I first heard about the horrific medical conditions of women giving birth too young and/or unassisted at least five years ago, and I'm unsurprised and depressed that the problem isn't being addressed in any serious way.

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What brings the girls to Dr. Waaldijk - and him to Nigeria - is the obstetric nightmare of fistulas, unknown in the West for nearly a century. Mostly teenagers who tried to deliver their first child at home, the girls failed at labor. Their babies were lodged in their narrow birth canals, and the resulting pressure cut off blood to vital tissues and ripped holes in their bowels or urethras, or both.

Now their babies were dead. And the would-be mothers, their insides wrecked, were utterly incontinent. Many had become outcasts in their own communities - rejected by their husbands, shunned by neighbors, too ashamed even to step out of their huts.

Until this decade, outside nations that might be able to help effectively ignored the problem. The last global study, in which the World Health Organization estimated that more than two million women were living with obstetric fistulas, was conducted 16 years ago.

Nor has a recent spate of international attention set off an outpouring of aid. Two years of global fundraising by the United Nations Population Fund, an agency devoted in part to improving women's health, has netted only $11 million for the problem.

The number of new cases is far outpacing repairs - not just here, but in other sub-Saharan nations like Kenya, Malawi and Uganda. Despite recent strides, said Thoraya Ahmed Obaid, the Population Fund's executive director, "at the current rate of action it will take decades to end fistula."

Few doubt that the problem is most concentrated in sub-Saharan Africa, where poverty and rudimentary health care combine with traditions of home birth and early pregnancy to make women especially vulnerable. In Nigeria alone, perhaps 400,000 to 800,000 women suffer untreated fistulas, says the United Nations.

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If I were, I would just go, and never stop working.

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Were it widely available, the United Nations agency states, a $300 operation could repair most fistulas. But Mozambique, with 17 million people, has just three surgeons who consistently perform those operations. Niger, population 11 million, has but six, the organization reported in 2002.

Nigeria, Africa's most populous country with 137 million people, has eight fistula repair centers, and Dr. Waaldijk, a Health Ministry employee, said he had trained 300 doctors in fistula surgery. Once trained, though, many leave for better paid jobs in wealthier nations.

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I have probably done a rotten job at inserting the above URL, hope it works for you.