Fistulas, that is. And in this case, specifically obstetric fistulas.
This was something Dr. Darius Maggi, founder of the West Africa Fistula Foundation, said to me yesterday when I was observing surgeries with him. He is a retired OB/GYN and has dedicated his retirement to helping women overcome the difficulties of living with fistulas by performing surgeries that fix their fistulas and leave them “dry”, sometimes for the first time in years. This is, in my opinion, an extremely honorable and impressive task considering the daunting nature of fistulas, the cultural perceptions of women with fistulas, and the infrastructural constraints that exacerbate the shocking maternal mortality rates in Sierra Leone. The women affected by fistulas are generally cast out from, or ignored by, society because they live with a serious, debilitating medical condition that leaves them, in many cases, constantly leaking urine.
An obstetric fistula is a hole that develops either between the rectum & vagina or bladder & vagina after complicated, severe or failed childbirth – unfortunately something that happens far too often here in Sierra Leone. Fistulas are not seen in the developed world because we have the care necessary for pregnant women before and during their deliveries to prevent such problems from ever occurring. Nick Kristof has brought a lot of attention recently to the increasing problem of fistulas in the Congo, many of which there are a result of repeated gang rape or rape with foreign objects, two tactics soldiers in the country use to torture and terrify the citizens of the country.
Here’s a story about fistulas in africa from 2009, “New Life for the Pariah“, and one from 2010 about fistulas in the DR Congo, “The World Capital of Killing“. The op-ed about the Congo and fistulas also has a video accompaniment that is pretty powerful.
(For those interested, there’s also a recent documentary about fistulas, Walk to Beautiful, that is a 2009 Emmy winner…just saying)
I had little idea of what I was walking into when I showed up at Bo Government Hospital yesterday. I had stopped by late last week and briefly met Dr. Maggi. He, in between doing patient consults, told me to come back early next week and I could observe a surgery if I wanted. I was slightly nervous about how I’d react to seeing surgery firsthand and up-close but after telling the CHO at Mercy that I might get to observe a fistula surgery and being asked, “do you really think you can handle that?” I was determined to prove him wrong. I guess there’s a lot to be said for stubbornness.
I got to the hospital around 11:15am and was in scrubs, in the operating room, by 11:45. It was quite unreal, and I am still in awe that I had such an incredible opportunity. Me, the girl who refused to take any biology/chemistry classes past the minimum requirements in high school and college, was able to observe 2 fistula surgeries and 2 abdominal surgeries to remove bladder stones, and Dr. Maggi was very attentive to make sure I knew what I seeing and understood, at least basically, the processes he was going through. And I didn’t get nauseous or lightheaded once!
The first fistula surgery was most complicated than the second, but the particular woman being operated on had previously had a fistula operation. She had been operated on by WAFF a few years ago, and her operation was successful (she, as they say, “was dry” — referring to the success of the operation to stop urine from constantly leaking). She then become pregnant, underwent another complicated, painful labor and delivery, and was left with another fistula. I can only imagine how devastating that must have been.
Women who have fistula operations are told that if they become pregnant, they NEED to deliver by c-section. However, whether the message is truly understood and/or the woman will have the ability to get to a safe facility to have a c-section done is never certain. This particular young woman was lucky – she was able to come back to WAFF and have a second surgery, successful again. However, this underscores the larger problems with maternal mortality in Sierra Leone – lack of adequate facilities, education and health practitioners leave women in a precarious situation that they can’t easily find their way out of. Birth control and family planning are not widely available throughout the country, further compounding the problems of pregnancy and delivery complications.
Did I mention WAFF provides all these opportunities – for care, surgeries, treatment and skills training (in addition to housing and caring for the patients between Dr. Maggi’s 3-week visits every few months) – completely free of charge? It’s pretty impressive. They are hoping to one day build their own facility in Bo that will perform fistula surgeries, provide maternal and child prevention, education and care, and address community health on a variety of levels. Check out their website, tell others about it, and I’ll do my best to follow up eventually with some photos of their clinic and ward.
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