In America, it is unimaginable for a woman to develop obstetric fistula.
The condition is caused by prolonged labor and consists of a hole between her vagina and rectum or bladder, causing uncontrollable urine and bowel fluid leakage. It is often found in rural settings that lack adequate health care.
And it's one reason why Dr. Jeffrey Wilkinson and his wife, Dr. Sumera Hayat, are preparing to move their family to Eldoret, Kenya.
The couple aims to expand the University's involvement in maternal health issues in less wealthy communities around the world by partnering with Moi University, the America/sub-Saharan Africa Network for Training and Education in Medicine Consortium and the Academic Model for Prevention and Treatment of HIV/AIDS program.
Wilkinson, an assistant professor of urogynecology, completed his fellowship concentrating in obstetric fistula. He cited western Kenya as an epicenter of maternal health issues including fistula, which can cause a woman to be ostracized by her community, putting her life and the life of her child in even more danger.
"You have women who are already marginalized by their gender and the social structure," said Wilkinson, who is also co-director of the Center for Minimally Invasive Gynecologic Surgery. "Then when you add in that they are unable to have sex, they are unable to have children, and they stink-they suffer unimaginable consequences."
Hayat, a clinical associate at the Duke University Medical Center, said she and her husband have been waiting for the opportunity to do an overseas maternal health project, noting that when her family last went to Kenya, they were immediately attracted to AMPATH's impressive HIV/AIDS program, which provides a wide range of services including home-based testing, treatment, education and basic resources for people living with HIV/AIDS.
"They've been able to figure out the needs of people living with HIV, which would be finding regular food, work and schooling for orphans," she said. "They highlighted these specific needs and realized with a little bit of input into these barriers they could change the lives of people living with HIV. They're trying to empower people to make their lives better."
Hayat emphasized the importance of working with an existing organization and building trust with the community.
"We didn't want to just start a clinic unless we were able to address the needs that the Kenyans have," she said.
Wilkinson, who said he has spent his career addressing the needs of women in underserved populations, said ASANTE recognized that its women's reproductive health care was lacking and needed an academic institution to take the lead on the issues.
More than 500,000 women around the world die each year during childbirth for a variety of reasons, including eclampsia, hemorrhage, infection, poor health care resources and obstetric fistula, according to the World Health Organization.
But with the outbreak of violence in Kenya, causing population displacement and 1,000-plus deaths since the allegedly rigged presidential elections Dec. 27, Wilkinson and Hayat may or may not change the location of their project in order to best provide comfort for their children.
No matter where the doctors and team choose to work, their vision of opening a clinic, reducing maternal mortality and training local African doctors, nurses and traditional birth attendants will remain the same, they said.
"There is so much poverty, lack of resources, devastation going on from HIV/AIDS [and] gaps between the rich and the poor that it perpetuates this cycle where people with less power seem to always get the worse end of the stick and women and children bear the brunt of a lot of the suffering," Hayat said. "The whole community here in North Carolina wants to find a partnership with another community in the world and to work with them to help empower the residents."
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