Constantly in pain, incontinent of urine and feces, bearing a heavy burden of sadness in discovering their child stillborn, ashamed of a rank personal offensiveness, abandoned therefore by their husbands, outcasts of society, they live, they exist, without friends and without hope.
– Reginald Hamlin & Catherine Nicholson, 1966

Nearly half a century later, that scenario of obstetric fistula continues to haunt the humanity and has been aptly termed ‘the scandal of the century’.

Between 2 and 3 million women, mostly in Africa, are in need of surgical repair with about 130,000 new patients being added annually.

This colossal embarrassment of our male dominated society will not be solved unless we address the root causes of lack of empowerment. In these societies, a woman’s low socioeconomic status and illiteracy often lead to child marriage followed by early pregnancy. The lack of obstetric care causes obstructed labor and ultimately complex injuries to vagina, bladder and rectum. In the worst case maternal death – which needlessly claims one woman a minute.

Unfortunately our developed world with its economic clout is not willing to come up with any significant help to emancipate the young women of the developing world with education and empowerment, nor with help in providing effective systems of maternal health care. Thus safe motherhood has largely become an orphan initiative.

Historically however we owe it to the African women for our knowledge and surgical technical developments in repairing these injuries. These surgeries were mostly initiated in the US through painful and degrading experiments on the enslaved women in the antebellum south in the 19th century. Those slaves from Africa sacrificed their dignity in muted agony without consent to the extremely painful experiments enforced upon them without anesthesia by racist white physicians and slave owners.

And now after centuries, our complacency in extending any helping hand to the African women is unacceptable and disgraceful.

Watch a webcast of my presentation Vesico-vaginal Fistula Management: A Tribute to Anarcha, Betsy, Lucy and the Hamlins at the 4th International Congress on the History of Urology.

– Sakti Das, 2009.

  • Comment & Share! Use the links to leave your comments/thoughts and share this with others. You can also contact me using the ‘Contact’ links.

MORE INFO & RESOURCES…

“A Walk to Beautiful” – Emmy Award winning feature-length documentary tells the stories of five Ethiopian women who suffer from devastating childbirth injuries and embark on a journey to reclaim their lost dignity. Rejected by their husbands and ostracized by their communities, these women are left to spend the rest of their lives in loneliness and shame. They make the choice to take the long and arduous journey to the Addis Ababa Fistula Hospital in search of a cure and a new life. [PBS/Nova]

LINKS

37 thoughts on “My Painful Musings on the Suffering of the African Woman from Obstetric Fistula”

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    Given the popularity of Anavar, a rival chopping steroid, that is indicative of Winstrol’s
    anabolism. Testosterone can both have good results and raise LDL cholesterol levels.
    Anavar helps with fat loss and rising power due to its DHT properties.

    Current prescription guidelines in the United States by the medical establishment
    name for the very same Anavar dosing protocol as originally described over three
    many years ago. To keep away from unwanted aspect effects like liver toxicity, hair loss,
    acne, and virilization in ladies, follow recommended dosages and cycle lengths.

    Do not enhance your dose or use this drug extra often or for longer than prescribed.

    When an anabolic steroid is misused or abused, you may have withdrawal signs (such as depression, irritability, tiredness)
    if you abruptly cease using the drug. The beneficial Anavar dosage for powerlifters is between 20 to 80mg per day,
    depending on experience level, targets, and body weight.

    It is advisable to start with a lower dose and gradually improve it to the
    desired level to allow the physique to adapt to the consequences of the
    drug. Anavar, also called Oxandrolone, is a well-liked alternative among athletes and bodybuilders because of its mild nature and potential advantages in enhancing muscle definition,
    strength, and performance.
    Nonetheless, these unwanted aspect effects are typically
    minimal at decrease doses and may often be alleviated by taking Anavar with food.
    For endurance athletes, a lower Anavar dosage of round 20mg to 40mg per day could also be adequate.
    This dosage can improve stamina and endurance without considerably
    impacting weight or inflicting undesirable side
    effects. It can also be essential to notice that Anavar should not be used for greater
    than eight weeks constantly.

    References:

    Crazybulk legal steroids, huntsrecruitment.devwithasad.com,

  34. Though a Winstrol-only cycle is not a typical choice for male users, PCT is still required when you
    do go this route. A quality phase of Clomid PCT following a Winstrol cycle is, subsequently, crucial.
    No specific time of day is taken into account best for taking Winstrol, and it will range in accordance with your
    training or performance schedule. With a half-life of around 9 hours,
    oral Winstrol does not need to split the dosage into a number of day by day
    doses like other steroids. Simply like testosterone,
    ladies additionally naturally have very low levels of DHT,
    but never sufficient that it would trigger the development of masculine bodily
    traits.
    Customers can count on to sculpt and outline their physique during this cycle, as the compound works to intensify vascularity and pump
    up endurance ranges, enabling more durable and longer exercises.
    Winstrol is not usually beneficial for females, as they can be susceptible to virilization results from this drug.
    However, in small and cautious dosages, we’ve seen females expertise
    high-quality outcomes with minimal antagonistic
    effects.
    These two are well-known steroids, widely used to enhance performance, facilitate fats
    loss, and help in muscle definition, usually during slicing cycles.
    Both are acknowledged pillars in a field where power, power, and aesthetically pleasing physiques are
    extremely sought. Winstrol is known for its ability
    to provide dry, lean positive aspects in muscle mass.

    Anavar might help restore muscle damage via training
    and allow most of these athletes to coach tougher,
    and more regularly. It may help repair muscle harm after a player receives and impression injury i.e.
    from a body examine, fall or fast paced collision. It’s
    advised not to increase the dose too dramatically whilst on a cycle.
    That means after the primary week (30mg per day) you’ll go upto 40mg for the second week and then 50mg for the third week.
    For males who’re new to Anavar it’s advised to take 30mg
    a day for the first week. Relying in your results and the way you
    are feeling you can then begin to improve the
    dosage for the subsequent couple of weeks. If you’re worried about your testosterone levels, then get them checked out by your physician earlier than taking any steroids and make-sure you go for normal verify ups to extra
    cautious.
    This way, the risk of unwanted side effects is minimized and
    you’ll see how your body responds to the steroids.

    If you are contemplating stacking Anavar and Primobolan, you will need to first
    consult with a healthcare skilled and a knowledgeable steroid coach or trainer.
    They may help you establish the appropriate dosage, cycle length, and monitoring protocol to make sure the safest and best
    use of these steroids. Anavar, also recognized as Oxandrolone, is an anabolic steroid that is derived from
    dihydrotestosterone (DHT). It was first developed within the Sixties to assist promote weight
    achieve in sufferers who had lost weight due to surgery, chronic infections, or
    trauma. Primo is available in each oral and injectable types and is taken into account to
    be a mild steroid with low androgenic and estrogenic exercise.

    Primobolan was initially developed within the Nineteen Sixties for medical purposes such as treating muscle losing
    and osteoporosis.
    Ladies are more probably to construct extra muscle than men when taking Anavar, due to females having decrease testosterone levels.
    Thus, when Anavar administers of their system it’s extra prone to shock their muscular tissues
    into growth, as a outcome of this sudden surge of
    exogenous testosterone. Nonetheless, this compound
    won’t produce the massive bulking positive aspects that come with stronger mass gaining
    steroids corresponding to Anadrol or Dianabol. However, this isn’t to
    say that Anavar won’t ever trigger unwanted effects. In research, Anavar does have the
    flexibility to suppress natural testosterone ranges; although this modest discount will later reverse, with levels recovering post-cycle.

    Some individuals use strong medicines called steroids, but
    they can be risky and have unhealthy side effects. In this text, we will evaluate Winstrol vs Anavar and explain how they work, their advantages,and which one may be greatest in your goals.

    Many other international locations do not have such stringent laws; plenty of nations
    legally allow the use and even the open sale of Turinabol.
    Thailand is one such location, and it’s quite frequent for folks to travel
    to nations like Thailand, where steroids are more readily available
    for buy.
    However, dying through liver cirrhosis is possible if Primobolan is taken in excessive dosages, for
    excessive periods, or given to debilitating individuals.
    Primobolan is considered one of the most secure steroids
    men or women can use; however, it’s not free from unwanted effects.
    “5 mg of anavar is roughly the equivalent of 25mg of anadrol for threat of virilization”.

    Veins which are notably prominent can often resemble a street map on a person’s physique.

    1) get stronger or 2) enhance cell swelling (also generally
    known as hypertrophy training i.e. pumping up the muscles).
    Circulating testosterone because the hormonal foundation of sex differences in athletic performance.

    Furthermore, if a person has experienced gynecomastia, this is
    a sign that the substance is Dianabol (42). These
    are some of the points bodybuilders who go to
    our clinic face when buying UGL Anavar. Equally, utilizing Anavar all year round on a lower dose compared to administering a higher dose in the brief term, the individual is less more doubtless to notice outcomes.

    This is undoubtedly a big profit that Primo has over Winstrol.
    Primo can also be thought of much less dangerous to ldl
    cholesterol well being compared to Winstrol.
    To add to this, Winstrol’s reputation for causing typically very extreme joint pain is not a recognized problem with Primobolan.
    It is identified as one of many extra suppressive
    steroids, although not the worst by any means. Beginning PCT
    after a Winstrol-only cycle is really helpful within about
    12 hours of the tip of the cycle because of the short half-life of this steroid.
    You will aim to reverse the results of the other steroids, somewhat than Winstrol, during your PCT cycle.
    Your power might be each maintained and enhanced even on a strict food plan. Winny will add that good granular look that you miss out on when using Anavar alone.
    Winstrol is well-known for its performance-enhancement advantages, which is why it’s been used by some
    of the finest athletes on the planet up to now. In these
    instances, athletes are not taking Winstrol to enhance their physical look – it is purely about getting probably the most power and pace.

    Newbies, for example, may need to begin with 10 mg per day and
    steadily improve the dosage by 5 mg each two weeks. Comparable to Anavar,
    Winstrol doesn’t aromatize; consequently, striations and
    muscle definition will turn out to be extra outstanding, as nicely as vascularity.
    This is a consequence of the depletion of extracellular water retention, which is the fluid
    that accumulates between the dermis and muscle.
    Winstrol outcomes, actually, any anabolic steroid results,
    could be noticeable, and very notable over several cycles should you really push
    your self. Let’s now discuss you through the Winstrol side effects, each short
    and long-term. The side effects will also apply to using Anavar, or any other illegal anabolic steroid.
    Thus, bodybuilders under our care report greater total fat
    loss on Anavar (vs. Turinabol), especially in the midsection, because of
    a lower in visceral fats.

    References:

    t ball steroid – git.indata.top,

  36. Girls may also experience virilization, which includes signs similar to deepening of the voice,
    facial hair development, and enlargement of the clitoris.

    It’s necessary to consult a medical professional earlier than beginning an Anavar
    cycle to reduce these dangers. Anavar, also identified as Oxandrolone, is an artificial anabolic steroid derived from dihydrotestosterone (DHT).
    It was initially developed for medical purposes, such
    as treating muscle-wasting illnesses. Over the years, it gained recognition among bodybuilders and athletes because of its capability to increase muscle mass and energy, in addition to reducing body fat within the course of.

    When you embark on an Anavar cycle, you can count on to experience significant positive aspects in muscle mass.
    Anavar promotes lean muscle growth without inflicting
    extreme water retention or weight gain. This makes it an ideal selection for individuals who wish to
    achieve a extra defined and sculpted physique.

    Furthermore, these modifications enable the steroid to be consumed orally, as an alternative of
    via an injection. Post-cycle therapy should always be integrated for psychological and physical
    recovery. The heart will also be more protected when a lean person takes Anadrol in comparability
    with somebody who is chubby. Due To This Fact, should you
    do take Anadrol with grapefruit juice, be wary of overdosing because of elevated absorption. We have treated patients after taking Anadrol, trenbolone, and testosterone concurrently, and their outcomes have been noteworthy.

    (Personally, I’ll use the drug for no much less than 6–8 weeks.) Spreading out my dose throughout the day on the identical pace each
    time (20 mg/20 mg/20 mg) yields the greatest results
    for me. Use 50 mg of clomid every single day in the course of the post-cycle remedy part, and
    you need to recover quickly. The common duration of an Anavar cycle for
    males is roughly eight weeks, while the utmost length for women is six weeks.
    As A Substitute of using Anavar constantly for extended periods of time,
    the safest and most successful method to forestall virilization is to take the medicine in cycles of a few
    weeks and in low doses. Nonetheless, earlier than you purchase Anavar on-line,
    you have to have an intensive understanding of how the steroid features and
    the kinds of outcomes to anticipate. In this article, we’ll talk about the benefits of using Anavar for bodybuilding.
    In addition, we are going to present steerage on the way to use this steroid safely and keep away from any potential unwanted effects.

    After finishing an Anavar cycle, it’s beneficial to permit the physique time to recuperate and rebalance its hormone levels.
    Preserving the impressive features achieved with the cycle also demands a disciplined diet and
    routine exercise. Half-life of Anavar is around 6-9 hours, so the plan is to take
    about two to four evenly spaced doses throughout the day.
    Anavar cycles final for 4-8 weeks, for both men and women, the place some males even do a 12 week cycle, normally professional bodybuilding competitors.
    Clenbuterol has additionally been proven to exhibit anabolic effects in animals.

    Thus, by spiking HGH, customers may effectively be growing their own risk for most cancers or worsening any current (unknown)
    tumors. We haven’t discovered HGH to trigger a come-down impact upon cycle cessation, in distinction to steroids, so post-cycle therapy isn’t
    required. Take this treatment by mouth often 2
    to 4 times every day or as directed by your doctor. You can’t use a potent drug like Clenbuterol and not have a lot of unfavorable feedback or complaints/concerns
    being shared.
    People over 40 should think about age-related components and
    regulate their cycles accordingly. Cycles of Anavar may help you achieve muscle, strengthen, and lose significant fats.
    Nevertheless, smart use is crucial to keep well being and security in mind and reduce possible unwanted facet effects.

    Anabolic steroids are much more highly effective than most people assume,
    and so they don’t require big doses to construct a major amount of muscle and energy.
    In today’s article, as you probably can little question surmise from the title, we’re going to try tips on how to dose
    Oxandrolone, aka Anavar. When it comes to an Anavar cycle, the outcomes can range tremendously primarily
    based on a number of elements. Cautious planning helps form up the perfect regimen to
    meet your health objectives. Whether Or Not you are
    aiming for muscle definition, a leaner physique, boosted energy,
    or even weight loss, Oxandrolone’s low androgenic
    properties make it less excessive than different steroids yet efficient.

    A general rule for males stacking Anavar with other steroids is to take a moderate day by day dosage in the range of 20 to 50 mg.
    Many bodybuilders benefit from the elevated capacity to lift heavier
    weights or carry out extensive routines. This amplified strength is a direct results of the steroid’s influence on muscle
    contraction and short-term energy output. Overall, Anavar
    has become an integral a half of bodybuilding, serving to people not
    solely to reshape their bodies but in addition to improve their overall coaching effectiveness.

    Anavar, also identified as Oxandrolone, is a widely known anabolic steroid, sought after for its ability to assist in improved muscle definition and
    total body composition. When you take Anavar the thyroid-binding globulin or TBG
    in your body is decreased while the thyroxine-binding prealbumin or TBP is increased.

    This ends in a cellular improve within the T3 thyroid hormone in your body.

    When undertaken fastidiously, these girls can obtain significant benefits while carefully controlling the side effects.
    On the other hand, you presumably can look at Anavar-only cycles
    in addition to a deviation from utilizing testosterone as the first compound.
    Anavar-only 6-8 weeks cycles could presumably be between 40mg and 100mg
    daily dosing, with less suppression than Dianabol. Anavar is excellent for fat-burning and drying out the physique,
    although, so if that’s your objective,
    it’s the go-to compound. The most common of all steroid effects is an increase in protein synthesis19, with nearly each steroid promoting protein synthesis to
    some degree. With a higher-than-normal price of protein synthesis going on, your muscular tissues can grow
    faster and extra extensively – it sounds simple, but
    that’s the ultimate aim of utilizing steroids (at least for bulking).

    Females will use HGH for a range of reasons – both for its pores and skin and anti-aging
    benefits and higher sleep or for correct health and physique results.
    Women can anticipate similar results and outcomes to male users of HGH in phrases of rejuvenation, recovery, and fats loss.

    The outcomes males can count on will again closely depend
    upon the purpose of use. Unlike standard AAS
    cycles, you can’t put a figure on expected positive aspects with HGH as a result of
    it’s going to improve your steroid cycles somewhat than acting as a standalone muscle builder.
    HGH known as Somatotropin, a peptide hormone naturally produced in our
    physique. As you might guess from its name, progress
    hormone is critical for its results on growth.

    However there’s much more to HGH than that… HGH is a fancy
    hormone; when you perceive its major functions and effects,
    you’ll have the ability to see what makes it appealing to
    bodybuilders and athletes.

    References:

    what do steroids (Jobsforfiji.com)

  37. Firstly, Winstrol is a stronger steroid than Anavar and might result in larger features in muscle mass.

    Nonetheless, it may possibly also have extra side effects
    corresponding to joint pain and liver toxicity. In conclusion, Anavar is an effective slicing agent
    that may help to preserve muscle mass whereas promoting fat loss.
    It can additionally be crucial to remember that Clenbuterol isn’t
    a magic tablet and must be used at the aspect of
    a nutritious diet and regular train. It is not an different
    to hard work and dedication in reaching a leaner and fitter physique.
    It can be important to seek the guidance of a healthcare professional earlier than beginning any Clenbuterol routine to make sure its safety and efficacy.

    A higher dose can lead to dramatic transformations, whereas lower doses can ship refined but vital
    changes. The ideal dosage plan tailored to an individual’s distinctive requirements and targets.
    A well-structured Oxandrolone dosage technique ensures that well being and safety remain paramount while striving
    for spectacular bodily gains. It’s essential to note that extending cycles beyond 12 weeks necessitates the
    addition of a testosterone base and the incorporation of liver assist supplements.

    After a cycle, using DHEA can boost power and velocity up pure testosterone recovery.
    These effects improve nutrient supply, strength constructing,
    and restoration, resulting in most gains.

    Avoid high doses and prolonged cycles to attenuate the danger of side effects when taking Anavar.

    This is certainly one of the primary causes Anavar for ladies is so highly desired as it is considered one of the few
    anabolic steroids they can use successfully without nasty side-effects.
    If you complement with the Oxandrolone hormone and
    start to show indicators of virilization simply
    discontinue use instantly and the signs will go away.
    It is when such symptoms are ignored and allowed to set in that they turn into a problem.
    Utilizing steroids for weight reduction doesn’t need to imply introducing male
    hormones into the body. The main goal right here
    is to reduce the chance of virilization, and Anavar excels in this area
    for women. Known for its fat-burning properties, capability to boost athletic
    efficiency, and capability to forestall muscle loss throughout weight-reduction plan, Anavar stands out as a robust anabolic steroid and fats burner.
    Its decrease chance of inflicting virilization makes it a best choice for ladies looking for to lose fats.

    One methodology I like is to stay with one dose for 2 weeks, then improve it by
    20mcg. A easy 6-week cycle with this technique takes you from 40mcg to 60mcg, then 80mcg for the ultimate
    two weeks. Should you employ Clenbuterol to lose fats should you don’t intend
    to stay with a calorie-controlled food plan and do consistent physical training?
    While Clen can still enhance your metabolism and doubtlessly have you dropping some
    physique fat without exercising, the quantity can be minimal and not worth the unwanted side effects.
    In addition, misusing Anavar or mixing it with different anabolic steroids renowned
    for their high toxicity is more probably to exacerbate undesirable effects,
    which can result in a decline in an individual’s health.

    All The Time seek the guidance of with a healthcare professional before utilizing
    any new treatment or complement. Unauthorized use
    or misuse of this substance can lead to severe authorized
    consequences and well being dangers. When contemplating the suitable Anavar dosage cycle for ladies, it’s paramount to do not overlook that everybody’s
    body reacts in another way to substances, and what works for one particular person could not work for another.
    Strive Anvarol Today and experience a boost in your fitness journey in a secure,
    authorized manner.
    One of the the cause why Primobolan is so effective at selling lean muscle mass is that it considerably will increase the manufacturing
    of IGF-1, a hormone that plays a key function in muscle growth and repair.

    Moreover, Primobolan helps to increase the sensitivity
    of cells to testosterone, resulting in increased protein synthesis and muscle
    progress. Girls utilizing Winstrol sometimes
    experience a big discount in physique fats and a rise
    in lean muscle mass. This would not necessarily translate to a substantial improve in size,
    but somewhat leads to a extra toned and strong physique.
    In Contrast to other anabolic steroids, Anavar is taken into account to have a decrease efficiency in phrases of selling weight loss.

    A typical suggestion for novices is to provoke with a day
    by day dose starting from 5 to 10 milligrams. This
    average dosage serves as an introductory level, enabling users to judge how properly their
    physique tolerates the steroid. It is essential for customers to closely observe their progress, assess results, and monitor any potential
    adverse outcomes as they acclimate to the brand new addition to their fitness routine.

    Unlike different steroids, Anavar is particularly designed for girls,
    so it’s much safer and simpler. When used correctly, Anavar will assist
    to increase metabolism and promote fats loss. In particular, Anavar
    or Oxandrolone is a steroid that can be helpful for girls
    who need to enhance their physique and efficiency.

    Beneath, we are going to talk about the benefits of Anavar for ladies and how it
    might help them achieve their fitness targets.

    Regardless Of its overall success, scientists found
    incidents of somatrem causing antibody reactions, reducing its organic availability and effectiveness.
    Nonetheless, Ostarine remains a analysis chemical, and thus we
    do not know its side effects long-term. The above Ostarine cycle is widespread amongst female novices
    who have not cycled Ostarine beforehand. Based on our LFTs (liver operate tests),
    liver enzymes will temporarily rise on Ostarine, causing slight hepatic irritation (4).

    However, this is unlikely to be troublesome, considering Ostarine’s gentle
    nature and the resilience of the liver. Some girls struggle with low vitality, fatigue, and a lack
    of motivation, significantly when they have estrogen dominance.

    Anabolic steroids, when used by females, result in the event of male bodily features.

    Women can use Winstrol at very low doses with little or no danger of these virilizing unwanted effects, but
    at doses of 15mg or more every single day, a feminine runs a excessive threat of changing into more masculine in many ways.
    Though she won’t flip into a person, this powerful androgen,
    when used at excessive doses or for too lengthy, will take away femininity and cause a lady to look and sound very totally different.
    Males undertake post-cycle therapy following a steroid cycle due
    to the suppression of their pure testosterone manufacturing.
    This is not a problem for female steroid customers and implies that once a lady finishes a Winstrol cycle, there’s nothing else to do and
    no PCT to worry about. Winstrol and all different anabolic steroids
    are listed as Schedule III managed substances in the Usa.

    Individual responses to Clen will dictate a comfortable and
    efficient dose for you and how long you employ it. If you check out many Anavar reviews,
    you will find that this drug offers very good long-term features.

    Specifically the small lean muscle gains and impressive fat loss that’s seen via Anavar results won’t simply disappear inside
    a couple of weeks as lengthy as you run a great
    post-cycle remedy (PCT). Distinction this to different drugs like Dianabol and Anadrol, which do not normally ship
    as keepable of features. Anavar is primarily taken orally, a key
    distinction from many injectable anabolic steroids.
    Its C17α-alkylation allows effective systemic absorption through oral tablets, usually available in 2.5 mg,
    5 mg, or 10 mg doses for exact adjustments. Due to its quick half-life, customers usually break
    up every day doses to take care of steady blood ranges.
    This contains Canada, the UK, and a few EU countries like Denmark, Norway,
    Finland, and Sweden. Winstrol is usually straightforward to seek out and legally bought
    in plenty of different nations, including India, Greece,
    Thailand, and Egypt. In these cases, when you’re already very lean, you don’t have
    plenty of fats to lose besides some stubborn areas.
    Winstrol outcomes will begin approaching quick because of its
    fast-acting nature, and without any estrogenic side effects,
    you won’t be worried about bloating ruining your physique.

    References:

    steroids safe (dev.aimplace.io)

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