Ending Obstetric Fistula

22 May 2015

Obstetric Fistula? Some might nod their head and pretend they know what these words mean, but many Canadians do not.

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

Malagasy Ladies
VVF patients – Madagascar 2015

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 recently returned from the Africa Mercy where she spent three months working as a Nurse and caring for many fistula patients.

“If a woman in Canada can’t have a vaginal delivery she has a C-section and no one’s life is jeopardized. In certain cultures in Africa some women are left to deliver their babies in isolation as a rite of passage, or they are too far away from a hospital, or can’t afford medical care for their delivery” says Monica.

The Africa Mercy is currently docked in Tamatave, Madagascar where It is estimated by the World Health Organization (WHO) that 2,000 Malagasy women develop fistula each year with around 50,000 Malagasy women in need of surgery.

 “When I visited the local children’s ward there was a baby with her grandmother because her mother had died giving birth. There is no reason why a woman should die during childbirth. For all the doctors and nurses working in labour and delivery in Canada, the women of the world need you”

Monica cared for patients who each had an unbelievable story to tell.

Patients like Florine.


Florine is 39 and has lived with VVF for 25 years. She was married around 14 years old to a young man in her village, which is located in a remote part of Madagascar to the north of Tamatave. Shortly after her marriage Florine got pregnant, but when it came time to delivering her child there were complications.

There was no midwife present and after an undetermined amount of time, Florine lost the baby. Florine became sick after the birth and it took one full month for her to recover. It was during this time that she realized she was leaking urine. Florine brought three other babies to full term to have them die at child birth, two other pregnancies were miscarriages.

Unable to conceive children and incontinent, Florine was abandoned by her husband. She was alone in a small village in the extreme north of Madagascar.

Despite all this, hope was on the horizon for Florine as she heard on the radio about a foreign organization coming to Madagascar to perform surgeries including operations for women who suffered from VVF! She set out with her mother and sister on a journey that took nine days on foot and an overnight ride on a taxi brousse. Unfortunately Florine thought the surgeries were happening in Tana when in fact they were happening in Tamatave, which was much closer to her village.

After giving up their search for Mercy Ships, Florine, her mother and sister rented a small home in a village on the outskirts of Tana, which primarily made bricks. This is where Florine met Rosette, who lived behind the rental home.

Florine holds her appointment card next to Rosette

Florine, her sister and her mother pulled their wages together by carrying bricks from their village up to the main road along some precarious paths. When they had enough money to return back to their village, Florine came down with malaria. Suffering from VVF and with malaria, Florine was too sick to travel but her mother and sister were insistent on returning home. Rosette stepped in and asked that Florine be left in her care. The mother and sister agreed and took Rosette’s phone number with them but they have not been heard from since.

Florine’s apparent abandonment upset Rosette and her family as well as others in the village. Neighbors banded together to help care for Rosette. What little clothes they had were donated.

This community, which is among the poorest of the poor that we have seen in Madagascar, gave where they could not give and at the center was Rosette, who knew it was the right thing for Florine to stay and find her healing.

Rosette’s faith was rewarded when in December they heard that Mercy Ships was holding a screening in Tana. Florine returned home with Rosette after the screening where she continued to focus on her health. Despite obvious financial difficulties, Rosette never shared those burdens with Florine.

Rosette’s children adopted Florine as an elder sibling giving her the title of “zoky”, which is a Malagasy title reserved for the oldest and most respected sibling.

Florine holds Rosette’s daughter’s baby.

Florine has become a part of the family and when Rosette’s 21 year old daughter went into labor in February, Florine was home alone with her. Florine prepared the water and helped deliver the baby. Florine said that despite the fact that she had lost six babies, she was overjoyed to be able to be present for this one’s birth. She cleaned the baby and put her on her mother’s chest.

Why did Rosette bring a stranger into her home? Why would she choose to do this when her family is as poor as they are and take on another person to clothe, feed and care for?

Her answer was so simple and yet so beautiful. It was love. She wanted to show Florine a love like she had never seen before.

Finally it was arranged by the Africa Mercy communications team to bring Florine and Rosette back to Tamatave. The experience of traveling with three vazas (foreigners) and one translator is an experience these ladies will not soon forget. New experiences included using a door handle, buckling a seat belt, ordering off a menu, using utensils…and seeing the ocean for the first time!

On April 1st, 2015 Florine’s life was changed  forever.

As Rosette waited for Florine to be brought back to the wards from her surgery, she paced the hallways. Finally the moment came when Florine came back and Rosette’s smile was not easily forgettable. She pointed up and put her hands in praise and kept saying “vita, vita” Malagasy for finished or it is finished as in her fistulas are no more.

Florine is now dry and can start a brand new chapter in her life free from pain! 

To support Mercy Ships Women’s Health Program and others like Florine click HERE