Image courtesy of Mairead Kelly.
John Kelly was a Scottish surgeon. Over the course of 45 years he operated on thousands of women in Africa to save them from fistula - a debilitating condition where a tear in the birth canal is caused by prolonged labour. If untreated, it can leave a woman with chronic incontinence and in most cases a stillborn baby.
In 1967 Kelly took a sabbatical to do voluntary medical work in Nigeria during the Biafran War he subsequently returned to Africa in 1970 when he was asked to help a pioneering husband and wife team in Ethiopia called Reg and Catherine Hamlins who founded the Addis Ababa Fistula Hospital. The two surgeons were overwhelmed by the number of patients and the sheer scale of what turned out to be a silent epidemic.
That was Kelly’s first experience of the condition and its devastating impact on women. It changed the course of his professional life. Back at work in Birmingham, the Royal London Hospital-trained surgeon planned further trips to Sudan, Somalia, Somaliland, Uganda, Ghana and Pakistan.
He asked his private patients if they would donate their fee to a fund for ‘Third World Projects’ as he called them at the time. This money went to fund his work next trip, and the next, and the next.
Paying tribute to Kelly, IPPF Director General Tewodros Melesse said: “John was an example to us all. A highly skilled surgeon he devoted his life to helping thousands of women often from remote rural locations in Africa and Pakistan. The best tribute we can pay him is to ensure that we continue to tackle fistula and its causes and we rededicate ourselves to that fight in his honour, thanking him for all his work.”
Untreated, fistula can also lead to a variety of appalling conditions. As well as incontinence it can cause ulcerations, kidney disease, and nerve damage in the legs.
It’s most common in poor communities in sub-Saharan Africa and Asia where access to or use of obstetric care is limited. Surgery can normally repair the injury.
A few weeks before he died Kelly talked about his work.
“The tragedy is that most fistula is preventable,” he said. “Delay is the main cause. And I can see why people delay in seeking help. There are many reasons. If you live in rural Sudan, for example, it’s dangerous to travel after dark, the cost of transport is prohibitive, or you may need your husband’s permission to go to hospital.
“And then there’s cost. When you get to a clinic you will be asked to pay for an IV drip up front and even an anaesthetic. People have to weigh up carefully if they can afford these services. And so they delay and prolong an already obstructed labour. The result is fistula, or worse still, haemorrhage.”
Kelly was convinced that the route to solving fistula was not simply a surgical one.
More midwives and training of traditional birth attendants to spot the signs of fistula before it happens, or to advise women to space their births, to help young girls avoid getting pregnant before their bodies are ready: all these can help bring down the rates.
And a sequence of his former patients became midwives – their experience and their training combining to help them explain to women in their local communities about ways to avoid the condition.
Fistula may be preventable, but today at least 2 million women in Africa, Asia and the Arab region are living with the condition, and some 50,000 to 100,000 new cases develop each year. Like maternal mortality, that other preventable tragedy, fistula affects the most powerless women.
Kelly quickly found that his work was not simply a case of surgery.
“It’s really a team effort involving cleaners, midwives, electricians, builders…
“I quickly learned that wells have to be fenced so animals didn’t pollute the water. High-powered medics in London don’t have to think of these things.”
To reach Kelly, women would often have to travel large distances. Some would use plastic bags to protect their clothes from leaks.
“One woman came to us after a dreadful journey, it had taken her days because she had arrived at the stop with a rusty tin can to sit on for the long and arduous journey. Spotting the tin, the driver wouldn’t let her on the bus. In some parts of Ethiopia they would be turned off the bus, even in the middle of nowhere. It made me realise how debilitating fistula can be.”
After that he took steps to ensure a female aide accompanied women to the bus stop to ensure they were able to travel.
In Darfur he founded a clinic that has now expanded to include a medical school. Medical supplies are provided in part by the International Planned Parenthood Federation.
In his final interview Kelly said: “I’m waiting for the day when I open the door and there are no more women waiting for fistula repairs. It’s got to come.”
Let’s make sure his dream becomes a reality.