Skip to main content


Log in

Another view of “humanitarian ventures” and “fistula tourism”

  • Letter to the Editor
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript


There are many ethical issues involved in medical missions to developing countries. The Current Opinion/Update “Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world” raised many concerns about surgical trips to treat obstetric fistula. Despite a lack of experience with obstetric fistula, western surgeons may still bring surgical and public health techniques that may be of value to health systems in developing countries. Emphasis should be placed on program development and assessment first. This should include not only surgical training but also help with counseling, prevention and reintegration. Participation in clinical trials should be up to the health care personnel in the country being helped, and aide should not depend on such participation. Success will likely be determined by a national effort and integration into existing health systems, not isolated “fistula champions.” The appalling situation of obstetric fistula in the twenty-first century should be a wake-up call to obstetricians/gynecologists and urologists. The dictum “first do no harm” must not evolve into “first do nothing.”

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.


  1. Wall LL, Arrowsmith SD, Lassey AT, Danso K (2006) Humanitarian ventures or ‘fistula tourism?’: the ethical perils of pelvic surgery in the developing world. Int Urogynecol J Pelvic Floor Dysfunct 17(6):559–562

    Article  PubMed  Google Scholar 

  2. Murray C, Goh JT, Fynes M, Carey MP (2002) Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula. BJOG 109:828–832

    Article  PubMed  Google Scholar 

  3. Browning A (2004) Prevention of residual urinary incontinence following successful repair of obstetric vesico-vaginal fistula using a fibro-muscular sling. BJOG 111:357–361

    Article  PubMed  Google Scholar 

  4. Mteta KA, Mbwambo JS, Eshleman JL, Aboud MM, Oyieko W (2000) Urinary diversion in children with mainly extrophy and epispadias: alternative to primary bladder closure. Cent Afr J Med 46(12):318–320

    PubMed  CAS  Google Scholar 

  5. Li SW, Zhang SW, Lin XG, Zhang K, Yang W (2004) Sigma rectum pouch for urinary diversion. Chinese Med J 84(13):1096–1097

    Google Scholar 

  6. El-Lamie IK (2001) Preliminary experience with Mainz type II pouch in gynecologic oncology. Eur J Gynecol Oncol 22(1):77–80

    CAS  Google Scholar 

  7. Fisch M, Wammack R, Hohenfellner R (1996) The sigma rectum pouch (Mainz pouch II). World J Urol 14(2):68–72

    Article  PubMed  CAS  Google Scholar 

  8. Lassey AT, Peterson CF, Ampofo K (2002) Pregnancy and delivery after ureterosigmoidostomy for vesicovaginal fistula. Int J Gynecol Obstet 79:25–26

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mark A. Morgan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Morgan, M.A. Another view of “humanitarian ventures” and “fistula tourism”. Int Urogynecol J 18, 705–707 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: