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  • Bonnie Ruder

Celebrating smiles of healing and hope on International Day to End Obstetric Fistula

Two smiling women in decorative blue hospital gowns, one laughing, the other proudly holding her baby

There’s something extraordinary about the smiles that beam from the faces of obstetric fistula survivors at Terrewode Women’s Community Hospital. They exude joy and relief, gratitude and resilience, hope and dignity—once lost to a childbirth injury that left them continuously incontinent, ashamed and ostracized from their communities.

More than 1,000 women and girls have come to Terrewode Women’s Community Hospital since 2019, taking their first steps toward healing, renewal, and self-empowerment. Obstetric fistula is rarely discussed here in the US— thanks to high-quality reproductive healthcare, especially cesarean deliveries when needed, they are virtually unknown. Yet, in Uganda more than 100,000 women are needlessly suffering with fistula, as it’s both treatable and preventable.

I’ve been marking International Day to End Obstetric Fistula every May 23 since I first began conducting research on obstetric fistula in 2010. In those days, women shared heartbreaking stories about waiting years for treatment, taking pills and any medication recommended to them (none successful—fistula can only be cured with surgery), and traveling to distant cities in search of treatment— at a great cost to themselves and their families.


Many times, they were forced to return home still leaking because of overcrowded conditions at the “fistula camp” where they went seeking treatment.  This was a huge disappointment, source of shame and humiliation. Other times, women had had multiple surgeries, but were still leaking—unsure why, leaving them feeling broken and often suicidal.


Woman in bright red dress drapes a red shawl on the shoulders of a fistula survivor in a blue hospital gown

These are the women who inspired Alice Emasu’s vision for Terrewode Women’s Community Hospital—a vision that became a reality thanks to the support of caring and generous people like you.

We knew there was a better way. We knew women with fistula deserved compassionate, holistic care to end their suffering. And given the deep poverty they experienced, we knew that care needed to be provided free of cost.


Hundreds of women each year are now receiving the care we dreamed about at Terrewode Women’s Community Hospital. Every day, the amazing Terrewode doctors and nurses are changing lives, helping women not only regain their continence, but also heal from the trauma of fistula— letting them know that they matter, that they are worthy, that the Terrewode team and a growing community of supporters cares about them. Deeply.


This alone is huge progress. Yet, to truly end fistula, treatment is not the ultimate solution. To end fistula, women need access to high-quality reproductive healthcare. This is how we ended fistula over 100 years ago in the US and most developed countries across the globe. And this is how we will end fistula in Uganda—and everywhere women are still suffering from this preventable injury.

For over 20 years, Alice Emasu and the Terrewode team have worked to raise community awareness and provide safe motherhood education in order to prevent fistula. And families have responded. Today more women seek early prenatal care and deliver in health facilities than ever before in Uganda. Yet, the quality of maternal healthcare in most parts of rural Uganda is shockingly poor.


Today, we hear stories of women going to a health center in early labor, but their complications go unrecognized until it is too late, or they find transport to the regional referral hospital but don’t have the money needed for a C-section. These delays cause the tragedies you have read so much about—stillbirth, fistula, lives in ruin.


So now we have another dream—to take the next step in preventing fistula by providing world-class maternity care alongside fistula treatment at Terrewode Women’s Community Hospital with Phase 2, Terrewode Maternity. We’ll be sharing more about this exciting new chapter for Terrewode later this year. In the meantime, our work to end obstetric fistula continues—one patient, one surgery, one hopeful smile at a time.


Bonnie Ruder is co-founder and executive director of Terrewode Women's Fund.

Photos by Lynne Dobson, Terrewode Women's Fund board director and humanitarian photographer.


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