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Obstetric fistulas were common in the United States generations ago. L. Lewis Wall, an obstetrics surgeon and president of the Worldwide Fistula Fund (WFF), told Christianity Today that due to modern health care, fistula has been "lost from the collective memory." (See "Jesus and the Unclean Woman.")

A fistula develops when bladder or rectal tissue is damaged during obstructed labor. In most instances, the mother is unable to deliver her baby because her pelvis has not fully grown. Typically her child dies, and unless surgery is performed, the woman remains incontinent for the rest of her life. Medical experts estimate that more than 90 percent of the 2-3 million women who need the surgery live in the developing world.

WFF is the first American organization focused solely on fistula. Wall and WFF vice president Steve Arrowsmith have performed thousands of fistula repairs since the 1980s. Arrowsmith has a sense of humor about his expertise. "I used to tell everybody I was one of the top five fistula surgeons in the world. There were only four of us, but I was definitely right up there in the top five."

Australian physician Catherine Hamlin and her late husband, Reginald, were the modern pioneers of fistula surgery. In 1974, the Christian couple founded Ethiopia's Addis Ababa Fistula Hospital, which has provided free surgery to more than 34,000 women. (Hamlin, who turns 86 this month, still performs surgeries.)

Fistula surgeries are also regularly performed aboard Mercy Ships' Africa Mercy, a nonprofit floating hospital where Arrowsmith serves as surgery coordinator.

Intensive media attention has brought the need for fistula surgery to a worldwide audience. Both the BBC and Oprah have aired programs on the topic. And a 2007 Emmy-winning documentary, A Walk to Beautiful, followed five women through fistula repair in Ethiopia.

New York Times columnist Nicholas D. Kristof has written on fistula many times and featured it prominently in Half the Sky, the 2009 book he wrote with journalist wife Sheryl WuDunn. Kristof told CT, "Fistulas were almost unknown ten years ago. It was considered a fairly disgusting topic, not appropriate for polite conversation." Fistula sufferers are "the most voiceless people in their societies."

As more Americans learn about the situation of the most voiceless, more want to do something. Enter the influential Michael Horowitz, a senior fellow at the Hudson Institute and a general counsel for the Reagan administration. He specializes in assembling broad-spectrum humanitarian coalitions focused on human trafficking, religious persecution, and prison reform, among other concerns.

"In all of these fields, you find some heroic person or people barely keeping the flame flaring, doing everything they can," said Horowitz. "By now I have an instinct for what kinds of things can catch fire."

Last year, Horowitz connected with Kristof, WFF, and Wall. All parties have put their stamp of approval on a global campaign to provide fistula surgery to any woman who needs it. The $1.5 billion campaign, funded by donations and U.S. foreign aid, would pay for 40 fistula surgery clinics, each having 40 beds and costing $2.5 million. Nations in which fistula is widespread would be leading candidates for clinics.

Each facility would provide surgery and other medical treatment for fistula patients, as well as train surgeons and medical staff. Other programs would educate communities on fistula prevention through improvements in female and maternal care and midwife training.

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January 2010, Vol. 54, No. 1