Over the past 11 months I have been working to develop a children’s book called, Yeshialem Learns About Fistula, which addresses a maternal health condition known as obstetric fistula. In December 2014, the Student Enterprise Office at my University—the School of Oriental and African Studies (SOAS)—announced its annual Ignite Competition for student entrepreneurship. I applied to Ignite by submitting a two-minute video pitch proposing my project. My pitch was successful and thus began my process of creating this children’s book. Before I go any further, allow me to explain what obstetric fistula is.
Obstetric fistula is an injury that results from a prolonged and obstructed labour. Women who develop fistulas can be in labour for up to five days. Because the birth canal is blocked and the baby cannot come out, it will apply pressure to the tissue of the mother’s internal organs causing a hole or fistula to form between her vagina and bladder or rectum. As a result, urine or feces will constantly drip from the woman and she becomes socially-ostracized due to her smell. There is an estimated 2 to 3.5 million women living with fistula across Africa and Asia. It is difficult to have precise statistics around the number of fistula sufferers given that it affects women in remote areas that can be inaccessible.
I first learned about fistula when I was 12 years old. I was about to enter the seventh grade and decided to do a bit of research on West African ethnic groups during my summer break. My search results brought me to an article about a young girl named Anafghat Ayouba who was from Niger’s Tuareg people. Anafghat had endured a four-day labour, which resulted in the still-birth of her child. She eventually developed a vesicovaginal fistula, meaning a hole between her bladder and vagina.
I had never in my life encountered fistula and I was devastated to learn of the consequences—involuntary urination, shame and abandonment—that it had on the patients. Anafghat’s fistula was successfully repaired by a team of surgeons in Niamey and she returned to school in her town, Tarbiyat. In re-establishing herself in her community, she spoke on the local radio about the need to end early marriage. Anafghat wanted to become a doctor, but suddenly she died from an infection a few years after her fistula had been repaired. I was struck by the tragedy of all that had happened in her life over such a short period. Anafghat’s experience with obstetric fistula awoke in me a great desire to study more about the condition and to eventually lead awareness-building around the affliction.
That school year, my seventh grade French teacher, Mr. Melvin, had the class write fictional stories that had to be accompanied by illustrations. For my story, I decided to write about fistula. I called it, Yeshialem the Daughter of Negash. It told the story of Yeshialem, from Negash in northern Ethiopia, as she travelled across Africa learning writing systems that she would later use to help eradicate fistula in Ethiopia. It was this initial story, Yeshialem the Daughter of Negash, that I recently developed into Yeshialem Learns About Fistula upon receiving support from the Student Enterprise Office.
At the time of writing the story for my classroom assignment, my knowledge of fistula was flourishing. I became very passionate about the obscure affliction (that denies so many women across Africa and Asia their dignity). I would continue to write short stories and articles explaining fistula for school newspapers and local writing competitions. A few years later in 2012, I visited the fistula hospital in Addis Ababa and developed my non-profit, the Women’s Health Organization International, WHOI.
As an African, it was really important to me to not harp on the doom and gloom that is too often associated with the people of the African continent and all matters pertaining to them. I happened to read Richard Dowden’s recent blogpost for the Royal African Society and I could not be more in agreement with his opening line, “Africa suffers from adjectives: hopeless, dark rising. Good or bad they are all wrong and should be banned.” In my writings and presentations on fistula, I thus make a deliberate effort to include information about the culture and people living in countries affected by fistula. As you might imagine, I was very excited when SOAS’s Student Enterprise Office decided to support my project, for their support has given me the opportunity to not only bring crucial attention to fistula but to also discuss elements of culture, language, and society, which are part and parcel to the reality of fistula patients.
Around the time I first learned about fistula, I also developed a profound interest in African writing systems and language. African writing systems such as Fidäl and Tifinagh (from the Tuareg people) are integral to the theme of the story. It is in learning to read and write these scripts during her journey across the Sahel that Yeshialem finds ways to help end fistula in Ethiopia.
When writing the story, I thought carefully about the character development of Yeshialem who is the protagonist. I wanted her to have a Pan-African outlook, which I find so relevant to our times considering the ethnic tensions and nationalism that is prevalent in many African communities and the legacies of the Berlin Conference (1884-1885) that are still felt today. Yeshialem’s intercultural insights weave us together. She is Ethiopian in the story— still, she is at once a Nigerien, a Libyan, a Rwandese, a Sudanese—and her sense of belonging to various cultures is not at all in contradiction to her national identity (Ethiopian). In the story, I have reflected Yeshi’s sense of multiculturalism in her clothing, her linguistic capability and in her ability to challenge herself to go outside of her comfort zone which is evidenced in her epic journey from Ethiopia to Niger in the west and back. I deliberately gave her gold hoop earrings that are typical among Fulani women in Mali.
The more I talk to people about fistula, is the more I realize how important it is to share knowledge about the condition. I am extremely motivated by the gasps, winces, and cringes of audiences when I explain the consequences of this heart-rending affliction that causes so many African women to suffer in silence and at times to die in vain.
Fistula patients have a struggle to overcome their affliction and regain their autonomy. I like to think of advocacy around fistula as my part of the struggle in ending the affliction. I do it through the creative—through storytelling.
On November 17th 2015, I will launch Yeshialem Learns About Fistula at SOAS. The event will build important awareness around obstetric fistula. It will underscore that beyond the suffering and tragedy that is fistula exists a great potential for readers everywhere to learn about the rich heritages of many of the countries affected by fistula that Yeshialem visits and their longstanding traditions of literacy. I hope to see you there!