Obstetric fistulas remain largely unknown to women living in Western Europe, Canada, and the United States, where medical care or other professional assistance such as midwives is available to women before, during, and after childbirth. In parts of the world where medical care remains unavailable, however, this problem is much more common. Obstetric fistulas develop during obstructed childbirth, when a baby’s larger head exerts pressure on a woman’s smaller pelvis, cutting off the blood supply and damaging tissues. In obstructed childbirth, women without access to regular medical care endure labor for ten days, with the baby dying in the process. As the damaged internal tissues die, they leave behind holes called fistulas. These fistulas often occur between a woman’s bladder and vagina or between a woman’s vagina and rectum, resulting in permanent incontinence of urine, feces, or both. In addition to the health problems fistulas create, these women endure public shunning from their spouses and families, and personal humiliation. But this traumatic condition can be resolved in part through surgery and education, at least according to Mary Olive Smith and Amy Bucher’s documentary A Walk to Beautiful. The 54-minute NOVA version chronicles the journey from shame to dignity for three Ethiopian women suffering from obstetric fistulas.
Ayehu is 25. She lost her child in childbirth, and her husband left her after the incontinence began. Ayehu also suffers embarrassment because her own mother refuses to allow her in the house because people might come visit. As a result Ayehu sleeps in a makeshift hut attached to the back of the main house. Ayehu talks openly about wanting to die and her situation seems hopeless until her friend, Fikre, suggests she take the journey to the Addis Ababa Fistula Hospital. The journey requires several hours of walking and bus riding, but Fikre claims the trip changed her life.
The hospital offers hope for a normal life for Ayehu and other fistula sufferers. Smith and Bucher show the hospital as an oasis, with helpful staff and beautiful grounds. Fistula surgeon Dr. Ambaye Woldemichael explains that just in coming to the hospital, fistula sufferers begin healing because they realize they are not alone. Along with counseling and surgery, the women receive education about their condition’s causes and preventions. Women recovering successfully from the surgery also receive new clothes and bus fare home.
Along with Ayehu, two other women seek help at the hospital. Twenty-year-old Almaz suffers a double fistula, and she undergoes surgery to correct the problem. Seventeen-year-old Wubete is returning to the hospital for the third time because previous surgeries failed to fix her problem. Wubete learns that her bladder operates at a reduced capacity, and she receives a special plug to help with her condition.
The stories for all three women end happily. Almaz recovers from surgery and returns home to her husband. Ayehu goes home to her mother, daughter, and others, and she returns to sleeping in the family’s house and socializing with guests. Ayehu and her mother also dismantle the hut. Wubete finds work at Grace Village, an orphanage for children whose parents died of AIDS. She works as a “mother” to four of the children, and she is happy with the treatment and her new life there.
Smith and Bucher offer extensive interviews with both fistula sufferers and the hospital doctors and staff, with some interviews from family members and other advocates. Without a voiceover or on-screen host, A Walk to Beautiful allows these women speak for themselves about their experiences. Subtitles translate the native languages into English. The doctors, nurses, and others place their stories into the contexts of Ethiopia and the country’s healthcare system. Ruth Kennedy, the hospital liaison officer, explains how the lives of hard labor starting at a young age and a diet without enough calories result in these women growing up short. This height deficiency, according Woldemichael, gets more complicated as these girls get married and pregnant as young as 11, making them too small for carrying a child to term and even having natural childbirth. According to Dr. Catherine Hamlin, who co-founded the Addis Ababa Fistula Hospital, these women are not welcome in regular hospitals due to the limited health care. In a country of 77 million people, only 146 gynecologists and obstetricians practice, and most of them live in the cities. Yet most of the women suffering from this problem live in the countryside, hundreds of miles from regular access to healthcare.
Smith and Bucher use their cameras to highlight subtle but powerful points. For example, they use discrete shots of Ayehu’s calves and ankles with streams of urine flowing down to illustrate what the incontinence looks like. The directors include surgery sequences, but they remain behind the protective sheets, focusing instead on the doctors working and showing some shots of bloody gauze. A shot of a doctor walking into a bright light emphasizes the hero status bestowed on him by the women he helps. At Grace Village, a young child climbs on an abandoned tank while playing.
A Walk to Beautiful was released on DVD through PBS’s NOVA, and it includes a short piece titled, “Fistula Worldwide: The Hidden Epidemic,” which provides more information about fistulas within other parts of Africa, Asia, and the Middle East, and the efforts to assist women who have them.