International Urogynecology Journal

, Volume 17, Issue 6, pp 559–562

Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world

  • L. Lewis Wall
  • Steven D. Arrowsmith
  • Anyetei T. Lassey
  • Kwabena Danso
Current Opinion/Update

DOI: 10.1007/s00192-005-0056-8

Cite this article as:
Wall, L.L., Arrowsmith, S.D., Lassey, A.T. et al. Int Urogynecol J (2006) 17: 559. doi:10.1007/s00192-005-0056-8


The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote ‘fistula tourism’ rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about ‘fistula trips’ of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a ‘fistula champion’ who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.

Copyright information

© International Urogynecology Journal 2006

Authors and Affiliations

  • L. Lewis Wall
    • 1
  • Steven D. Arrowsmith
    • 2
  • Anyetei T. Lassey
    • 3
  • Kwabena Danso
    • 4
  1. 1.Department of Obstetrics and GynecologyCampus Box 8064, Washington University School of MedicineSt. LouisUSA
  2. 2.Department of UrologyRehoboth-McKinley ClinicGallupUSA
  3. 3.Department of Obstetrics and GynaecologyUniversity of Ghana Medical SchoolAccraGhana
  4. 4.Department of Obstetrics and Gynaecology, School of MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana