VOA标准英语2011--Healing the Pain of Obstetric Fistula

A medical aid group says many pregnant African women suffer needlessly from complicated or prolonged labor¹. As a result, they're forced to live with obstetric fistula – a condition that scars them physically², emotionally and socially. Doctors Without Borders is highlighting the problem as the world marks the 100th anniversary of International Women's Day on March 8.
Obstetric fistula is a problem rarely seen in western countries, but it can be all too common in developing nations. It's a hole between the vagina and bladder. It's caused when the baby's head places too much pressure on soft tissue in the pelvis. The blood supply to the tissue is cut off, causing it to die and leave a hole. It happens in labor lasting³ days, not hours.
Surgeon Michiel Lekkerkerker, the group's medical advisor⁴ for reproductive health, says, "It is of course certainly a medical problem, but maybe even [a] bigger social problem because many of these women are just ostracized⁵ by their families or their social fabric⁶, so to say, because they are wet all the time. But they smell, too. And since they don't want to be wet all the time, these women also tend to limit their water uptake. And therefore the urine gets more concentrated and they may be less wet, but they start to smell even more."
It gets worse.
"They lose their husbands. They're kicked out of their house. They often have to fully⁷ take care of themselves because they have dropped out of their [social] system and they even have to resort to becoming whatever, sex workers or something," he says.
Doctors Without Borders, also known as MSF, has fistula repair and treatment projects in Burundi, Chad, Nigeria, DRC, and Central African Republic. It estimates that two million women worldwide have fistulas, most of them in Africa.
MSF
Esther Feibouko of CAR developed a fistula in 2008. She says, "When I walked, I would leak urine, and it made me feel bad."
Surgery to repair the damage during childbirth is complicated and requires great skill. It can take anywhere from a half hour to several hours, depending on the damage.
"The majority is quite difficult," he says, "It is of course delicate surgery in a very confined environment because 95 percent is operating within the vagina."
Dr. Lekkerkerker says obstetric fistula usually occurs among young women. But there are cases of women who have been living with the condition for 20 years.
Fistula is just a symptom of a much bigger problem. And that is lack of access to obstetric care. There may be many more women that die as a consequence of a lack of access than you have women that survive with the price of a fistula," he says."
He says we may never know just how many poor women die from a lack of obstetric care.
What's being done
The good news is that with proper medical care fistula can be prevented. And with surgery, repaired.
Prior to surgery, while women are at MSF clinics, they are told to drink a lot of clean water. Usually something they avoid because of their incontinence.
MSF
Fistula patients wait outside the operating room for a consultation⁸.
Lekkerkerker says, "You want to kind of clean the system. And the less the whole environment is, let's say, infested⁹ or contaminated with bacteria the better. So, ideally, you only operate [on] these women when they produce colorless and odorless urine. And indeed in a good fistula repair environment you have many women that are waiting to be operated [on], but there is no stench of urine. There may be puddles¹⁰ of basically water everywhere that those women lose, but it is so unconcentrated that there is no urine stench."
Once the fistula is repaired, recovery may take several weeks. Patients will probably need to use a catheter to urinate, so there isn't much pressure on the surgical¹¹ area.
However, women still may be incontinent after the surgery. Dr. Lekkerkerker says that may disappear with rest or pelvic floor exercises.  Sometimes the catheter will be left in for a few more weeks and in some cases more surgery may be needed.
An African proverb says, "The sun should not rise or set twice on a woman in labor." Doctors Without Borders says the best way to ensure that holds true is to improve medical care for African women.

1 labor   

n.劳动，努力，工作，劳工；分娩；vi.劳动，努力，苦干；vt.详细分析；麻烦

参考例句：

• We are never late in satisfying him for his labor.我们从不延误付给他劳动报酬。
• He was completely spent after two weeks of hard labor.艰苦劳动两周后，他已经疲惫不堪了。

2 physically   

adj.物质上，体格上，身体上，按自然规律

参考例句：

• He was out of sorts physically,as well as disordered mentally.他浑身不舒服，心绪也很乱。
• Every time I think about it I feel physically sick.一想起那件事我就感到极恶心。

3 lasting   

adj.永久的，永恒的；vbl.持续，维持

参考例句：

• The lasting war debased the value of the dollar.持久的战争使美元贬值。
• We hope for a lasting settlement of all these troubles.我们希望这些纠纷能获得永久的解决。

4 advisor   

n.顾问，指导老师，劝告者

参考例句：

• They employed me as an advisor.他们聘请我当顾问。
• The professor is engaged as a technical advisor.这位教授被聘请为技术顾问。

5 ostracized   

v.放逐( ostracize的过去式和过去分词 )；流放；摈弃；排斥

参考例句：

• He was ostracized by his colleagues for refusing to support the strike. 他因拒绝支持罢工而受到同事的排斥。
• The family were ostracized by the neighborhood. 邻居们都不理睬那一家人。 来自《现代英汉综合大词典》

6 fabric   

n.织物，织品，布；构造，结构，组织

参考例句：

• The fabric will spot easily.这种织品很容易玷污。
• I don't like the pattern on the fabric.我不喜欢那块布料上的图案。

7 fully   

adv.完全地，全部地，彻底地；充分地

参考例句：

• The doctor asked me to breathe in,then to breathe out fully.医生让我先吸气，然后全部呼出。
• They soon became fully integrated into the local community.他们很快就完全融入了当地人的圈子。

8 consultation   

n.咨询；商量；商议；会议

参考例句：

• The company has promised wide consultation on its expansion plans.该公司允诺就其扩展计划广泛征求意见。
• The scheme was developed in close consultation with the local community.该计划是在同当地社区密切磋商中逐渐形成的。

9 infested   

adj.为患的，大批滋生的（常与with搭配）v.害虫、野兽大批出没于( infest的过去式和过去分词 )；遍布于

参考例句：

• The kitchen was infested with ants. 厨房里到处是蚂蚁。
• The apartments were infested with rats and roaches. 公寓里面到处都是老鼠和蟑螂。

10 puddles   

n.水坑， （尤指道路上的）雨水坑( puddle的名词复数 )

参考例句：

• The puddles had coalesced into a small stream. 地面上水洼子里的水汇流成了一条小溪。
• The road was filled with puddles from the rain. 雨后路面到处是一坑坑的积水。 来自《简明英汉词典》

11 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。