Obstetric fistula is as old as mankind. While the incidence has diminished progressively with better health care in Western societies, the situation has changed little in many developing countries. Fistulae of pelvic organs, often monstrous defects, still are a major complication of child-birth causing misery to uncounted young women, and if they cannot find help in one of the very few hospitals with trained specialists, they became urological cripples losing everything: family, home and job. The magnitude of the problem is illustrated by some figures given by Reginald and Catherine Hamlin-about 700 fistula patients treated each year-a total of over 10,000 cases operated upon in their fistula hospital in Addis Ababa, Ethio pia. Most of these injuries could be prevented by better health care at the village level as some studies have shown conclusively. The incidence of fistula is an indicator of the standard of health and obstetrical care. The author of this book-Obstetric Fistula-is an internationally known Australian gynaecologist who for many years has been interested in all aspects of gynaecological urology, especially urinary stress inconti nence, other forms of involuntary loss of urine, and associated gynaeco logical conditions. He has devised a number of new operations to treat pelvic defects. Robert Zacharin's interest in obstetric fistula was a con sequence of his surgical activity in developing countries.

There is now a worldwide awareness of the vast number of women with untreated childbirth injury in Africa and other poor countries. These shameful injuries are preventable but this will not occur until there is improved access to quality obstetric care. While improvements in these services are the top priority, there is a great need to train more surgeons, especially nationals, to have the skill and resources to help these long-suffering incontinent women.

This practical manual has three main objectives: to draw attention to the urgent issue of obstetric fistula; provide background information along with principles for developing fistula prevention and treatment strategies and programmes; and contribute to the development of more effective services for women under treatment for fistula repair.

Essential Surgery is part of a nine volume series for Disease Control Priorities which focuses on health interventions intended to reduce morbidity and mortality. The Essential Surgery volume focuses on four key aspects including global financial responsibility, emergency procedures, essential services organization and cost analysis.

Over the past few decades, maternal childbirth injuries have become a potent symbol of Western biomedical intervention in Africa, affecting over one million women across the global south. Western-funded hospitals have sprung up, offering surgical sutures that ostensibly allow women who suffer from obstetric fistula to return to their communities in full health. Journalists, NGO staff, celebrities, and some physicians have crafted a stock narrative around this injury, depicting afflicted women as victims of a backward culture who have their fortunes dramatically reversed by Western aid. With Beyond Surgery, medical anthropologist Anita Hannig unsettles this picture for the first time and reveals the complicated truth behind the idea of biomedical intervention as quick-fix salvation. Through her in-depth ethnography of two repair and rehabilitation centers operating in Ethiopia, Hannig takes the reader deep into a world inside hospital walls, where women recount stories of loss and belonging, shame and delight. As she chronicles the lived experiences of fistula patients in clinical treatment, Hannig explores the danger of labeling “culture” the culprit, showing how this common argument ignores the larger problem of insufficient medical access in rural Africa. Beyond Surgery portrays the complex social outcomes of surgery in an effort to deepen our understanding of medical missions in Africa, expose cultural biases, and clear the path toward more effective ways of delivering care to those who need it most.

The accomplishments of pioneering doctors such as John Peter Mettauer, James Marion Sims, and Nathan Bozeman are well documented. It is also no secret that these nineteenth-century gynecologists performed experimental caesarean sections, ovariotomies, and obstetric fistula repairs primarily on poor and powerless women. Medical Bondage breaks new ground by exploring how and why physicians denied these women their full humanity yet valued them as “medical superbodies” highly suited for medical experimentation. In Medical Bondage, Cooper Owens examines a wide range of scientific literature and less formal communications in which gynecologists created and disseminated medical fictions about their patients, such as their belief that black enslaved women could withstand pain better than white “ladies.” Even as they were advancing medicine, these doctors were legitimizing, for decades to come, groundless theories related to whiteness and blackness, men and women, and the inferiority of other races or nationalities. Medical Bondage moves between southern plantations and northern urban centers to reveal how nineteenth-century American ideas about race, health, and status influenced doctor-patient relationships in sites of healing like slave cabins, medical colleges, and hospitals. It also retells the story of black enslaved women and of Irish immigrant women from the perspective of these exploited groups and thus restores for us a picture of their lives.