Saturday, March 12, 2022

There's a Place for Me


Imagine being newly married and pregnant. Imagine having a difficult and long labor without access to an epidural or pain medication much less a cesarean section. Now imagine you experience a stillbirth and then realize in the days after that not only are you having normal postpartum bleeding, but you are also unable to control your bladder. In fact, you are wet all the time. You begin to smell of urine, and your skin becomes calloused with exposure to the acidic urine. You stop drinking water, as the dehydration lessens the wetness. This causes the smell to increase with the concentration of urine and puts you at risk for kidney stones. Imagine your husband calls you “detestable” and refuses to let you stay with him. Your friends abandon you and laugh at your condition. You go back to your family without the expected grandchild or niece or nephew, and after a short time, they also decide that they cannot stand being around you or their house smelling. Imagine having no place to go, being utterly alone. The following three paragraphs are three different first-hand accounts, translated as closely as possible from their mother tongue to French and then English. Grab a tissue.

“I was expecting a child and for a whole week I had labor pains so I was taken to the hospital of [omitted for privacy] after having already labored in a health center. And I delivered a boy and the urine started to pour out of my vagina, but my son was killed mysteriously by the sorcerer. Now it has been 29 years that I’ve had this sickness. After having it, I started to be uncomfortable, as I had to wash all the time in order to not smell like urine. I couldn’t stay in the community because I smelled like urine, I avoided the church because I was wet just sitting down, and even my business I could no longer do because I was not going to be received well knowing that I would dirty their chair or their bed with urine but that also, I smelled like urine. My husband heard the news on the radio and we came. After this operation, I think that this time I will be healed and I have not had any more leakage of urine this time. It is a good thing. I will be able to get my life back and I will be happy.” -29 years after symphysiotomy, a process by which the pelvic bones are separated/broken apart at the cartilage in the front in order to expedite a delivery when a cesarean section is not feasible.

“I was suffering from abdominal pain and the doctors said that I had appendicitis and an ovarian cyst and that it was necessary to operate, but one week later, it hadn’t happened. We had changed the hospital and they told me that my vagina didn’t form all the way and they operated. Urine started to pour out of my vagina. We put in a vaginal compress and the doctors assured me that there would be no further leakage but it continued and as the days passed, there was a lot of urine and also poop that came out of my vagina. We returned to the hospital but they said they could not do anything more for me. Other girls my age laughed at me, I was uncomfortable to see girls my age who were in good condition and not me, and everything made me so sad that I got a stomach ulcer. I believe that I’ll be healed after this operation and that I will wait. I will be very happy to feel that all the openings were closed and I will be able to live like all the girls my age and think of getting married and having children and even my parents will be happy. We heard it on the radio, that’s why we came.” -young woman with transverse vaginal septum (a congenital malformation) who had a large 7cm left ovarian cyst and 3 separate fistulas: one into her bladder, one into her rectum, and one from her bladder to her upper vagina.

“Everything started in 1981 by the first pregnancy that I had and the infant was blocked by the head at the entrance of the vagina and the labor was long before I could deliver and the baby was dead. It was after that difficult delivery that I developed the fistula. My husband abandoned me after that, telling me that I leaked urine from my vagina and I was gross and he said a lot of other hurtful things before he left me. My brothers abandoned me, telling me that my urine leaked out of my vagina and that no one could look at me anymore or love me anymore, in the family or in the village and to live I was forced to sell my goats and chickens to be able to eat. I spent my life thinking of my situation, my state of being and my son that I lost who could have helped me. Instead, I was alone. For 41 years, I tried to get fixed and was operated on 3 times and that didn’t work. So, when I heard the information [about the fistula campaign] I came. I believe that this time I will be healed of this sickness and I will live my own life. I cannot do anything more.” -delightful older woman who came alone, without a fistula but without ability to control her urine as her urethra was destroyed.

This year, our fistula campaign presented more women with complex fistulas, malformations, double and triple fistulas, multiple prior repairs, no urethra, and bizarre presentations after symphysiotomy. For one, we even had to reconstruct a urethra out of skin from the inside of her mouth. These complex ones are done primarily by expert fistula surgeon and urologist Dr. Paulin Kapaya of Kinshasa, although we all work as one team with two operating tables in the same room in order to be able to discuss difficult steps and share ideas. We operated for 8 days instead of 6 as we had in previous years. Dr. Sarah Kennedy and I spent most of our days operating, as you might imagine. Thankfully the third member of the US part of our team, Katherine Krosley, was able to get out into the community, take part in a public health class at the nursing school, visit health centers, watch normal labor and delivery, experience the malnutrition center, and perhaps most importantly, spend some quality time with the fistula patients post operatively.

If you know Katherine, she is quite a talented musician. She can make up a song on the spot, infuse it with humor or sadness, and brilliantly deliver. Many people in Vanga were blessed by her songs. Each year after all of the surgeries are completed, we have a party to celebrate all the work we have done and all the work the postop and kitchen teams have yet to do. We always debrief about the campaign as a whole, both its strengths and weaknesses. This year, a strength that was highlighted was the psychological and spiritual healing spurred on by the time that Katherine spent with the patients, singing and playing guitar with some of the medical students and nurses, and hearing some of their stories which we have highlighted. Perhaps no one interaction made more of an impact on Katherine or the patient herself, than when she sang to woman who was utterly alone for over 40 years.

She sang… 

Who the Son sets free, is free indeed. I'm a child of God. Yes, I am.

In my Father’s House, there’s a place for me. I’m a child of God. Yes, I am.

There’s a place for me. We can’t even imagine the pain, the loneliness, the shame she has endured. Though her situation is difficult and complete physical healing which we trust in will be a miracle, she can know now that she is not alone. She’s a child of God. She may not be completely continent, but she can know she is completely loved. There’s a place for her, just as there’s a place for me.

Saturday, February 26, 2022

Together, Ensemble

 "It would not be a trip with Shannon if there weren’t any excitement along the way,” Ryan remarked as we jumped into the car to hastily make our way BACK to the airport the morning of departure. He was referring to several other travel escapades we have had, the most memorable being an in-flight baby delivery. Sarah Kennedy, an OBGYN resident, and I had found ourselves in a bit of a frustrating back and forth during check-in. We had 9 bags filled to the weight limit stacked next to the desk, having just said goodbye to our families. 

We were anxious to get rid of our burden for a moment and get through the security line, but the process came to a screeching halt as the agent scrutinized our covid tests. “It needs to be 3 days before arrival. This won’t work.” We showed her the official embassy website (even updated this month) which clearly states a neg covid test is required from 3 days before DEPARTURE. She called the helpline. They wouldn’t budge. We couldn’t check in. I called Ryan to come back to get us instead of going to work.

Thankfully, the third member of our team, Katherine Krosley, had gotten her test a day later and thus, was given the green light. She stayed with our bags while Sarah and I ran to the car and sped to a just-opened urgent care with rapid PCR testing. Minutes ticked by, and finally we were told we had neg tests. As soon as the papers were in our hands, we ran out the door and back to the airport. Back through check-in, then to security and onto the gate where our plane was already boarding. Our seats weren’t together. When we finally made it to the first of our layovers in Atlanta, I grinned and said, “Sarah, meet Katherine. Katherine, meet Sarah.” We were finally able to establish our team.

Lounging during a layover

The details of this fistula campaign are very similar to last year. Same dates. Same place. Same urologist and his resident. But this year has felt more like a smooth zipper bringing all the people, organizations, and supplies together, slowly but steadily, whereas last year was a parting of the waters and a muddy slog through a COVID red sea, with ultimate success. Both feel equally orchestrated by the hand of God.

Our team was the first of the details to come together. I had dinner with the Krosley family just before Thanksgiving, when Katherine happened to mention that she had a free semester prior to starting nursing school, having just obtained a degree in public health. The conversation went something like this: Do you want to come to Congo with me? Yeah, I’d love that. Are you serious? Yes! I’m very interested. A few weeks later when we proposed dates of the trip, I let her know and she started making plans to come.

Sarah’s participation was a welcome surprise. I sent an email to the residency director asking if any resident would be able to participate, fully expecting to be told it wasn’t enough time to arrange a schedule and apply for funding, etc. But instead, it was, “I have a resident who is planning a career in global health and we’ll try to make it work.” We applied, got approved, and with hesitant excitement pressed forward. We knew if Congo went to level 4 or 5 health risk (covid) that it would be a no go. This was in January at the height of the most recent wave of covid in the US, and when the US itself was likely a level 4. Like I said, hesitantly excited.

Covid has kept planning a little dicey. I was not surprised to test positive in January given the sheer number of exposures I had every week at work. Katherine had it around the same time. The silver lining in this was the knowledge that for the next 90 days, a positive PCR would not hinder us from returning to the US. We would not be stuck overseas. It was eerily similar to last year when I had tested positive in December and got vaccinated Jan and Feb. This year I had the new variant, then got my booster.

World Medical Mission has again been instrumental in supporting our work. They have assisted in security, travel, and managing the funds donated towards the work. As much money as I can raise myself, and this year together with Sarah and Katherine, that is how much we can use. With the scale of work and the number of fistula patients continuing to grow as we get into an annual rhythm, I have had a long-term goal of having another resource to support us. It seems to be coming together! One of the doctors in Vanga applied for support and funding from the UNFPA, the United Nations Population Fund. I didn’t find out until we landed in Congo that they are indeed supporting us with materials and potentially even funding. Dr Paulin, the urologist on our team, is well-known in Kinshasa for fistula surgery. This, combined with the evidence of our commitment to repairing fistulas in this region over the last few years made a strong case for their support!

Box of supplies from UNFPA

Another new development has begun this year. One of the patients in my practice put me in contact with a microfinancing organization in St Louis who is already working in Congo, in another region. We discussed the possibility of helping the fistula women not only with their health and healing, but also in helping them get out of poverty by supplying a small loan and means to repay it. Sometimes this is in the form of animal husbandry, 2 pigs becoming a litter and giving back to the program 2 piglets to pass on to another in need. Sometimes it is a loan for materials to support a trade, such as supplies for a hair shop or an oven for a bakery. These details came together nicely and there is a team of 3 people joining us for the second week in Vanga. This is PERFECT timing, as we will have done the bulk of our operations and will be able to help facilitate discussions and teaching with the women who are convalescing.

Lastly, surgeries cannot happen without supplies. I was accepting items daily to bring to Congo. A satellite phone for safety reasons. Bags to help support a maternity safety kit to distribute to the community. Ethicon, the main manufacturer of sutures, donated a large box for the campaign. Throughout the last year, the hospitals I work at have helped collect unused items which are essential. A last-minute need for spinal needles was supplied within an hour of my asking the day before we left. All of the items we have stored in our basement, and it felt filled to the brim. We were able to get humanitarian fares and thus were able to bring 3 bags each. Nine bags filled with essential donated items- so exciting to watch all of this come together. In French, the word is "Ensemble"

So the snafu at the airport with the covid tests? Honestly it didn’t even make my heart race. I had such a peace that this barrier would not stop us. We are so grateful to be together, ensemble.

Thursday, March 11, 2021

I Heard It On the Radio


My favorite moment in the operating room this year was the reaction to one spoken word by my assistant, and its aftermath. Let me set the stage. For the fistula campaign in Vanga, we operate in a larger room that accommodates two surgical teams. This works quite well for our urology-gynecology team: Dr. Paulin as urologist and fistula surgeon from Kinshasa, and I as gynecologist from the US. We each operate primarily on one side of the room, while also being able to easily stay scrubbed in and sterile while looking over the other’s shoulder to see the demonstration of an interesting finding or a different technique for repair. All fistulas are different, so there are many ways to approach them. Dr. Paulin likely has the most fistula repair experience of any urologist in western Congo, so he naturally tackles the complex ones, and I try to stick with vaginal cases when possible. As we frequently say, that is “ma boutique.”

Part of the OR team

On this particular day, Dr. Paulin had labored long and hard with a very difficult case. In that time, I was able to finish two simpler vaginal cases, taking a bow when he looked up with a mixture of surprise and pride. He has mentored me well. The next two patients presented an interesting challenge and we ended up switching sides of the room. I started the abdominal case while Dr. Paulin used his skill to reinforce a weak urethra, an operation which is typically much shorter in duration. Dr. Odjum, a senior staff doctor at Vanga, and I worked quickly on our abdominal case, and the minute we had closed the fistula, he yelled out, “brancard!” which means “stretcher!” Heads whipped around, students stopped talking, and all eyes were on us. Paulin jumped up from his seated position in front of his patient, ran over and peeked over my shoulder in disbelief. Odjum just grinned. We still had to close the bladder and finish other steps, but we had succeeded in closing the fistula, so he wanted everyone to know. When Dr. Paulin and his team finished their case and called out for the stretcher as we were still closing the fascia, they all insisted this was “brancard vrai!” Stretcher for real! Paulin remarked as we were writing our operative notes, “Tu m’a tué!” Translated, dying from laughter.

Though we worked extremely long hours, we enjoyed camaraderie

More than double

Due to our delay in Kinshasa (see prev post), we frantically saw the patients lined up for us on Saturday afternoon-evening. We had more than double the number of patients with true fistulas this year than in our campaign in 2019! I worried that we would have to turn some away or somehow triage them and choose who would get an operation this year. Here are some of their stories. *Names have been changed, and photos attached are an assortment from my collection and are simply representative of some of the sweet patients I have met over the years.

Mutala is 31yo, and her story is very similar to many fistula patients. Four years ago, she had a long labor at a local health center, her baby died in utero, and finally was stillborn weighing about 5kg. Adding to her sadness and pain, she found she could not control her urine. She went to a doctor who did not tell her the diagnosis but did give her some medicine which she tried for 2 months without improvement. She went to another health center, but no one helped her. She came to third health center where a doctor offered to operate on her, but not having confidence in the surgery, her parents refused to pay for it. She has been taunted by many, rejected, and people refuse to be in her presence. However, her family supported her to come to Vanga, and thankfully her husband stayed with her. On exam, her entire bladder was open to the vagina. Her urethra was a separate tube without use. The ureters were easily seen within the bladder tissue open to the vagina. Her surgery required a complex procedure which included using a flap of skin and fat pulled down and underneath the newly constructed bladder to support it as she did not have enough vaginal skin remaining.


Amaya heard about our campaign on her radio. She had been leaking urine for over 40 years, after having had a cesarean delivery, presumably for obstructed labor. Her infant did not make it. She was abandoned by her husband. Her mother and sisters supported her, and she had an attempted fistula repair in 1990, but it failed. She came in search of hope again. We found her to have 4 residual holes into her bladder. Due to previous repair, there was significant scar tissue. Both Dr. Paulin and I worked hard and thus far she is dry after surgery. Overall, fistula statistics show that first time repair has 90% chance of healing, 2nd repair is 70%, and 3rd repair only 30% chance. This is why we prefer that no one who is inexperienced attempt a repair. 

A gyn case

At 19 years old, she had suffered immensely. For the past 3 years, she had excruciating pain every month, and it was only getting worse. On top of this, she dealt with the shame that she had not yet started her period. Pressure from family to get married and have children is high, so this could make it impossible for her to find a husband in the future. She underwent an abdominal surgery for suspected appendicitis. Still no relief from the pain. Finally, she heard on the radio that there was a gynecologist coming to Vanga. She and her mom set out, on foot I presume, to come see what might be the problem. A simple exam revealed that her vagina was congenitally not open, and an ultrasound revealed a uterus full of liquid. Under spinal anesthesia, I examined her again. I poked a needle in a trajectory toward the uterus. Sure enough, dark blood oozed out. After that, it was a simple cut through the thick septum in the same direction as the needle, and THREE YEARS of menstrual blood poured out, along with all the pain she had endured.

They come in threes

Sana is only 10 years old. Their family heard about the campaign on the radio and were convinced they needed to help her get to Vanga. Her dad brought her. She suffered from urinary incontinence since infancy. Despite trying to toilet train and clean well, she leaked urine all the time. Her family had no idea how to help her until they heard about the campaign in Vanga.

Similarly, Munikasa is only 14 years old and has had leakage since infancy. Her classmates mock her. Her parents went from health center to health center, searching for a solution. She tried various treatments and medicines without help. When they heard on the radio that there was a team coming to Vanga for urinary incontinence, the did not hesitate a minute. They took a motorcycle to a nearby health center where they found a team from Vanga who were there to recruit patients and this is how she was able to come.

Both she and Sana were found to have a rare condition caused by congenital ectopic ureters. Simply put, the tube taking urine from the kidney was connected to the vagina instead of the bladder. Dr. Paulin was easily able to find the ureter, cut it from its connection to the vagina, and reimplant it into the correct position in the bladder. We expect a full recovery and normal life hereafter for both girls. Believe it or not, a third young girl presented on the last day of our campaign, and she will be taken to Kinshasa where Dr. Paulin will be able to perform surgery there.  

In summary

I am so grateful to report that we were able to include all the fistula patients who presented (on time) into the schedule, although it was packed! We did 8-10 operations a day M-F and then 4 more on Saturday, for a total of 51 operations. In addition, 2 operations will be paid for but done by the local team next week (a colostomy and hysterectomy), and 2 patients that came in the last day of the campaign and were confirmed to have fistulas will be sent to Kinshasa for a fistula campaign which will start March 16 with the urologist and a team from Belgium.

Postop, we had 36 in one room, and 8 in another

Post op care team at the maternity

The patients ranged from age 10 to approximately 85. They were leaking urine for a range of 6 months to over 40 years. All but two appeared malnourished to some extent, and we have in our procedures to feed them well for the duration of time they are with us and healing after, which can be up to a month. Now we wait for the healing that only comes from the Lord, and we pray they will go home with the knowledge that they are not forgotten, that God loves them, and that they can trust this mission hospital if they have needs in the future or become pregnant again.

Until next time...

Wednesday, March 10, 2021

Parting the Waters for a Fourth Fistula Campaign

 Preparing in earnest amidst uncertainty

Planning a fistula repair surgical campaign in the era of COVID was ambitious. While it is essential to plan quite far in advance, making announcements about the free surgery provided in remote villages only accessible by motorcycle or on foot or by boat, it is also very difficult to know for certain that all the pieces will be able to come together to be successful. At any moment, we had to both continue these preparations and realize that one misstep or change in protocol could cause it all to be for nothing. Just a few of the pieces were my ability to get time off work in the US, the availability of the Congolese urologist in Kinshasa and his willingness to travel, negative covid tests at multiple junctures, the recruitment of the patients, and the procurement of the necessary materials. It was especially hard to hear that 12 (TWELVE!) women had come to Vanga for the fistula campaign which was cancelled in May 2020 due to COVID. I can only assume that they had no communication about the global pandemic and the impossibility of travel at that time. It breaks my heart. I hate that women are suffering from constant urine leakage and childbirth injuries, much less that they had made such an effort to get to the hospital only to find everyone masked with precautions in place and no possibility of a cure at that moment. I prayed that these women would have the courage and faith to return amidst uncertainty.

Ladies gathered, waiting for the surgical team to arrive

We had been tentatively planning this since November, even as cases in the US were rising rapidly and no vaccine had yet been released, and it seemed like it may not happen. Even by the end of January with a significant delay in the documentation from the Congo side, I was skeptical that my visa would be back in time to be able to go. My other proposed teammate was forced to back out, and I was getting discouraged. However, I had peace to continue pursuing the visa just in case, so I sent all the documentation and my passport to the Congolese embassy in Washington D.C. on a Thursday morning. We were startled with a knock on the door on Saturday morning, and my heart sank as I saw the familiar envelope in the USPS worker’s hand. I must have forgotten some postage. But when I touched it, I only felt a passport. I ripped it open to find my passport with a visa stamped inside!! It was unreal, especially when it has taken months sometimes, and caused cancellations of other trips. One day. Perhaps I am one of only a few that were crazy enough to apply right now.

Ryan brought me to the airport. My superman has been so supportive. 

Another snafu

Travel to Kinshasa was uneventful other than a 2 hour unexplained delay in Togo. Having a negative covid test was certainly helpful. Masks were required except when eating. When we got off the plane in Kinshasa, we descended the steps, our temperature was taken, and we were herded into a crowded bus. The bus took us a short way across the tarmac to a temporary tent that had been set up. This was also crowded, but the process was to get our official covid test registration paper. After that bottleneck, we were led to a second tent where there were health workers in full PPE to take the mouth or nose swab. It was very efficiently done at that point. I exited that last tent and found myself outside in the dark, without clear indication where to go next. The building with lights on was a few yards away, and I remembered it was where our bus normally dropped us off for customs. Normal procedures here, stamping passports, etc, but NO line. Next was the health stop where they normally check for our yellow fever vaccination card and take our temps. It was all about covid now. No one checked for my yellow fever card. 


A prearranged taxi driver helped me get a luggage cart. We waited for luggage. In Africa, many people wrap assorted packages with rolls of plastic, like Saran wrap. This particular flight from Togo had more random balls of plastic than traditional suitcases. The result was that the normal luggage carousal was not well suited for rolling plastic balls. It became quite comical for me to watch as the conveyer belt spitting the luggage and plastic balls became clogged with the balls of plastic. Everything would stop. They’d extract the balls from the conveyer and restart, only to have the next round of balls clog it up again as they rolled cattywampus down the belt and encounter a normal suitcase. Eventually, they took the plastic balls to the overweight baggage area and the process normalized. All my bags arrived.

As we approached the place where they run our luggage through the machines one more time, to extract taxes where appropriate, I was bracing myself. Last time I brought an electrocautery machine into DRC, I was taken aside to a separate room and questioned. At that time, I had offered to give the machine to them if they wanted it as I was not trying to sell or gain anything from it. I had simply told them I was using it for the surgeries I was undertaking. They had let me go. This time, to my great relief, the passenger just before me in the luggage line made quite a stink about something, and they quite ignored my bags as they went through. We picked them up and got out the door without incident.

A beautiful place to rest

We drove through Kinshasa toward the house where I would be temporarily staying until I flew to the village. I noticed many people rushing about, more hurriedly than normal for this time of night. Then I saw groups of policemen and barricades. My taxi driver informed me that our plane had been 2 hours late, and thus we were fast approaching the curfew of 9pm set by the government. They were closing the highway as we were driving, right behind us. We passed at least 5 roadblocks being put up, and I found out that we would have been stopped and proof of flight required to get through. I was so grateful to avoid that step and additional time on the road, but I realize that my driver then was forced to sleep in his car as he could not return back to the airport through the barricades without a passenger. 

I had a day to rest and enjoy reconnecting with long-term missionaries at their house. The flight to the village was scheduled for the following day. The urologist, Dr. Paulin Kapaya, was prepared to leave as well, with a negative Covid test in hand. However, the MAF (Mission Aviation Fellowship) pilot for our flight to the village received a positive covid test the evening prior to our flight. We scrambled to decide what our options were. We could attempt to drive to the village, but it was too late to arrange for this. The simplest solution was to take another test and hope the first was a false positive. Due to the number of patients waiting for us, we could not afford to be delayed longer, so we also made preparations to drive. We would arrive exhausted and worn out, and thus, the road was not an ideal option. In the end, we received word of a negative test from the pilot, and we were able to get on a flight only 1 day delayed.

Just after landing, this was our crew. Top right: Vanga Hospital is close to the river


After touching down on the grass runway in our tiny, 4 seat airplane (including the pilot!), we were met with the usual crowd of village children and hospital personnel. However, there was not the usual Landcruiser. They informed us that the road had washed out. Good thing we hadn’t attempted the road! 

We then walked from the runway to the hospital, and a half a dozen people carried our suitcases and packages on their heads to help us. We went by the hospital, where there were joyous reunions and smiles all around. (The urologist was born in Vanga, went to nursing school there prior to med school, and still has family there. Likewise, I had lived in Vanga with our family for over a year.) 

The fistula patients and the family members who accompany them were waiting for us. During our introduction to the patients in their local language, I kept hearing the word, “Moses.” Indeed, like the Lord parted the water of the Red Sea for Israel to cross over on dry land, it felt like the Lord had parted the waters of Covid restrictions to make it possible for our team to arrive.

Monday, February 18, 2019

Meant To Be: Coming Full Circle

How our second fistula campaign came to be in Vanga. It shouldn’t have happened. But God broke down the barriers one by one. This blog meanders but stick with it and I promise you will be amazed as well. God cares about the details.

Shortly after Whitney’s birth, as we were contemplating our last few months in Africa for this season in our family, Dr. Tim Rice made an interesting proposition. If you don’t remember Tim, you probably haven’t been following our journey, but I’ll remind you. Tim is the Saint Louis University doc that I first went to Congo with in 2012. For 2.5 yrs, our families were inseparable. We went to language school together and then were in Vanga, DRC until our family moved to Togo. We’ve stayed in close communication, and their family has visited us in Togo, Kenya, and on brief stays in the US. Tim’s proposition was for our family to make a stop in Vanga “on our way” back to the US.
Whitney had never been to Vanga
Tim, now the medical director at Vanga Hospital, had a critical conversation with Dr. Paulin Kapaya, a urologist living and working in Kinshasa at St Joseph’s Hospital. Dr. Paulin had received part of his medical education in Vanga, and he had been part of the fistula team led by Dr. Delores back in the summer of 2016. (Read about that in my blog “Realizing the dream.”) Tim and Paulin met and discussed the plight of women in that area of Congo, along with the capacity of Vanga Hospital to potentially become a center for fistula care. Many women had been transferred, at great expense and inconvenience to families, to get fistulas repaired in Kinshasa at St. Joseph’s. The alternative was to repair these childbirth injuries during local fistula campaigns. Considering the success of the first campaign, it was certainly possible to do it again in Vanga instead of continuing to pay for them to travel to the capital.
Rivers are a major means of transportation
Village life
Dr. Tim’s question to me was whether we could make it a priority to come to Vanga in order to be part of the surgical team for a fistula campaign. At the same time, our family could come back to a much more peaceful setting (than when we left) and see our beloved househelp, the midwives we had taught, the maternity nurses, the students and doctors who are our friends, the place where Zack was born, and the place where part of my heart will probably always stay. It seemed like a pipe dream, but we promised Tim to check on the possibility.

Samaritan’s Purse gave us the approval to travel for the fistula campaign. Step one of many completed. We needed to get our Congo visas. They are notoriously difficult to obtain. Normally, they must be applied for in one’s passport country. Living in Kenya, this would mean sending our passports by mail to the US and back. Also, they may or may not approve a visa, and the reasons for refusal are not often known. The time it takes to obtain the visa is not consistent. It is a reminder of just how difficult it can be to live in Congo and dealing with the uncertainty of a process.

As I described in my blog about Whitney’s surgery, her paperwork and documentation all needed to be in order prior to our quick trip to the US for my younger brother’s wedding in October. We absolutely did not want to miss that wedding because her passport was in the mail or waiting on the DRC visa in Washington DC. We were thus unable to apply for the visas until after our family’s October trip. There was a short window between the October trip and her original surgery date, and this was the window we needed to apply for the visas.

I prepared all the documents, gathered the passports, wrote down the address for the US embassy, looked up the DHL office location, hired a taxi driver for the day, and headed to Nairobi with Whitney on a mission to get our visas applied for. There was a slim, minute chance that I would be able to apply for the visas in Kenya because we were Kenyan residents, but I wasn’t holding my breath. We drove to the central business district to a nondescript office building, and I let the taxi driver know that I would call him once I figured something out.

The DRC embassy was on the 12th floor. Other than a large Congolese flag, it was hard to know that I was in the correct place. A small waiting room with one desk was on the right, and two or three locked doors flanked the small hallway. That was it. The process was unclear, but that isn’t surprising. I sat down with Whitney and waited for someone to come to the desk. A business woman entered and took her place behind the desk and I waited for the other people in the room to make a move. They sat there. Finally, I went up and presented my documents. She looked at them and said, “Oh, these are the wrong forms.” Face palm. That’s five copies of unnecessary paperwork. Sigh. She looked at the baby in my arms and offered to help me fill a couple of them out. One of the other ladies in the waiting room offered to hold Whitney. I started working on filling out the exact same information (in the same order too) on a form that looked very similar. Sigh.

As she was going through Whitney’s information, she noted that Whitney did not have a dependent’s pass that was valid for 6 months after our trip to Congo. I explained that we would be going on to the US and not coming back to Kenya. She said it was the rule. She went out to talk with her boss. I waited, praying fervently that there would somehow be favor. Her boss came in and talked with me, saying they could probably get visas for all of us except Whitney. Would I be willing to travel without the baby? They assumed not. And here I was stressed that our residency cards had expired, and we were all on residency extensions. But instead we were dealing with a problem with Whitney’s residency status. They went again behind closed doors to talk with someone else.

My hope dwindled. I continued to pray. I really didn’t want to be spending all this time in this office just to turn around and have to spend time and money finding the DHL office and sending our passports into the oblivion that is international mail. Yikes. They came back at one point and asked me for our old passports. More prayer. More waiting. Finally, the boss came back. She said, to my surprise, “Looks like you guys are still considered residents of Congo with your 5 year permits which expire in 2020. So we will allow your baby to come as well. Just go pay the application fee and the visas should be ready by Monday.”

I could hardly believe it!! Not only could we get this done in Kenya and not risk losing passports in the mail, but we also knew for certain that our applications were approved before we paid, and we could plan our trip for the fistula campaign with certainty. A minor benefit was that the visas would be ready in 3 days instead of the 10 days which is clearly written in multiple places as the processing time. I praised the Lord over and over again and still am in awe of this little miracle confirming our trip to Congo was in God’s will for us. Step two complete.

Last school assembly at RVA
In order to apply for a Congolese visa, we needed to have flights reserved coming and going to Kinshasa. Step three complete, or so we thought. We turned all our attention on getting through Whitney’s surgery and finishing well at the school, both monumental tasks which I tried to describe in my last blog. After the successful surgery and easier than expected healing period, we strove to say goodbyes well, packing up our lives into 4 checked bags (not counting some bags which others volunteered to carry for us at various times throughout the year). The night before we left for Congo, as Ryan was checking into our flights, he realized we had overlooked a crucial detail in our busyness. We hadn’t actually booked our tickets!

We are so thankful that Ryan was checking in online 24 hrs ahead of time and that the US is in the middle of a work day as we are going to bed. Though extremely stressful, on top of our baseline stress, after 4 hours we had confirmed tickets to Congo. Whew. Step three actually complete. Our flight to Congo was uneventful, other than seeing two men riding camels on the side of the freeway going north. We joked that they were going to find the Christ child as it was early December and they were headed in the direction of Bethlehem. 😊

In Kinshasa seeing some of our best doctor friends, former neighbors in Vanga
Our kids got to know each other too :) Zack was born a month after their oldest
We made it to Kinshasa. After a day of rest and reunion with several Congolese friends who had moved to the capital in our absence, we joined up with Dr. Kapaya and the Rices for the flight to Vanga. Grass runway, hundreds of kids, and a friendlier governmental process awaited us. Several midwives I had taught were overjoyed to see me. The reunions and memories they conjured were at once joyful, painful, sweet and healing. We walked the same paths we had walked before, showed the kids where Zack was born, where Sydney chased piglets, where Grandpa made the swing for Sydney, where we had pizza nights at the Brothers, where we sat on the porch swing overlooking the Kwilu, and of course, the Kwilu River where we swam most afternoons/evenings.
Grass runway and Vanga village. Kwilu River and Vanga Mission and Hospital at the top

Greeted at the airport/runway by former midwife students :)
 Despite the looming overdue presidential elections to be held later that month, the atmosphere in Vanga was calm and welcoming. The sense of suspicion and heavy spiritual darkness was gone. The new district pastor had forbidden the witch doctor from coming on the mission and disturbing people. So, a nice change indeed. The good people who had faithfully worked in hard circumstances before now seemed to be flourishing. Life is hard, death is all around, but a less oppressive and corrupt atmosphere goes a long way. When there is a gap between expectations and reality, placing trust rather than suspicion in that gap is a relief. (I stole this concept- not mine!)
Greeting hospital staff on our arrival. Can you see that the sun is hot?
Swimming in the Kwilu again!
Aunt Kathy reading stories. Kids' happy place
Whitney learned to sit in Vanga
After a couple of days getting reacquainted with village life prior to the medical work commencing, we had a setback when we realized that the main Vanga doctor coordinating the fistula recruitment efforts was unavoidably detained at a remote village without much ability to communicate. He would not be present for the week. Despite this huge disappointment, we pressed on. It was clear the Lord had made a way for at least the Potter family to participate. Soon Dr. Paulin Kapaya, the urologist, shared the obstacles he had overcome and we were blown away. I’ll try to be objective and truthful, as I know anything posted on the internet can be abused. People everywhere are people, and thus make mistakes. I’m far from perfect.

The Kwilu River. Upriver by several hours is the city of Kikwit.
If I understood correctly, the UNFPA had allotted money for a fistula campaign in the nearest large city of Kikwit for the 2018 year. Nothing had been organized nor was this widely known when we started making plans for the fistula work in earnest in Vanga this fall. Health officials in Kikwit called St Joseph’s Hospital to find out Dr. Delores’s availability, only to be told that she was out of the country and Dr. Kapaya was her backup. They contacted Dr. Kapaya. He was already committed to the fistula work in Vanga, a non-governmental hospital with private funding separate from the UNFPA. They ordered Dr. Kapaya NOT to come do the fistula campaign in Vanga. He was called in by the provincial health minister and told, in no uncertain terms, that this would jeopardize their need for the fistula campaign in Kikwit. No fistula campaign. No funding from the UNFPA.

Dr. Kapaya told the health minister that he had already committed to Vanga and could not turn his back on “his community.” This relational aspect is a much stronger component in Africa than it ever would be in the West. The health minister contacted St. Joseph’s Hospital to try to force his hand. St. Joseph’s then told Dr. Kapaya that he was not permitted to do this fistula work in Vanga. Dr. Kapaya solved this by taking a leave of absence without pay and carried a document that stated he was not getting paid by the hospital during this time. He kept it with him during the fistula campaign.

Officials in Kikwit also contacted other doctors at Vanga and told them not to do the fistula campaign. Dr. Kapaya was even told to gather all the patients who were planned for surgery in Vanga and transport them from Vanga to Kikwit. Money talks. The UN has money. Our private funding through donors was not nearly as profitable for the doctors or hospitals who have big organizations involved with their funding. There was an invisible war on, and it sadly had nothing to do with the plight of the women suffering from obstetric fistula. The love of money is the root of all evils, right? Well, evil did not have the upper hand. Dr. Kapaya was faithful to his word to Dr. Rice and to Vanga, and we went ahead with the campaign in Vanga despite the obstacles!

Papa Modja, nurse anesthetist and head of the operating room,
 consults with Dr. Paulin Kapaya and me as we get a game plan for the week.

The women came from far away villages. We transported 4 of them by airplane, and 6 came by motorcycle from a remote hospital. They had suffered from urinary incontinence for 3 months up to 40 years, and some had previously had attempted repairs 2 or 3 times. It was a busy week. In all, we operated on 32 patients with incontinence or prolapse, 26 for true obstetric fistulas. It was a great atmosphere and we had camaraderie. He was a urologist and I am a gynecologist. He preferentially operated on the abdominal cases and I did the vaginal cases. The tables are in the same operating room, so he would come and verify my work or make suggestions on difficult cases, but I was working primarily with my assistants as he worked on the most complex cases, some involving ureteric reimplantation or flaps. It was a great confidence boost for me as I’d been out of practice for many months after Whitney was born. Fistula surgery is technically difficult on any day. Praise God for His guiding my hands.

Dr Paulin Kapaya

Whitney got plenty of time in the operating room as
I needed to feed her regularly while operating all day. 
Mama Lutti, our previous Congolese nanny, easily got into the swing of things again with the kids, falling in love with Whitney immediately. Zack and Sydney enjoyed romping around outside in the sand and mud, climbing on the huge fallen tree and playing with Aunt Kathy’s legos and reading books. Ryan mostly hung around the house with the kids but took them exploring several times. We got out on the Kwilu River with Tim’s awesome powered dugout canoe a couple of times, and at the end of the busy fistula surgery week, we had a picnic at Lunungo Beach.
Whitney trying Tata Mbuta's pizza. He was our cook and now the Rices employ him
Chilling with Mama Lutti

Outdoor bathtime because it was hot!

Making sugar cookies!
Picnic with the fistula team at Lunungo Beach
I was called to the hospital at night a couple of times during the week for catheters that had fallen out, but other than those couple of concerns, our patients did great. They stayed in Vanga for quite a while, getting fed through the nutrition center to help their healing tissues. We tried to avoid a long motorcycle drive back to the villages by providing transport in a vehicle, and just this month we heard back from the women who had been transported by plane. “The women, when they arrived back at Kikongo, were very, very excited by the results and immediately headed back to their villages to celebrate their recovery.”
Rounding on patients post-op

Dugout canoe with an outboard motor
A perfect getaway on the Kwilu!
Mama Lutti
Getting ready to fly out
 I want to celebrate too! It was such a good way to cap this season in Africa, doing surgeries which I’ve dreamed of being able to provide to the poorest of the poor. We were able to use some of the donations sent in to us expressly for this purpose. It was a joy to be a part. It was wonderful for our family, and so healing for my heart. Who knows what the future holds?  

Zack loves to fly