For some 2,000,000 women living in the shadows with fistulae, all attempts to alleviate their misery are laudable, but huge obstacles remain:  poverty, women’s' rights, access to care, trained specialists, and above all child marriage.  Just this morning there was an outcry from all over the world to punish an eight year olds’ husband, a middle aged man, and family who arranged the marriage in Yemen because on her wedding night she received severe internal injuries, lacerations to her genitalia, profound bleeding and death.  In much of the Middle East child marriage has been accepted for centuries.  It is encouraging to see comments from Kuwait and Dubai calling for change.