Fieldset
Post 18. More Fistulas!

In our last mission in the Democratic Republic of Congo, I wrote extensively about our fistula campaign.

In our last mission in the Democratic Republic of Congo, I wrote extensively about our fistula campaign. A vaginal fistula results from prolonged and obstructed labour, when the baby’s head pushes against the wall of the vagina for an extensive period of time, cutting off circulation to the tissue, which then dies. The resulting hole, when left unrepaired, leaks a steady stream of urine, leaving the woman wet, stinky, and prone to infection and a host of medical complications. They are often abandoned by their husbands and isolated from their families and communities.

In the DRC, 80 women were rounded up from surrounding villages and brought to our swelling hospital to undergo surgery to repair their fistula. Many of the women we treated had suffered for years with this condition. This was the 4th fistula campaign MSF had conducted in the region, and due to overwhelming need, it was followed by a 5th and perhaps 6th.

As a non-medic, I was first of all quite surprised how entire dinner conversations could focus on female sexual anatomy without the blink of an eye. As the campaign got underway, I was awed by the precision and technical wizardry of our German surgeon who could reach into the depths of a patient and stitch up a hole or rebuild the vaginal wall, essentially by feel alone. However, what most impressed me and what moves me to this day, was the instant, profound, and permanent change this surgery has for the woman, her disposition, her spirit and her life. It is really like giving her back her soul. The tents where the women stayed for 3 months were a haven of solidarity, hope, anticipation and rebirth.

Here in Chad, the problem of vaginal fistulas is no less severe than in the Congo. There is often little provision of health care and many births take place at home. It is frequently too late when, and if, women try to come to a health centre or hospital. This is compounded by the young age of many of the mothers and the prevalence of female genital mutilation.

Poster for the MSF fistula program in eastern Chad

Poster for the MSF fistula program in eastern Chad

MSF’s strategy in Chad, however, differs from that in Congo. Instead of an annual campaign, MSF has a permanent fistula program, housed in a regional Ministry of Health hospital. A team of outreach workers is constantly combing the countryside looking for women with fistulas. Patients are brought to MSF’s “Women’s Village” in the hospital where they prepare for surgery, undergo the procedure, and spend weeks in physiotherapy, relearning how to control their bladder, for example.

All of this had absolutely nothing to do with Grant and I until the fistula outreach workers came to Am Timan to train our own community health workers and our maternity staff how to identify and refer fistula patients to their hospital. This sensitization was so successful that within 24 hours they had 7 patients to take back to the hospital with them. In the 3 weeks that followed, 7 more patients were sent and another 6 are lined up and ready to go. Grant now spends a small part of each week coordinating transportation to fly patients to the hospital and we just had a dozen pairs of ultra absorbent underwear fabricated by a local tailor to make sure they travel in both comfort and style. Go ladies, go!