Obstetric fistula is a birth complication that almost always results in the death of the baby and leaves mothers, if they survive, with incontinence. It’s a devastating condition that often leads to social isolation, depression, and sometimes serious health conditions.

Estimates vary widely, but all point to at least several thousand new cases per year and about half a million women who have suffered from fistula. Frustratingly, the affliction is both preventable and can usually be repaired with proper surgery. In 2017, over 8,200 women were treated by United Nations-funded initiatives alone, according to a Maternal Health Thematic Fund annual report.

Bangladesh is aiming to end obstetric fistula nationwide by 2030 — a bold goal in which Dr. Iftikher Mahmood will play a major part.

Mahmood, a Miami, Florida-based pediatrician, is the driving force behind HOPE Foundation for Women and Children of Bangladesh, an organization that has been tasked by the government with overseeing the elimination of obstetric fistula in the country’s largest geographical province. This province, the Chittagong Division, is home to more than 30 million people, or about 18% of the total population in the South Asian country.

To accomplish eliminating fistula in this region, HOPE is currently building a new hospital, which will allow them to care for more women during childbirth. Additionally, HOPE’s team of specialized obstetric surgeons will be training new surgeons, as well as creating a curriculum to inform even more doctors, on how to avert the condition. A major challenge in Bangladesh, however, is the paucity of doctors, of all specialties, per capita, with only 3.6 per 10,000 people. The U.S. has 24.5 and Qatar, the most, has 77.4, according to the World Health Organization.

If women don’t receive the care they need during pregnancy, serious complications can occur. “As a physician, I believe in  health care for everyone. So when I learned about this fistula problem, I decided I will do something about it, in Bangladesh,” Mahmood told Direct Relief during a recent visit to the organization’s California headquarters.

Mahmood and his organization were entrusted with such a wide swath of the nation based on the strength of their past work, which began in 1999. HOPE began as a one-room, outpatient clinic built on land Mahmood’s family owned and was staffed by a volunteer doctor. It grew exponentionally, and the foundation reported treating 222,000 patients last year across its two hospitals and 18 health centers, many of which are in underserved, rural areas.

HOPE also conducts midwife trainings and is present in the Rohingya refugee camps, where they treat more than 300 patients per day, despite often facing adverse natural and social conditions.

Though they help fill gaps in the Bangladesh’s healthcare system everyday, this mission of responding to crises has endured. Over this past summer, Mahmood led a mission 500 miles away from his group’s home base, in Cox’s Bazar, to the north of the country in order to help victims of flooding.

HOPE was able to respond with crucial supplies, including Direct Relief donations, such as water purifying packs, Vaseline, soaps, vitamins, medicines and first-aid kits.

Bringing Realizations to Life

In dealing with fistula, Dr. Mahmood, who was born in Bangladesh and completed his medical residency and fellowship in New York, is manifesting two separate insights he had many years ago.

Growing up,  Mahmood said he witnessed many inequities in the health system. “There were a lot of difficulties in accessing medical care,” he said, and those insights motivated him to go to medical school.

“I have the ability and I learned a lot [in the United States] so instead of using it for my personal benefit only, I wanted to share with people who really need help,” Mahmood said.

Regarding his decision to address maternal health in Bangladesh, Mahmood said he determined that, in order to have healthy children, care must start at the earliest juncture possible.

“The reason I focused on maternal health being a pediatrician, is that I realized that if you have a healthy mother, you have a healthy child,” he said.

The HOPE Foundation aims to continue its work in caring for the most vulnerable populations in Bangladesh by increasing its capacity via new infrastructure projects as well as ongoing partnerships with Direct Relief, Unilever, and the United Nations Population Fund.

“If we can share some of the resources for the people that cannot afford health care, it is a blessing that we can be part of these kinds of efforts,” he said.

“We’re all human beings and we all have feelings like joy and pain. We all go through diseases, and health is important for all of us,” he said.

Additional reporting contributed by Paulina Ospina and Joe Harrison.