SINGLE: Good Missionary?

**John Dickson** (0:05)
Undeceptions podcast.
Okay, let's focus on your specialty. Let's go as visceral as you like. I mean, it's commonplace for you, but some of my listeners might go, what?

**Andrew Browning** (1:05)
Well, I must say, I spoke at a boy school not so long ago, and one of the boys fainted when I, and it turned out that he was Australia's boxing champion for his age group. And so, yeah, I can say that I knocked out a boxing champion.

**John Dickson** (1:23)
That's good knowledge for his next opponent. Just say the words, obstetric fistula.

**Andrew Browning** (1:29)
He's down on the ground, he's out for the count.

**John Dickson** (1:30)
Tell me, what is an obstetric fistula?

**Andrew Browning** (1:34)
So I'm what's called a fistula surgeon, I'm a gynaecologist, and obstetric fistula is a birth injury. The word fistula in Latin just means pipe or a hole.
So it's a hole that women get from a long, difficult labor.

**John Dickson** (1:50)
That's my friend, Dr. Andrew Browning. He's an Australian-trained obstetrician and gynaecologist. He spent 17 years as a surgeon in Ethiopia and Tanzania. And he's written a book called A Doctor in Africa. Not a very exciting title, but a very exciting life. It's all about his experiences as a Christian missionary doctor, and we'll talk about that title missionary in a moment.
Hey, and I should warn you that some of the descriptions of obstetric fistula in this episode are pretty full-on.

**Andrew Browning** (2:26)
Anywhere in the world, about 5 percent of women will get into what's called obstructive labor when they have their baby. So baby's got to come through the mother's pelvis to be delivered, and it's usually the head first. Sometimes it's the bottom first. Other times it's the shoulder first, all sorts of presentations, but most of the time the head comes out first.
If the baby's head's too big for the mother's pelvis, it'll get stuck or maybe the head's coming out in a different angle, so it gets stuck. So 1 in 20 women, when they're in labor, that will happen too. So ordinarily, you'll find that in labor, the midwife looking after you in the hospital in Australia, she'll diagnose that the baby's getting stuck. She'll call the doctor, he'll have a caesarean on operation to have your baby, fine. But most of the women I treat, almost all the women I treat haven't had access to a hospital. There's simply no hospitals that are too far or they're too poor to access it. So they deliver in their village and home. As a result, in one area where we work, 1 in 12 women will actually die in their lifetime having a baby.
If you get it stuck in labor, this is obstructed labor, then you stay in labor. The ladies I treat have been in labor for 3, 5, 7, 10 days. If they survive, and often they don't, the child inside almost always dies.
After the child dies, sorry for getting descriptive, the intracerebral pressure decreases in the head, the skull bones collapse, so the diameter of the head decreases, they can eventually deliver a stillborn child. They're usually unconscious at that stage. It takes them on average 2 days to regain consciousness on the floor of their hut, and when they do regain consciousness, they find that they're leaking uncontrollably from their bladder, and sometimes their bowel as well. The long labor, the baby's head is pressed against the bones of the mother's pelvis, so all the tissues between are crushed, and has its blood supply cut off. So there are the tissues of the bladder, birth canal, rectum, birth canal. All those tissues, in the crows we call it, the blood supply's cut off, they die. So after they deliver their child, all those dead tissues come away, and they're left with a fistula, or a big hole between the bladder, birth canal, rectum, birth canal. Sometimes 10 centimeters in diameter, huge hole. Sometimes the whole birth canal is destroyed, urethra's destroyed, bowel's destroyed, everything's destroyed. So they leak, they smell, they're ashamed. They're usually divorced. The husband won't have them back in their house.
Might be looked after by their mother. The mother won't be able to look after them in their house. So they might build a little lean-to. And I've had patients locked away in little lean-tos for 12 years, not going out at all in 12 years. Smelling and just leaking urine and feces.

**John Dickson** (5:18)
And is the ostracization, because they're considered damaged goods now, or is it simply that they smell, or is it some other cultural thing?

**Andrew Browning** (5:25)
All of the above.
They think they're cursed.
Other people will think they've done something wrong. They're cursed. But more that they're ashamed. They're ashamed of the smell. So they'll self-hide away. And other people will mock them when they come close to them. They'll be ridiculed. So they hide away. 40% have thought about or attempted suicide with this condition. And if they don't get surgical treatment, they'll live like that for the rest of their lives. And we think there's about 2 million patients. They hide away, so it's difficult to know the number. But they think there's about 2 million of these patients in Africa still waiting for the treatment.