In many parts of the developing world, “lady troubles” still holds a medical and social stigma, as two determined U of T medical students discovered last summer. Though connected only by their work with the University of Toronto International Health Program, Alice Han and Deana Hathout share empathy, tenacity and a desire to change the plight of women in the developing world whose health issues are often overlooked.
Both students were recipients of the 2006 Medical Alumni Association scholarship, an award funded primarily by the MAA and offered to a handful of first- or second-year medical students involved in UTIHP. The scholarship enables students to spend over two months in a developing country, which Han and Hathout spent investigating issues of women’s health.
Han, UTIHP’s medical co-director and a sophomore med student with a seemingly infinite supply of energy, described her months in Eldoret, a large town in the western highlands of Kenya. As well as completing a surgical elective, she researched the little-known but devastating effects of obstetric fistula, a problem that can occur during prolonged labour. The condition is characterized by the formation of a hole between the vagina and bladder or the vagina and rectum, causing constant leakage of urine or feces.
“It’s a huge problem,” said Han. “There’s obviously physiological consequences…but more devastating is probably the social consequences because a lot of the women are cast out from their homes, ostracized, scorned by their families, [and] their husbands just abandon them.”
Why such ostracism?
“For one, the smell,” explained Han. “The smell-it’s unpleasant, to put it mildly. But they also lose their child-bearing abilities and that’s a way that [a lot of] women in Kenya…receive their status, from bearing many children.”
The loss of childbearing abilities is compounded by a number of other problems. Not only does this condition afflict the poorest of the socioeconomic spectrum, and mostly very young women, but repairs of obstetric fistula are also notoriously time-consuming and delicate. Han’s supervisor in Eldoret, Dr. Hilary Mabeya, is one of about five doctors in Kenya who perform the surgery. He makes regular field visits into rural areas for hundreds of free fistula repairs and conducts regular workshops to train more health professionals to deal with the condition. The women treated by Dr. Mabeya most often have no money and no other means of obtaining health care.
“It really helps them bring their life back,” said Han.
“I think what really struck me about [Dr. Mabeya] was his absolute dedication to this problem,” she said, recalling a visit to Kisumu, a small city by Lake Victoria. “When we were in Kisumu, we would be up by six in the morning, at the hospital by eight and then operation after operation. Sometimes [Dr. Mabeya] would go without lunch, without coffee. It was just amazing, the stamina…some invisible force driving [him].” With such enthusiasm, even the vivacious Han struggled to keep up the pace.
Thousands of kilometers to the north, working at Al-Azhar University in Cairo, Hathout investigated a different set of women’s health issues: the complex relationship in developing countries between traditional culture and the growing demand for artificial reproductive technology.
“A lot of cultures around the world are very pro-natalist,” Hathout explained. “[This] means there’s a high emphasis on reproduction and in such cultures to be infertile is actually a devastating thing.”
For a woman to be divorced because she can’t get pregnant, according to Hathout, is “pretty much her death sentence.”
Conducting interviews with couples seeking reproductive technology, Hathout encountered a mixture of eagerness and resistance to fertility treatments. Some women were desperate for it, Deana recounted, selling wedding bands and jewelry to cover the expense.
“There were a lot of people coming in to the urban centre from rural places, so a lot of people told me that they’d traveled for three days to get to Cairo.”
Often approached by more mature women seeking in-vitro fertilization, young women-often reproductively healthy newlyweds-would also seek treatment if they had not proven their fertility by conceiving immediately following marriage. Treatment was not offered in the latter cases. Neither was treatment always accepted freely by those it was offered to.
“Anything that’s new and anything that almost sounds like you’re playing with God is met with much resistance,” Hathout explained. “We know that in much of the world there’s still a lot of stigmatization with things like [in-vitro fertilization], a lot of people think that, ‘Oh, test tube babies, there might be a switch, that might not be my baby,’ et cetera.”
Cost was another major barrier to treatment. Never mind surgery, a few days of medication could tally up medical bills of approximately $100 Canadian, which few can afford. But with Al-Azhar University subsidizing the treatments-Hathout calls this a “stamp of approval from the Islamic university”-the burden of the cost and the ethical considerations is somewhat lighter.
Hathout’s studies found that women carried most of the monetary burden in most cases, even when male infertility was the cause of the couples’ troubles, as it was 70 per cent of the time.
“[Women] said, you know, ‘I would rather not expose my husband’s problem…I want to protect his pride.'”
That we don’t know how good we have it here was the resounding message both Han and Hathout conveyed.
With a new sense of respect for women in developing countries who face problems we take for granted in Canada, and a fresh enthusiasm for addressing women’s health issues world-wide, these two scholars and future doctors of Canada may one day become doctors of the world.
