Since opening the fistula center, Wall estimates the facility has taken on 50 fistula cases per month.
It's best to have the institution run by locals trained specifically in fistula repair surgery and care.
"People think fistula patients are witches and just have bad luck, " he says.
Fistula centers rely on donations and cannot afford to hire American gynecologic surgeons.
Bowen was shocked at how affordable fistula repair surgery is, by Western standards.
Now she has a fistula, causing her to urinate and defecate on herself.
An estimated 3, 700 new cases of obstetric fistula occur in Tanzania every year, but only about 1, 000 get treated.
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In most cases, a woman with a fistula doesn't know what a fistula is or that it's treatable with surgery.
Another West African woman in Heller's study, "Amina, " also has a severe fistula but only leaks when she sits down.
She asks that participants practice yoga daily for a week and raise enough money for one woman to have fistula repair surgery.
Fistula leaves women with chronic incontinence which renders them a social outcast.
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She had never heard of obstetric fistula until she read a book featuring a detailed story of an African woman with the condition.
Suffering from Crohn's disease can mean debilitating pain, fistula surgery and diarrhea that can be so severe it can bring on dehydration.
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But it's very difficult to get trained staff to run a fistula hospital, because of the lack of available education in Africa, he says.
"Habsu, " one 32-year-old woman in Heller's study, contracted a fistula in her ninth pregnancy and has had three previous surgeries, all of which have failed.
But even they aren't ideal candidates for the job -- since they never see fistula in their own country, they have no experience with it, he says.
In addition, young mothers face terrible threats to their health such as fistula -- a hole in the birth canal caused by prolonged labor without prompt medical intervention.
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Find an organization that fits your corporate mission and vision, such as imagine1day, the Fistula Foundation, or Partners in the Horn of Africa, and help it tell its story, with media and dollars.
Although he is a full-time professor, Wall last year opened the Danja Fistula Center in Niger, a 42-bed hospital specializing in fistula repair surgeries with an operating room, outpatient clinic and hostel facilities for about 100 women.
Bowen, who is in the process of making the fundraiser a nonprofit organization, says she hopes to help women who have already developed fistula, while the bigger organizations tackle other issues such as poverty, maternal health and human rights.
An estimated 20% of Paluku Lussy's fistula patients report feeling ostracized by their communities, and divorce is common, says the doctor, who started his residency in 2001 at HEAL Africa, a 155-bed tertiary hospital with a fistula repair unit.
One of the youngest in Heller's study, a 15-year-old girl who was married off to her uncle at age 8, spent eight months selling bags of candied peanuts in order to raise enough money to pay for a taxi so she could get to a fistula center.
Although an estimated 2 million women in Asia and sub-Saharan Africa live with untreated obstetric fistula, according to the Fistula Foundation, it's unlikely for these women to meet or hear of anyone else suffering from the same injuries, because of the lack of modern forms of communication and also the women's reluctance to discuss the condition, Heller says.
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