A Celebration of Healing: The Dress Ceremony at Freedom from Fistula

Recently I was fortunate enough to attend a weekly dress ceremony at the Freedom from Fistula Foundation in Tamatave, just a short drive from the ship. 

Two Organisations, One Shared Mission

Whilst Freedom from Fistula (FFF) and Mercy Ships are distinct organisations, they share a long-standing medical partnership. Back in 2015, both charities worked together to open a specialised obstetric fistula clinic in Tamatave, Madagascar. 

The clinic is so successful that Mercy Ships' surgical plan no longer includes obstetric fistula surgeries, with FFF treating up to 800 women each year in Madagascar alone. 

One of the wards at the Freedom from Fistula clinic

The operating room

The Post-Anaesthesia Care Unit (PACU)

Two international surgeons - supported by Malagasy nurses trained by Mercy Ships - care for up to 90 women at a time. News of the clinic often spreads through word of mouth through the testimony of healed patients returning home. Some of the women have lived with a fistula for up to 30 years and the youngest patient seen at the Tamatave clinic was only 14 years old. 

What is an obstetric fistula?

Obstetric fistulas are a preventable and mostly treatable condition that primarily affect young women in developing countries. Caused by prolonged, obstructed labour coupled with a lack of access to timely emergency medical care (such as a C-section) obstetric fistulas can lead to permanent incontinence resulting in the woman being shunned by her family, abandoned by her husband and ostracised from her community.

The reality of rural healthcare in Madagascar

Whilst women who live in towns have easier access to healthcare facilities, those who live in remote areas of Madagascar could be several days away from their nearest hospital. 99% of women in the countryside give birth in their home village, which may only have a CSB level 1 medical facility. A CSB-1, or a Centres Santé de Bases 1 medical centre, is the most basic healthcare facility and is usually located in the smaller, isolated communities. CSB-1s have a midwife or nurse, whereas CSB-2s have a resident doctor and are located in urban communities or larger population hubs. 

The impact in numbers

  • 50,000 to 100,000: The number of women worldwide who sustain an obstetric fistula during childbirth each year (UN Population Fund)
  • 2 to 3 million: Women currently living with untreated fistulas across Asia and sub-Saharan Africa (WHO)
  • Up to 90%: The rate of stillbirths in prolonged, obstructed labour cases that cause a fistula - meaning most mothers endure this trauma while also grieving the loss of their baby
  • 91%: The success rate of surgical repair for vaginal fistulas
  • 8%: The proportion of maternal deaths worldwide directly linked to obstructed labour and obstetric fistula

Healing and renewal: Dress ceremonies

Following their operation, healing and rehabilitation can take time with the average stay at the clinic being 2-3 weeks. 

Once fully healed and ready to return to their homes and communities, all the women gather to take part in the 'dress ceremony celebration' where those ready to leave are given a new dress and other gifts as a symbol of their healing and new beginning. 

The 8 women ready to return home this week

To learn more about the global fight to end obstetric fistula, visit Freedom From Fistula.

Home - Freedom From Fistula UK

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