Fighting fistula: Razia's brave recovery from pregnancy nightmare

In a remote village in central Pakistan a teenage girl is screaming for help in unbearable labour pain. There are no trained midwives or doctors around for miles in Rahim Yar Khan District in southern Punjab.

The only help at hand is the neighbourhood dai, or traditional birth attendant. She doesn't have the skills or the training to handle a complicated pregnancy.

Still, she gets on with what she knows best: pushing and pulling with her hands, as if trying to rearrange the insides of the young woman.

The pain becomes so severe, the woman, Razia Shamshad, loses consciousness.

Her ordeal drags on for about four days, at the end of which the dai manages to pull out the remains of what would have been a baby girl.

As if the trauma of losing her first child isn't enough, Razia is also left with chronic incontinence. But the dai tells her not to worry, saying "it's all going to be fine in due course".

Instead, Razia's condition worsens as she starts leaking faeces and urine from her vagina.

'Worse than being blind'

What she doesn't know is that her long and fruitless labour has caused obstetric fistula - preventable and treatable, but not if you live where she does.

"My clothes were constantly wet and filthy below the waist. I would smell all the time. I felt helpless," she says.

"Some neighbours and relatives despised me. Others made fun of me. They said I must have done something to deserve this."

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But Razia's only fault, it would seem, was that she was born into a poor family and with a genetic sight disorder.

As a visually impaired girl, in a country which prizes boys, she was never sent to school, even though she was smart enough to memorise the Koran at an early age.

When she became a teenager, Razia was married to a man she did not really know. But she soon became a young widow when her husband died in a road accident. At the time, she was six months pregnant with her first baby.

Living with an elderly father-in-law and with no professional antenatal care at hand, Razia's pregnancy became her nightmare. The traumatic episode left her in a condition she describes as "worse than being blind".

Obstetric fistula is little known in Europe and the US where it has been virtually wiped out because of improved obstetric care.

/By BBC/