms and little equipment or funding. Angelique trekked from one health facility to the next in a frustrating search for a cure. One of the attempts doctors made to repair her fistula only made it worse. Eventually, she gave up, secluding herself at her mother’s home.
Moved by the plight of Rwandan women suffering from fistula, staff from Jhpiego organized a Miles for Mothers event in 2016 to raise funds for essential equipment and repair kits to support fistula repair surgery. Their goal: to restore hope to women like Angelique.
The Miles for Mothers team—full of passionate runners, walkers, cheerleaders and gift givers—raised enough funds to purchase a surgical bed, dozens of fistula repair kits and 30 hospital beds (plus mattresses and bedsheets) to support fistula repair surgery at Kibungo Hospital in Ngoma District, eastern Rwanda.
When Gloriose Abayisenga, a midwife working with the United States Agency for International Development’s flagship Maternal and Child Survival Project (MCSP), told Angelique about a fistula screening and treatment opportunity at Kibungo Hospital, Angelique didn’t believe it at first.
“I had lost hope … because of the previous [unsuccessful] surgeries I underwent. But I finally believed in Gloriose,” said Angelique. She became one of 51 women who underwent successful fistula repair surgery in the first 2 weeks of the fistula clinic’s operation, ending her 5 years of misery and humiliation.
Dr. Victorien Ndacyayisenga, one of only a few ob/gyns in Rwanda who can perform fistula repairs, screened Angelique and performed her surgery. When he met with her a few days after the surgery, he was overcome by emotion.
“Angelique came to me telling me she didn’t have a problem anymore and she had resumed her life. She told me she is now happy [because] she can attend public events,” said Dr. Ndacyayisenga.
“Fistula victims, they are [women] rejected by the society, especially their husbands. In addition, most of them [have] lost their children while giving birth,” added Dr. Ndacyayisenga. “They cannot contribute to the advancement of their families. Their hearts are wounded. The world needs to stand up to help these women resume normal lives.”
That’s what the Jhpiego Miles for Mothers team did: through their impassioned support, and along with incredible partners from the Rwandan Ministry of Health to MCSP, they restored hope and dignity to Angelique and other women with fistula in Rwanda.
“I am now living a normal life. I have found a husband. If I was still leaking [urine from the fistula], I wouldn’t have found someone to love me," she says. “I can attend church and market just like other women. I am happy.”
Mamy Ingabire is the Communications Specialist for Jhpiego and MCSP in Rwanda. Dr. Victor Ndicunguye, Maternal, Child and Reproductive Health Advisor at MCSP, and Charles Wanga, Jhpiego’s Africa Region Senior Communications Specialist, contributed to this story.
 World Health Organization. (2018). 10 facts on obstetric fistula. Retrieved from http://www.who.int/features/factfiles/obstetric_fistula/en/
 Wall, LL. (2018). Tears for My Sisters: The Tragedy of Obstetric Fistula. Baltimore: Johns Hopkins University Press. https://jhupbooks.press.jhu.edu/content/tears-my-sisters
 World Health Organization. (2015). Improving access to high quality care for obstetric fistula. Retrieved from http://www.who.int/reproductivehealth/topics/maternal_perinatal/fistula-study/en/