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For many, the “face” of early marriage is usually a young girl, often uneducated and unprepared both emotionally and physically to endure the practical and cultural responsibilities of a marriage.  However, for me, there is another face of one who’s been affected by early marriage—the elderly woman.


As a documentary filmmaker who produces films on pressing maternal health issues, I’ve met several of these women while shooting short films on a horrific childbearing injury that is often brought on by early marriage. It’s called obstetric fistula and is caused by a woman being unable to physically deliver her newborn baby naturally.

With early marriage comes early pregnancy.  A young girl, physically unable to deliver a baby, may experience an obstructed labor sometimes lasting up to four or five days. Without access to emergency obstetric care or a “C section,” she may lose her life.  If she is lucky, she survives but delivers a stillborn baby and experiences so much internal pelvic damage that she leaks urine (or feces, or both) continuously, for the rest of her life.

In Niger, Liberia, DR Congo and Sierra Leone, I have filmed several elderly women living with fistula.  They are beautiful women, oftentimes in their 60s or 70s, who have shared their stories about living their entire lives in shame (because of the constant smell from the leakage), in fear (because their health problems threaten their ability to be productive, working members of their community) and in physical discomfort (experiencing rashes, infections and “foot drop,” a neurological problem—caused by constant pushing during delivery—that affects their mobility).

The elderly fistula patients were few and far between. Most of the ones I’ve met were from rural areas, had lived with their condition since their teenage years and seemed uncertain about seeking treatment at this point in their lives.  The complications with their early pregnancy brought on by their early marriage became a life-long burden they accepted as their destiny.

Although many I’ve met lived in the shadows with their condition, this all changed during my 2011 shoot in Tanzania.

With the support of UNFPA (the United Nations Population Fund), I traveled to the coastal city of Dar es Salaam to document an innovative program with the CCBRT Hospital that used mobile phones and the M-PESA banking system to help identify, treat and provide transportation to women living with fistula in the rural areas.

“Community Ambassadors” throughout Tanzania’s vast landscape helped identify these women, received funds through M-PESA, then assisted fistula patients getting on buses to travel from far-away locations to receive free care.  The CCBRTHospital reports a marked increase in the number of patients served since starting its mobile phone program.

What this meant for elderly women, and the country as a whole, was that living with fistula was no longer a life sentence; it became a condition that could be managed and treated.  What was once seen as a huge undertaking for a fistula patient—to find a treatment facility that could provide free care, to find funds to cover the travel costs, to receive free food and lodging until fully recovered and to get free transportation back home—was relegated to a few phone calls, an exchange of funds and a bus ride to the hospital to begin the treatment process.

To see a woman who has been living with this socially and physically destructive condition for over 40 years live out her golden years without the discomfort and social exclusion fistula causes is a remarkable experience to witness and a testament to the incredible work being done on the ground by fistula advocates and care providers.  It’s an honor for me to see this transformation.

Lisa Russell is an Emmy Award-winning documentary filmmaker who uses the power of film to explore and challenge social injustices that affect our collective humanity. Completing her master’s in Public Health degree in International Health in 1998, Lisa has since turned a lens to pressing global health and development topics that have taken her to shoots in some of the world’s most remote locations. Some of Lisa’s work has been broadcasted on public television (including PBS and Channel 4 London), while others are tied into advocacy, fundraising or legislative efforts with the UN and international agencies. Currently residing in Brooklyn, NY, she is a teaching artist with Urban Word NYC, the city’s leading non-profit providing workshops in spoken word poetry and creative writing for NYC teens.

Follow Lisa on Twitter @lisarussellfilm and www.governessfilms.com.