Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world

Abstract

The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote 'fistula tourism' rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about 'fistula trips' of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a 'fistula champion' who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.

Vesicovaginal fistula: Do the patients know the cause?

“…American and European specialists also come as volunteers on short-term trips to perform fistula repair operations at the hospital. [13] After obtaining institutional permission and consent of the patients, one of the authors (MAH) administered pre-tested questionnaire on all the VVF patients who were on admission awaiting surgery or recovering from surgery from June to August 2003, on a one-on-one basis. It was a purposive sampling.…”

Ethical Concerns Regarding Operations by Volunteer Surgeons on Vulnerable Patient Groups: The Case of Women with Obstetric Fistulas

“…His point-and that of others who have since used the term (see Wall et al 2006)-was not to denigrate the good intentions of persons participating in short-term medical missions, but rather to emphasize the dangers involved in acting on good intentions unsupported by adequate personal skill or the institutional capacity to provide minimum levels of safe and appropriate surgical care. Just as there are minimum prerequisites for doing surgery safely, so too there are minimum ethical prerequisites for undertaking a surgical operation on another human being, regardless of the nature of her injury, skin color, ethnicity, financial status, or level of education.…”

Weibliche Genitalbeschneidung

“…[26]). In verarmten Gegenden Afrikas und Asiens stellen Fisteln aber immer noch ein gravierendes Problem dar, vor allem in Gebieten, in denen Frauen bereits im Alter zwischen 13 und 15 Jahren heiraten und gebären [27]. Gerade weil es in den Entwicklungsländern häufig an Kapazitäten und Know-how für die chirurgische Therapie fehlt, führen VVF oder retrovaginale Fisteln (RVF) zwangsläufig zu Harn-oder Stuhlinkontinenz.…”