Today is International Day to End Obstetric Fistula, but what exactly is Obstetric Fistula?
Although it affects millions of women, few Canadians know about it because very few women in Canada are at risk of developing this heartbreaking condition.
Obstetric Fistula, also known as Vesico-vaginal Fistula (VVF) is traumatizing. It is a child birth related injury where a hole develops between the rectum and vagina or between the bladder and vagina. Women who survive days of labor and the death of their baby are left incontinent, which means they have no control over constantly leaking urine and feces. This condition affects millions of women around the world, primarily in poverty stricken countries where there is very limited access to healthcare and an emergency caesarean section
Free surgeries are provided for women on board the Africa Mercy and training is given to local & international health care professionals including surgeons, nurses and traditional birth attendants.
Monica Ciolfi from Qualicum Beach, British Columbia, is a nurse who has volunteered with Mercy Ships during two field services and worked closely with ladies suffering from Fistula. We spoke with her recently about her work and what she knows about Fistula.
When did you first hear about Obstetric Fistula?
I first learned about Obstetric Fistula when I was researching Mercy Ships. many years before I applied. When I read specifically on the type of surgeries performed on the ship, I saw that vesicovaginal fistula repair was one of the major ones. I did not know at this time what this was, so I read up on it a bit more on the internet.
When did you first encounter women suffering from Obstetric Fistula?
In 2015 I spent 3 months aboard the Africa Mercy in Madagascar and was so blessed to have spent 6 weeks caring for women after they had corrective surgery for the their Obstetric Fistulas. In 2016 I returned to the ship and worked solely on the VVF ward for 10 weeks.
Was there one particular woman whose story moved you? Can you tell us about her?
Yes. One young woman was 16 years old and her boyfriend/husband accompanied her on the ship because she was under the age of 18, she had to have a caregiver with her. She had an obstructive labour when she was only 14 years old. Her baby died, as most of them do in these circumstances, and she was left childless and with an obstetric fistula. She also had drop foot on one side, presumably from nerve damage as a result of her prolonged labour. Unlike most women with obstetric fistulas, her husband stayed by her side. Despite all she had been through in her young age, she still smiled as if everything was going to be okay. Because of her resilience, I still remember her story and her sweet face.
Another young woman, who I think was in her mid-twenties also remains one of my most memorable patients. As a result of an obstructive labour, she not only had a vesicovaginal fistula (which left her leaking urine), but also a rectovaginal fistula, which left her leaking feces as well. Years before coming onboard the Africa Mercy, she met a doctor who told her he would give her a colostomy to allow her fistula to heal, and then eventually reverse it later on. She was never able to get her colostomy reversed because she was unable to pay for it. I found it so unethical that a doctor would leave this women with a colostomy, in a country where there are no resources or supplies to give her the quality of life she should have at such a young age. She had surgery on her bowel to fix the previous surgery that had been done before she could be considered for a fistula repair. She remained on the ward for weeks and because very well-known by all the hospital staff.
What sort of emotions were brought up while working with these women?
Pretty much every emotion at some point or another. Sadness, after hearing that their families had abandoned them due to their conditions and that their hope of a family of their own had been taken from them so abruptly. Hope, when women would come to the ship and then be cleared by the screening team to have their surgery. Excitement, when women would have their catheters removed and then void on their own for the first time since before their injuries. Happiness and Joy, when the women would go home with fully functioning bladders. Anxiety, when thinking about the women going home and all the post-operative instructions they needed to follow in order to keep their fistula from re-opening. They weren’t suppose to have sex for a minimum of 3 months after their surgery, and a lot of women were fearful that their partners would not be compliant with this. Some also had long journeys home, sometimes 12 hours or more on a truck, and they were afraid that the driver would not stop if they needed to empty their bladders, which were now up to 50% smaller than before.
Overall it was very emotional taking care of these women, but more so in a positive and fulfilling way. They all touched my heart in a different way.
What do you think is the biggest challenge is for these women?
It’s difficult to just choose one. But I would guess that losing a child that had been carried to term would be the hardest part. I am not a mother, but I hear a lot from friends and co-workers who are mothers and how having a child has changed their lives so significantly, but in the end they never regret having their child and are proud to say that it is the best thing they have ever done. I have never heard of a case where a woman with an obstructive labour leaving them with a fistula, had a baby that survived. For many mothers, I think their motivation to find strength and carry on comes from their children, so I can see the greatest challenge for women with fistulas is to have to face each day without their child, and often times, without their husband or family.
What are some of the differences between women in North America and women in Africa when it comes to childbirth and accessibility to healthcare?
In Africa, many women start doing physical work when they are young. In combination with malnutrition, this can cause stunted growth, leaving the women much smaller in Africa than North American women who are generally well nourished and do not do physical labour from a young age. During birth, a baby has a very difficult time getting through the tiny pelvis of a small women. In North America it does happen, but before the newborn baby is at any significant risk, the specialized doctor (in the hospital) or the midwife (potentially at home or in hospital) will intervene and get the birthing mother to a hospital where she can have a C-section to maintain the safety of the mom and baby.
In Madagascar and many other African countries, accessibility to health care is minimal. Most of the population of Madagascar is rural, and without access to a specialist who can perform a C-section (assuming the family can afford it), the odds of intervening on the labour in due time is unlikely. When we discharged patients after their surgeries, we told them to start saving as soon as they found out they were expecting so that they would have enough money to pay for a C-section, which kind of gives you an idea of how much planning and budgeting healthcare costs in countries such as Madagascar.
What needs to change to decrease the percentage of women who develop Obstetric Fistula?
So much. Mostly infrastructure and accessibility to health care services, and subsidized services for at-risk pregnancies. Preventing women from being in obstructive labour would mean changing their roles in their families/villages and ultimately their culture entirely. Ending malnutrition is always on the agenda in less developed countries. But if all women had access to get a C-section when they needed it, and could also afford it, I believe the incidences of new obstetric fistulas would decrease over time.
In Madagascar alone, their is one obstetric fistula clinic. For the majority of the country, it takes greater than 3 days to travel to it. Their is an estimated 80 000 cases of obstetric fistula in Madagascar, with 2 000 new cases every year.
More than 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are estimated to be living with fistula, and some 50,000 to 100,000 new cases develop annually. Yet fistula is almost entirely preventable. Its persistence is a sign of global inequality and an indication that health systems are failing to protect the health and human rights of the poorest and most vulnerable women and girls. – See more at: http://www.unfpa.org/obstetric-fistula#sthash.535LDJbq.dpuf
A Big thanks to Nurse Monica for sharing with us to help spread awareness around this critical maternal health issue!
For Bob Burlingame, it took a book, a sermon, and of course, a ballgame.This eye surgeon from the USA had always been interested in medical missions, exploring various opportunities in the past. But it was only when he retired from his busy practice in the states that hewas able to start figuring out what was truly next.
Years ago, Bob read a book by Don Stephens called Ships of Mercy, which left a lasting impression. Later on, he heard a sermon on Jonah which gave him a sense that he needed to do something more. But the final deal-sealer was an invitation to a ballgame.
It was from a friend he’d later learn was a Mercy Ships supporter. The other invitee seated next to him also happened to be a Mercy Ships supporter – Don Stephens: “I had a funder on one side and the founder on the other…so I called the next day and signedup!” Once on the Africa Mercy in Benin, Bob immediately got down to business performing pediatric cataract surgeries.
“Our goal is to restore sight in anyone we can,” says Bob, honored and excited to couple his skills with the ship’s resources. “On the Africa Mercy, we have not only first rate equipment and supplies that have been generously donated, but also a supportive infrastructure and people who have intentionally thought out every detail. When we deliver care, we make sure everything is right. That’s the way Mercy Ships works and it’s extremely gratifying as a surgeon to be able to do that.
”Watching patients receive their sight has made a significant impact on Bob. “I saw a little boy I had operated on that morning, sitting on his father’s lap. He was tracing out all the details of his father’s face because he hadn’t seen him in probably four or five years, if ever. And now, he was looking at the man he’d heard all these years, very intrigued with finding out – feeling, looking and seeing his father’s face for the first time.”
Bob has many more stories of how restoring sight also restores hope. “When you hear patients speak ofabout Mercy Ships and how it could give them hope and surgical correction of their problems, their eyeslight up, their hearts light up and their joy speaks….this is a great symbol of hope.”
Right from the start, the odds were stacked against him. Little Samsdine was born with a cleft-palate, and since birth had been suffering almost constantly from malaria. He lives with his mother in a remote village which made accessing treatment and medicines difficult – the future wasn’t looking good. Then his mother heard that the Africa Mercy was docked in Cotonou, Benin, and made the long, difficult journey to the ship with her son. When they arrived at the Africa Mercy, Samsdine was not only sick with a bought of Malaria but was also severely malnourished and in constant pain.
Thanks to volunteers and donors, Samsdine had the support he needed to become healthy enough for surgery. With his cleft lip gone, he will be able to grow up big and strong, happy and healthy!
Meet Juste – a character and a half, wrapped up in a four-year-old’s body. He doesn’t seem bothered by the lump on his head and already has a plan for when it’s gone. “After they do the surgery, I will become president, have money and buy a car!” Juste tells his mom, Elisabeth.
Elisabeth isn’t surprised by her little guy’s ambitions. He’s got a way about him – fearless, funny and uninhibited. She marvels at his carefree nature, wishing she could have a dose of it sometimes.
“I was afraid to send him to school for fear of what kids would do. I thought of putting a hat on his head … but could picture them taking it from him and teasing him. You know how cruel some kids can be.” Her thoughts of what could happen got the best of her. She and her husband decided to keep him home from school.
The lump started growing on the top of Juste’s head after he was born. When he was two months old, the doctor who delivered him tried to treat it. Not long after, it returned, so he tried a different technique to remove it. When it continued to grow back, larger each time, he told Elisabeth, “I can no longer help your son – you’ll need to try someone else.”
Elisabeth found another doctor, but the procedure came with a hefty price tag: 500,000 CFA (almost $900 USD). They had nowhere near that kind of money. She tried another hospital – but, again, the treatment was too costly there. She didn’t give up and found another option, one that was much more affordable through a locally-funded agency. But due to the volume of patients already waiting, Juste would be at the end of a very long waiting list.
By the time he was four years old, Juste’s lump had become larger than a golf ball, and Elisabeth was out of options, except one – prayer. “I prayed … and, soon after, I heard about Mercy Ships!” This brand-new possibility felt promising.
Elisabeth brought Juste to be screened by doctors at Mercy Ships, hoping to finally hear good news. But Juste’s condition required additional testing before a decision on treatment could be made. The wait for an answer seemed to last forever, but it was worth it when Elisabeth received an appointment card for Juste to have surgery!
Then, even better news surfaced. What was originally thought to be a more serious condition was actually going to be simpler to treat. Within just a few days, Juste’s cyst was safely removed for good, and they were given the “okay” by doctors to leave!
Once home, the two were greeted by a very eager family. “Overwhelmed with joy, my husband got down on his knees and said, ‘I’m so happy!’ and thanked God for healing our son through Mercy Ships.”
Will Elisabeth support Juste’s dreams to become president? Maybe. But, for now, she has some ideas on what he should accomplish first … like going back to school.
Story by Windsor Marchesi
Edited by Nancy Predaina
Photos by Timmy Baskerville
“When I gave birth to Dorkas, she was a healthy baby,” recalled Nicole. “But the problems started soon after.” As she watched her firstborn constantly squinting, she became concerned. “I started to wonder what this could be,” she said.
Her fears were confirmed and multiplied when, three years later, a new baby named Anna was born. “I couldn’t believe it,” said Nicole. “Her vision was even worse than her sister’s.”
To have not one, but two, children who could not see? This unbelievable situation weighed heavily on Nicole, who was raising her children alone. “Was this because of some sin I have committed. Is it a curse?” she wondered.
But in reality, the little girls’ condition was genetic. Dorkas and Anna were just two of the roughly 300,000 blind children in sub-Saharan Africa.* Most of these children would be able to see if they had access to modern medicine.
Nicole didn’t know that her children’s condition could be cured, but she sought help anyway. “The moment I realized that both of my daughters could not see, I began to hope that one day they would get surgery,” she said. Nicole followed her mother’s advice to go to the national hospital in Togo. An ophthalmologist examined the girls and quickly diagnosed their condition as cataracts. But there was no surgeon to help them.
“We waited and waited and waited,” said Nicole. Nothing ever came of it.
Then Nicole heard that Mercy Ships was close by, and they could treat children’s cataracts. “I went hopefully to them,” she said, making the trip from Togo to neighboring Benin. It was worth all the effort! Nicole left the patient screening site with yellow cards – the signal that her daughters were scheduled for free surgeries. “It was then that I started to believe,” said Nicole. “But I was still praying and wondering if they would really be able to see after the operation. I was not yet confident.”
Anna and Dorkas were operated on in the same morning. Six-year-old Dorkas came through fine, but Nicole was far more worried about her younger daughter, two-year-old Anna, because her vision had been much worse.
After Anna’s surgery, volunteer eye surgeon Bob Burlingame went to the wards looking for Nicole, who had stepped out. “I asked the translator to tell her that everything went very very well and that I expected Anna to see much, much better,” he said.
The translator left the room, and only seconds later Dr. Bob heard Nicole shout from the other end of the hall, “Praise God! Praise God! Mercy has saved my baby’s sight!” And she came running down the hall, shouting and praising God.
* http://10ga.iapb.org/2016/10/# (International Agency for the Prevention of Blindness)
Written by Anna Psiaki