Changing Global Cultural Perception of Burkina Faso’s Women Affected by Urogenital Fistulas: A community education and the improvement of victims advocacy skills as leverage to speed up this affection’s eradication

By: Stéphanie Dominique Amida Nama

Without the mother who gave birth to me, I would not be here. In the society where I come from and where I live, the collective perception of the role of the woman is that if my mother had not had a child, her role as a woman would not have been fulfilled. If she had not been united to my father, they would not have had me. We are all one because our lives are influenced by our culture and our common history.

Because order must be a priority for things to work.

Our ancestors understood that a structuring and a role assignment should be made for humanity to evolve towards a peak of its performance. Except that in this common evolution, we must not let things evolve that could slow us down or make us involute. No one should be left behind and every potentially life-altering problem should be solved because its impact is generational.

Our philosophy is the sum of our roots and contemporary environmental trends.

My desire to support women affected by obstetric fistula is the result of an overlay of realizations that I made growing up. I am from a generation that wades between two currents, one rooted in our customs and inherited from the common West African culture, which represents the woman as the pillar of the family home, the one who takes care of all the members of her family by actively participating in fulfilling the basic needs, i.e. food, care giving, mothering, needs related to moral and physical growth, education and emotional security. The other current was impregnated to me during my schooling and thanks to the exchanges with other cultures facilitated by the globalization and the digitalization. In the latter, the woman is perceived as a being endowed with an individuality and who should be able to aspire in accordance with her personal vision because she has the same rights as any other individual. Except that I find it difficult to understand how in a culture where the woman is the pillar, she must live without rights, only with imposed duties, and must let herself be alienated without having the possibility to increase her power of action for a better collective being. Thus, by excess of coercion, the woman has lost all her decisional power and her autonomy with it. Implicitly, local community considers that to avoid deviation of the “common direction”, the woman must remain concentrated on her ultimate role of family pillar, so that it was necessary to take away from her all. Today I feel the deep need to take the best of both currents, instead of having to choose and position myself at the extreme. I choose to militate for all humanity to organize itself so that everyone can play their role and act for a common good: the future of humanity. In this perspective, the improvement of the living conditions of the “family pillar” and the reduction to nothing of all the factors which can make it precarious appears to me of an ultimate urgency.

I am committed to the fight for equity of access to health and human rights. I therefore decided to invest all my energy in the cause of the most vulnerable. During my studies in medicine and public health, I focused my learning on acquiring the skills to become a voice for the voiceless. Women with obstetrical fistulas represent for me the perfect image of people left out. They acquire, without asking for it, indelible stigmas that have a multidimensional physical, psychological, behavioral, financial, and sometimes lifelong impact, which are not taken into account in their entirety. Worst of all is the social rejection that awaits them and the denigration they suffer from their own kind. I consider this a total injustice and unfortunately the healing of the fistula without any physical after-effects cannot solve this injustice. The return of their dignity and the end of stigmatization and rejection depends on them taking ownership of this struggle: giving them a voice to make us understand how they feel, empowering them to act at the local level to make things happen, and giving them the opportunity to use their experience as a weapon to fight for the implementation of women’s sexual and reproductive rights.

During my medical school years, I was impressed by the involvement of one of my mentors in the fight against obstetric fistula. I did not understand the reasons for his excessive voluntary involvement in a pathology that seemed to be quite rare, preventable by monitoring pregnancies, and surgically reparable. I therefore decided to dig into the question by taking it as the subject of my thesis and as the work progressed, I perceived the extent of the damage of this pathology on the woman and her family, and I caricatured it as a result and typical reflection of the intersectionality of the vulnerabilities of rural women. This work allowed me to realize that no matter how much technological advances are put in place and how much care is taken, if the perception of the problem at the community level is not aligned with the measures to solve the problem, then we will not be able to move towards its resolution. Furthermore, after participating in free repair campaigns organized for these women, I perceived that their psychological suffering related to how they are perceived because of the occurrence of fistula and their social rejection were a primary concern to be taken into account in order to move towards a complete cure. In addition, not being able to return home and continue their social role was a major concern for their future and their desire to live.

This project is destined to grow as a social advocate for women’s rights and to help to the improvement of women suffering from fistulas through better living conditions.