Q&A with Dr. Joseph Ruminjo about traumatic fistula

Dr. Joseph K. Ruminjo is the Clinical Director for the Fistula Care Project. He is an obstetrician-gynecologist with more than 20 years’ experience in reproductive health services in Sub-Saharan Africa.

What first drew you to the field of sexual and reproductive health? How did you become involved with traumatic fistula specifically?

As a medical undergraduate, and then as an intern and medical officer working in Kenya, I was struck by the large number of women dying, often with their babies, from pregnancy and delivery, conditions that are theoretically normal, safe, and routine. Worst of all, most of these cases were preventable with access to health care at either the community or facility level. On the positive side, it was very fulfilling to see the joy of a family saved from this situation by timely and competent care.

One of the most devastating situations, other than death, was obstetric fistula. Over time, I came to see cases of fistula that were from gynecologic trauma, rather than childbirth. I realized that these survivors suffered from the double stigma of having been raped and the inescapable smell from constant leakage of urine and/or feces. Sufferers are also more susceptible to HIV and other STIs and wrestle with issues such as unintended pregnancy.

Can you recount an especially motivating experience regarding traumatic fistula?

While working at a hospital in Kenya, I once treated a young girl who had been raped by an adult. The trauma had been so severe that the genital tissues separating both the rectum and bladder from the vagina were completely destroyed. To make matters worse, her attacker had been infected with gonorrhea. It was a difficult surgery—I operated on her for nearly three hours. Fortunately I was able to repair the fistulas, and she received the appropriate antibiotics. Her emotional rehabilitation will be an ongoing process, but she is now back at home with her family.

What changes have taken place as a result of your work and the work of the EngenderHealth Team?

I believe that we have fostered a greater awareness in the international community of traumatic fistula as a public health problem, as well as drawn attention to the deficiencies in program quality and service delivery for sufferers. We have also contributed to an increase in policy and advocacy support and encouraged greater commitment to prevent and treat traumatic fistula among non-governmental organizations (NGOs) and respective countries’ Ministries of Health.

How has working for EngenderHealth inspired or changed you? 

Through my work at EngenderHealth, I have been able to effect change not only on an individual, one-on-one basis, but also at the community level. At the same time, I have also realized that while numbers and magnitude are important, we must uphold the right to prevention and treatment of fistula one woman at a time.