Mrs. Sah developed a Fistula since she gave birth to her first stillborn child long ago, sometime in the early 1970s, when the country was in a civil war. She was mobilized by the Khmer Rouge to live in a camp where a traditional birth attendant (Yeay Morb) delivered her child.

A few weeks after the delivery, she realized that lost urine without control. She thought she was the only person having this problem and did not know how to handle the situation.

She was not able to consult with any experts or anyone, and she had to adapt herself living in such pain for more than 30 years.

Ms. Tak Eap developed a vesico vaginal fistula in the late 1990s after delivering her first stillborn child. She was in obstructed labour for 2 days before her family sent her to the hospital. While she was being transported from her village, she lost consciousness and the next day, she found herself in the hospital bed realizing that her baby was stillborn. She did not quite remember well what she had gone through. A few weeks later, her husband left her quietly after he found out that she was loosing urine in bed. She started to isolate herself from the other villagers as she got wet very often and she could not manage to change Sarong (made of fabric in flower pattern to wrap around the waist, worn by Cambodian women at home traditionally) most of the time. "I had a very bad smell, so I avoided meeting people. I am so depressed to live with this condition," says Eap, who is lying on the bed, preparing for her first operation after 13 years living with an obstetric fistula. The operation will be performed with assistance from the Children's Surgical Center and UNFPA Cambodia.

Preventing barriers:

After a long time of civil war and an oppressive regime Cambodia is rebuilding its damaged social infrastructure which was completely destroyed. People are struggling for survival. Access to social information and services remains a challenge and the fistula repair services were not available until lately. Women did not have access to maternal health care and information due to limited resources. Many women live in rural areas opted for traditional services provided by traditional healers or untrained providers. "I had undergone 2 fistula treatment surgeries before my 3rd surgery provided by the CSC in mid-2011," says Mrs. Sam Ean, who had suffered for 28 years with vesico vaginal fistula problem.

Born in a culture where gender inequalities are still rampant, women have considered with a lower status in the society. They have less access to higher education, resulting in fewer opportunities for employment, politics and public services. Women are expected to take care of house work, children, sick persons and elderly parents -- in most occasions, women do not attend to their own health condition and can tolerate various burdens. "Besides doing house work I have a very old and sick mother to take care of everyday," says Mrs. Met Yorm, 50 years old, residing in Trapean Veng Khang Lech village, about 60 km south from Kampot provincial town. She has been suffering from urine loss through a fistula for 20 years since the delivery of her 4th stillborn child.

Lack of money is a major obstacle preventing women from seeking treatment services. Most women who suffer from a fistula live in the rural areas where road, transport, and health services remain a challenge. Poor women have little knowledge about social issues such as fistula.

Mrs. Sam Ean and her family were hopeless and reluctant to seek treatment after a couple of interventions to repair the vesico vaginal fistula she had, but all were without any success. At the beginning, she was so depressed by unpleasant words from her community and had locked herself in the house for months until everyone was able to accept the truth. Suffering for 28 years, she had tried options with local healers suggested by friends, relative and neighbors but there was no good result. They all believed that this disease cannot be treated for life - it was such despondency, so they lived on as what it was. "I don't know where to go for a treatment, except getting services from local healers and district hospital. But it still cannot be treated", says Mrs. Ean.

The small family income from the farming mainly goes to everyday basic needs which make it difficult for women to arrange for extra luxuries. Therefore, they have less opportunity to seek for better health care services including fistula treatment.

New life has come:

It is unbelievable. Accessing to Fistula treatment is a miracle for many Cambodian women who live in poor and remote areas who had suffered silently in pain for decades. After such a long time, many women got back what they had wished for. It is a blessing for them and their family to be given back their new lives with hope, confidence and peaceful smile - it is such a content feeling. 
UNFPA Cambodia has partnered with the Children's Surgical Center to address Vesico vaginal fistula which were overlooked for decades and has helped many remote women get treatment services in a safe facility with professionally national standards. Poor and short statured women live in rural areas who are unaware of treatment or unable to afford services can receive free surgical repairing services facilitated by the joint-initiative toward ending fistula in Cambodia.
"I am so excited and could not express my feeling enough how happy I am now...." says Ean when sharing her treatment experience provided by the CSC and UNFPA in 2011 in Phnom Penh with her neighbors.
The Children's Surgical Center outreach team goes out to meet with vulnerable women in target provinces to raise awareness and give information about fistula. "We inform health workers and village chiefs about our upcoming trips, and found that upon arrival some women were waiting to discuss with us", says Mr. Sam Sitha, Smile Train/Outreach Coordinator of CSC. The mass media is another effective way to reach beneficiaries, especially for people living in remote areas where infrastructure and communication are still a challenge. Radio is the most preferred channel of communication in rural communities. "After I heard about it on the radio, I talked to my husband and daughter. Then, I was brought to the CSC in Kean Kleang, Phnom Penh in late 2011" says Mrs. Sin. Most survivors who were interviewed also identified radio as the best means to find out about the service.

Starting as a pilot project since December 2009 in 4 provinces in the northeastern part of Cambodia such as Ratanakiri, Mondulkiri, Preah Vihear and Stung Treng, where infrastructure and social services for women and girls have yet to be improved, the CSC has provided free fistula treatment services to almost 30 women who had suffered for decades silently.