Mayano is running her very first marathon, the Los Angeles Marathon on March 16, 2025 in support of International Medical Response's (IMR) efforts to end obstetric fistula! While the training and the race is sure to be full of challenges and difficulties, it will be nothing compared to the struggles that women with obstetric fistula face every day. 

Imagine you are a young woman in rural Pakistan. You get married, become pregnant, and soon find yourself in labor awaiting the birth of your child. The labor is long and difficult, and the baby's head gets stuck in the pelvis because it is too small to allow the baby to pass. After many days and with no access to a doctor to perform a c-section, a hole, also known as a fistula, forms between the vagina and the bladder, urethra, or rectum due to the unrelieved pressure. When the baby finally delivers, usually as a stillbirth, you are left with a fistula which causes uncontrollable and unstoppable dribbling of urine or feces through your vagina. 

If that sounds too horrible to be true, believe me, it's real. The WHO estimates up to 100,000 women develop fistulas every year, and most of them from impoverished areas around the world. They are left to suffer alone because they are ostracized from their communities due to the constant smell of urine and feces. Surgical repair is the only cure but many suffer for years, even decades, as there aren't enough skilled surgeons that specialize in this procedure.  

Today, I want you to support me in the effort to end fistula by donating to IMR, an organization that I co-founded and am the Managing Director of. 

At IMR, we fight to end fistula by:

1. Providing free surgery to victims of fistula in partnership with United Nations Population Fund (UNFPA) and hospitals around the world. We currently work in Liberia, Madagascar, Gambia, and Pakistan. 

2. Training gynecologists and other surgeons to become experts in fistula repair surgeries.

3. Training nurses that care for patients pre- and post-operatively in order to maintain the integrity of the repair.

4. Training midwives to identify abnormal labor so that women can be transferred for C-sections in a timely manner. 

Lastly, I want to leave you with this quote from a book Scream by Dr. Shershah Syed, translated by Humair Ishtiaq. 

“Fistula is a form of violence mostly against poor women in developing countries. It mutilates the female body, causes psychological trauma, suppresses self-respect, and creates a hateful environment for the sufferer who is compelled to survive under inhuman conditions. 

Fistula is also an act of violence against women committed by governments that are the main culprit. It occurs only because state-run health departments fail to provide primary healthcare and emergency obstetrical care to the poor women living in city slums and distant rural areas. 

Fistula is a kind of physical and psychological violence perpetrated by the immediate family members and the community at large because of the lack of awareness and understanding of pregnancy-related situations, and also because of the total disrespect to women’s right to life and health.”

I hope you join me in this effort to end fistula.

- Mayano