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.

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.