Until I met Mariama, ten years after her agonizing delivery, I had never heard of vesicovaginal fistula (VVF). That's because in the United States, stories like hers haven't been told in more than 100 years. Today, VVF keeps company with obsoletes like smallpox and polio in the shadows of Western medicine, where its symptoms are referenced in the past tense. But in sub-Saharan Africa and parts of Asia, more than 2 million women still suffer from the condition.
Until a decade ago, fistula was literally not on the global health agenda, even though it is arguably the most devastating and disabling of all childbirth injuries. The simple reason: women who suffer from fistula live almost exclusively in rural areas of very resource constrained countries, and are therefore some of the least empowered human beings on the planet.