Realizing a dream

As you may know, I became certain of my desire to become a doctor, and specifically an OB/GYN, when I was in Ethiopia in 2006. Visiting the famous Addis Ababa Fistula Hospital and seeing the complete transformation in these women’s lives was inspiring. My desire to emulate Dr. Hamlin, the hospital’s founder, remained a principle motivator as I went through medical school, residency, and then as Ryan and I applied to World Medical Mission to come serve Jesus somewhere in Africa where fistulas are still a problem.

The joy of going home healed! This is the first successful vesicovaginal fistula repair that I've performed here. 

My first 10 months here, we saw a few fistula patients. Two we operated on and failed. A third I put a catheter in to await the end of my pregnancy to give her the best chance for a good outcome (without my belly getting in the way of visualization and my fatigue decreasing the chance of success). When I came back from maternity leave, we joyfully found that she was dry and healed from a few months’ rest for her bladder. My desire to do fistula surgery waned.  After all, I hadn’t gotten good results at first and there was no one to coach me. Instead, I worked on other things- teaching vaginal surgery, improving prenatal care, teaching the midwife OB courses at the nursing school. Regarding fistula surgery, I had read extensively about it, watched almost 50 cases in Ethiopia on an elective rotation, and performed one during residency, but there is nothing that can replace experience. The only place to gain experience is in the developing world like Africa. And I was beginning to feel like Vanga would never be that place. Perhaps God was moving my vision elsewhere.

But then in May, we found out that there was a fistula surgery campaign that was being planned to come to Vanga! This was a “my cup runneth over” moment where God was giving me more than I asked for or even imagined. It was not just that I would get training and finally have someone to coach me (to cut a bit more here or to adjust the angle of the needle), but it was also that the OR and pre/post op teams would be updated on techniques and the very real difficulty of getting good visualization for the surgeon. It was not just that a couple of surgeons would come to help us, but also that these surgeons speak the local languages and know the culture as they are Congolese. I hadn’t even dreamed of such an experience!!

What a team! Dr. Delores of Kinshasa, Mama Maguy the chief of maternity here in Vanga, Mama Alice, community prenatal care here in Vanga, and Dr. Paulin Kapaya, fistula surgeon trained originally in Vanga as a nurse, now from Kinshasa

With the fistula team coming, excitement within me was building. But I was also left with questions. Why didn’t the administration tell me about their coming and ask for input? I’m the only (ONLY) OB/GYN specialist who isn’t working primarily in the capital Kinshasa in the whole of west DRC, but their arrival was only mentioned to me in passing one day. I decided to make an effort to go meet the team ahead of time in Kinshasa. Then it appeared that the campaign would be cancelled with our medical director out of town. A fellow staff doctor and I sprung to action and, with permission, coordinated everything, sent out radio messages, evaluated patients, organized payment structures, food for the patients, all stuff I’ve never done before much less done in a new culture.

Getting the message out by radio for the women to come in for fistula repair. (The reporter is holding a recorder and interviewed us all.) Yes, gulp, even me in French unedited on the radio. 

Our task was to find 40 patients. There were only 27 on a list previously made by administration. This was muddied by the fact that the memo sent out was for anyone with a fistula or anyone with a mass felt coming out of their vagina. It was hard to know if we’d get the numbers to ensure the team’s coming. They delayed their start date a couple of times due to this. I felt stressed and so very much did not want to miss this opportunity. I started intake of patients and diagnosed them prior to the team’s arrival. Even though we only had 12 confirmed fistulas, the team decided to go ahead and come.

Dr. Delores, medical director of St. Joseph's and fistula surgeon on the left. Justin, anesthetist on the right.

The miscommunication about the prolapse surgeries also being part of the program and free caused significant consternation. As the fistula patients started getting their surgeries scheduled, I had a throng of people I’d promised to do surgery on as well who accused me of abandoning them. Plus there was an influx of women coming to get evaluated. It was so busy. In addition, at home, Zack decided that this was a good week to stop sleeping well at night and to eat a lot extra. I had no extra milk supply; I had only “the daily bread,” so to speak. As surgeries started, I was frustrated to have to leave the very interesting, once-in-a-lifetime experience to go and feed Zack. All the women demanding to be seen as I passed them on the sidewalk walking up to the house also made it difficult. 

But oh the patients. The possibility of seeing them healed and lives restored is why we are in medicine! One had had the fistula for 17 years! One had an operation for the repair 3 times, another 4 times. I was beginning to understand why they didn’t come for surgery- destitute, with little guarantee of a good outcome. Their joy as they have been singing together in the wards is palpable, infectious, and makes all the work worth it. They cannot stop smiling as they walk about without leaking urine. It’s what I remember from Ethiopia.

Dr. Delores's time in Vanga was impactful in many ways, but above all her humble, caring and generous spirit towards everyone from the doctors to the people cleaning instruments to the poorest of patients. An inspiration.

We started discharging the first group of fistula patients this week, and it was a joy as well. I expect that as they go back to their villages, word will spread and women will start coming with their fistulas and we will be able to build capacity in this area. Perhaps it was the Lord’s will that we are taking a bit of a break to come to the US. Lord knows I cannot rest here if there are patients still waiting for me. In the end, though, we did work hard to make sure that most of them had gotten their prolapse surgeries before the team left, and the rest I am slowly finishing throughout these following weeks. It was such a mix of amazing and exhausting to have the fistula campaign here in Vanga; we have been truly blessed!

Dr. Paulin Kapaya, fistula surgeon extrordinaire. Justin, anesthetist, looks on in the back.

Several wonderful ladies who walked in with their uterus's swinging between their legs (complete vaginal prolapse) and who walked out without shame, dancing in the wards as they left.