One of the most devastating consequences of having a baby in a country lacking available medical resources is the development of a vesicovaginal fistula (VVF).  Can you imagine anticipating a new baby for over 9 months, finally going into labor and then the baby doesn’t come?  So you wait.  Many wait for several days of labor until travelling to a hospital for help…sometimes they wait because they don’t have a nearby hospital, sometimes it is a matter of family pride to deliver at home without assistance, sometimes it is a matter of money and families could not afford a needed cesarean delivery.   Whatever the reason, these women suffer tremendously through labor and almost always their babies do not survive such a prolonged labor.  Unfortunately, this is only the beginning of the suffering for a fistula patient.  Immediately after delivery, they begin to have constant leakage of urine, because in the process of an obstructed labor the delicate tissue between the birth canal and the bladder loses its blood supply, sloughs off and leaves behind a hole, or fistula, from the bladder into the vaginal canal. 

A constant leaking of urine makes home, work and social life impossible, especially for those who live in more isolated, remote villages.  Often the women’s husbands leave them after the fistula.  And if they have other children, the children are taken as well.  They are not allowed to live with their families, because of the leaking and are often sent out to live alone or with the animals so they won’t bother anyone.  They are not welcome at social gatherings or meals.  The only work they can find is seasonal field work where they can work and no one will be bothered by their smell or be able to see the urine leaking onto the ground.  Any plans or dreams they held for life are gone and many women have a great deal of difficulty finding something to live for.

This is my third trip to Africa for a fistula surgical mission and I am once again, completely humbled by what I see and experience when I am here.  We were able to complete two weeks of surgery, operating on about twenty women.  Each repair lasted between one and eight hours depending on the extent and location of damage.  In many cases the damage was so extensive, the problem wasn’t fixing the hole, but finding what was left to put back together.

This trip, as well as my previous trips, was coordinated through Mercyships (www.mercyships.org).  Mercyships operates out of an actual ship which serves as a hospital.  The patients, physicians and staff all live aboard and the surgeries take place on board.  The boat houses six operating rooms, four hospital wards, an OR recovery room and an intensive care unit.  Each outreach trip lasts, in total, for 1 to 2 years, depending on the needs of the country that the ship is at port.  Within each outreach there are blocks for different kinds of surgery.  For the fistula surgeries, we had two 6-week blocks this year that we covered with a group of international fistula surgeons, each volunteering for 2-4 weeks at a time.

Before leaving we were able to discharge our first set of recovered, dry patients home.  One of the traditions of fistula surgery is to hold dress ceremony at the time of discharge.  It started as a necessity, because the clothes that fistula patients arrive in are always terribly soiled and unfit to wear home after surgery.  So the patients were given a new, clean dress to wear home.  The dress ceremony quickly evolved into a true ceremony with lots of music, dancing and public speeches from the patients.  When these women were given a new dress , it really symbolizes a new life, a ticket back into their homes and lives that were so abruptly taken before the fistulas came.