Hope in the Margins

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On International Day to End Obstetric Fistula, we asked Brooke Sulahian, Founder of Hope for Our Sisters, to help us learn more about this tragic injury and the ways in which it might be prevented, treated, and healed.

In June 2010, I read about fistula for the first time. That day, God allowed my heart to break, and my life was forever changed.

For the many of you that have not heard of fistula, let me take a moment to explain the nature and causes of this horrific injury. Obstetric and traumatic fistula presents as a hole between the tissues of the vaginal canal and bladder, vaginal canal and rectum or all three. As a result, women with fistula constantly leak urine, feces or both. Many are shunned and abandoned by their husbands, families and communities. An estimated 2-5 million women worldwide suffer from fistula due to obstructed labor (76-97% of fistula cases), trauma (usually caused by violent rape) or medical error.

Many Americans have never heard of fistula, because it is a condition that is nearly obsolete in the developed world. However, it is a huge problem in developing nations where poverty, malnourishment, early marriage and pregnancy, low education levels, political unrest, use of violent assault as a weapon and lack of access to adequate medical care all contribute to the occurrence of fistula.

Perhaps the most tragic aspect of fistula is the ostracization it causes. Women with fistula are made to believe that they have no value and contribute nothing to their community, larger society or the world. In 90% of obstetric fistula cases, the unborn baby will die. Yet rather than receiving the comfort and love of family during this time, these precious women and girls created in God’s image, are pushed to the margins of society in their loss, and fistula keeps them there.

After first reading about fistula, I envisioned isolated women suffering without dignity or hope. And yes, this is the tragic case for many women with fistula. However, recent trips to Angola and the Democratic Republic of the Congo (DRC) challenged this view as I witnessed the dignity, hope, strength and courage of fistula survivors.

While traveling with World Relief in the DRC, I met my first survivors of rape, many with traumatic fistula. Their stories told of their miraculous transformation, from a desire to die to the desire to live, hopelessness to hope and a lack of dignity to a belief in their priceless value in God. Here was strength and courage in the margins.

In Angola, I witnessed Maria put on earrings before we took her picture. I witnessed Celia, battling an infected colostomy, surprise us with smiles, jokes and confidence. Here was hope and dignity where I believed it could not be found!

We cannot let fistula destroy this dignity, hope, strength and courage. Instead, I believe that our investment of hope, love, prayer and resources will eventually defeat fistula, so that the next generation of girls in developing nations won’t have to face such a life of loss.

At Hope for Our Sisters, we began by funding fistula surgeries and will continue to do so. However, we know that treatment is not enough. We want to invest in our sisters before they become injured and prevent fistulas before they are created. Our answer? Prevention, treatment and empowerment.

Obstetric and traumatic fistula is 100% preventable. And though prevention can be hard to measure, it has the potential for lasting impact. Preventative measures are everything from education and awareness, to prenatal care, to proper nutrition, to assisted delivery, and help covering the costs of each of these treatments. At Hope for our Sisters, we partner with World Relief and other organizations to meet these needs.

In cases where prevention is sadly no longer an option, women suffering from fistula need a variety of interventions and treatments to help restore them to health and wholeness. We help to fund fistula surgeries to restore these women to their optimal physical health status, as well as creating empowerment programs that are key to repairing some of the psychological trauma associated with suffering from fistula. Marketable skills, such as sewing items or weaving baskets to sell in the local markets, equip women to contribute to their families and communities while rediscovering a sense of value.

We are also very proud to partner with World Relief on their Sexual Gender-Based Violence (SGBV) program. These groups provide our beautiful sisters with much-needed community, assistance with owning and sharing their stories, opportunities to give back by providing for women who join the groups and the encouragement to help change their culture one step at a time. SGBV groups teach communities across the DRC that all women have inherent value, no matter their circumstances.

We at Hope for Our Sisters and our partners at World Relief see our sisters’ priceless value. We see the lives they could be living and the contributions they could be making. We envision a world where women are valued, live to their fullest potential, and are positive change-agents within their communities.

Together, we can bring God’s precious daughters out of the margins and back into fullness of life.


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Brooke Sulahian - Following a successful thirteen-year career in Human Resources and four years as a stay-at-home mom, Brooke’s eyes were opened to the plight of women and girls around the world who lacked access to medical care and suffered from, or were at risk, for fistula. As a result, she co-founded a volunteer group in October of 2010, which led to the founding of Hope for Our Sisters, Inc. in January of 2012. She is driven by her belief in the inherent value of each person and her hope that women and girls around the world will one day be fully cherished and valued by their families and communities, as God intended. Brooke lives in the Boston area with her husband and two children.