Our 6th fistula campaign in Vanga, 2023, is best summarized by a dance. There are several reasons. Fast and slow, complicated and simple, we moved and worked together to bring healing to many precious women suffering from injuries caused by childbirth and trauma. A quote that stuck with me prior to the trip, and in fact was written on my fridge before being taken over by a packing list, was an African proverb. “As the music changes, so does the dance.” Also, I recall an old journal entry in which I wrote, “When we get close enough to one another, we will step on each other’s toes.” Lastly, this campaign was full of dance because the gyn resident who joined our team this year minored in dance during college. What a joy to see how dance could uplift broken hearts and spirits, break through language and cultural barriers, and join us together with a smile! So, shall we?
Travel this year was smoother than ever before, with the
lifting of covid restrictions. All four American members of the team benefit
from extensive travel experience: Nancy Rice, NICU nurse, previously lived in Congo
with us, Madison Strausbaugh, fistula team nurse from World Medical Mission
travels so much that her desk calendar is still in January, and Dr. Torie Hayes
would likely be living overseas if she weren’t in gyn residency. We had no lost
luggage and made our connections, albeit running to our gate in Paris,
Home Alone-style.
There was this one incident, however, with fish. Imagine a Toyota
Landcruiser with many large boxes of “frozen” fish on the roof rack fighting
the humidity and heat, melting down the sides and the windows, blurring our
vision of Kinshasa traffic as we drove at 5am to catch our domestic flight to
Vanga. Imagine luggage porters running after us, stuffing small fish that were
steadily dropping out of our luggage cart straight into their shirt pockets. Imagine
the smell. Soaked, cardboard-turned-mush boxes destined for Vanga to help feed
our patients for the next month. We paid a little extra to park close to the
entrance of the airport where we were weighed along with our baggage. The
degree to which this was a ridiculous request for checked baggage is also the
degree to which the MAF (Mission Aviation Fellowship) staff took it all in
stride. Sure, we lost many fish to the pockets of the porters and people
helping us to repackage the fish into plastic water-tight bags, but most of it
made it to Vanga and was still edible!
We met many of the women suffering with fistula the day we
arrived. They were awaiting surgery together in a pavilion just outside the
main hospital. Since December, the Vanga team had been sending out radio
messages and occasionally doctors themselves to rural communities and referral
centers for recruitment. Some patients came from nearby, but others had
traveled over 500km from Angola and the Republic of Congo to get surgery. The
road to the hospital is still impassable by car, so by dug-out canoe or by
motorcycle or by combination of bus-taxi-foot, the patients came. We screened,
consulted, and scheduled for surgery these patients during our first full day
on the ground. Then to connect with them prior to starting operations, we
returned to the pavilion arm-in-arm with about twenty enthusiastic nursing
students. Torie, the gyn resident, our team athletic director, and our dance
instructor led us in a collective African line dance to the song Jerusalema. Oh,
how we laughed! Though we had practiced at home, it was a whole new level to
try to dance with 50 women on uneven dirt and grass, avoiding ants, tree
branches, or random rebar sticking out of the ground, and laughing so hard at
each other that we could not hear the music.
Operations started with our usual team, led by Dr. Paulin
Kapaya, fistula surgeon and urologist from Kinshasa. Each OR has a culture of
its own, but the whole team adapted quickly, with the Congolese staff warmly
welcoming the assistance of Nancy and Madison as they learned the ropes of
circulating and assisting with surgeries. It is always fun for me to come back
to the same faithful nurses, doctors, and residents and to see them continuing
the good medical care provided with such limited resources. The poor air
conditioners in the wall fight hard against the African sun, but with cloth
gowns and long days, it is always advised to end the day by jumping into the
Kwilu River before sunset. The butterscotch water runs over smooth sand, daring
us to compete with its current. And our other option of a bucket bath shower is
much slower at rinsing out shampoo than swimming upstream for a few seconds!
The music changed with the arrival of a team of urologists,
nurses, and anesthesiologist from Belgium. Médecins du Desert (doctors of the
desert) is an organization with 13 years of experience doing fistula missions
all over Africa, and they were invited jointly by Dr. Paulin and Dr. Junior (One
of Vanga’s supervising doctors and my friend since we were both residents in
2012) to help with this year’s campaign. The rhythm and tempo in the OR
changed, the composition both strange and beautiful. Medicine is an art as well
as a science. MDD had a unique challenge to jump into surgeries after we had
already consulted and scheduled the patients. Different protocols and
requirements for reporting back to our various funding sources caused some
duplicity and confusion. However, the diversity and depth of experience in
tackling the difficult cases was a huge blessing. By the second day of
operating and working together, our dance took shape. We were unified in our
goal of helping more women with fistula, and getting in the trenches with the
same goals significantly accelerates connection with others.
The weekend was a welcome rest from surgical work, and there
was a lot of dancing! Saturday, the American team left the urologists to do and
teach purely urological procedures and took a 2 hour boat ride up the river to
celebrate the opening of a new hospital. After our canoe touched the shore, we
clambered out and up the sandy slope to a waiting vehicle which took us to what
we thought was just going to be a simple meeting for the Vanga team to discuss
logistics of staffing the hospital. The Landcruiser stopped in front of a large
group of people singing and dancing. They were gathered outside the new
hospital building, shaded by tarps held up by bamboo poles. After greeting a
long-time missionary friend, Katherine Niles, we were paraded into the
gathering and placed near the front. We had just come from the river and
weren’t quite dressed for the occasion which seemed formal with dignitaries and
police and pastors and priests. We settled in, a bit confused. Later, Katherine
said, “NONE of this was planned. I had NO idea!” She was even called upon to
make a formal speech. Improv at its best.
Sitting there, guessing where we were in the formal program,
I took note of the arrangement. As I mentioned, there were bamboo poles holding
up tarps which were temporarily attached to the building. There were long rows
of people under these tarps, but where the shade ended, so did the people. About
75 feet! back, there was a tree providing shade, and there were about 3 more
rows of people sitting or standing, as if they were just behind the row. The
sun cut right through the crowd. From where we sat, the speakers were quite
loud and close to us. Dr. Tim Rice, not a novice at such things, put earplugs
in as we listened to the speaker. However, this became complicated when this
pastor finished speaking and came back to sit down, right next to him! In a
particularly smooth move, Tim discreetly raised his left hand to his ear to
take his earplug out. The row of us Americans behind him could not contain our
smiles and then outright laughter after calling him out in private later that
day.
The Sunday service is always filled with the choirs of children and men and women singing. One cannot help but smile seeing the joy. One particularly endearing part about the choirs is the small children that are a part of an adult choir. Our second Sunday there, the four of us Americans were invited to come up to sing. We decided the best course of action was to learn a Kituba song and the whole crowd joined in, thankfully drowning out our voices for the most part.
All of the teams, American, Belgian, Kinshasa, and Vanga teams were invited that afternoon to take a ride on a larger rented boat. What a delight to get to know the other teams outside the stress of the OR and hospital! As we neared our destination, a sandbar just in front of an island, ominous clouds threatened and lightning and thunder came rolling in. Being in one of the lightning capitals of the world, I usually avoid this danger, but frankly, we had no good options. Under a tree, in a boat, or in the water, we were about to get soaked and the lightning was still several miles away. Throwing caution to the wind, one by one everyone got out of the boat, ran across the sand, splashing, high-stepping, and dancing, flinging themselves into the river. For those that could not swim and had never been in the Kwilu, this was particularly delightful as the water was shin-knee deep. Rain came pouring down and we danced and laughed like schoolchildren, from the oldest Belgian professor to the youngest Congolese medical resident. When lightning encroached, we got out of the water, staying close but not too close to the trees and huddled around a fire. Rain continued, so we started our journey back, holding makeshift tarps over bamboo arches until we finally came out of the storm. Sometimes memories are best when the unexpected happens.
Surgeries continued and our Kinshasa and American teams left
a couple days ahead of the Belgian team. Our postop nursing staff and the lovely
ladies cooking for our patients will continue as we see the healing process
continue. One by one the ladies will get their catheters removed. They will
stay for at least a week before heading back home due to the extreme difficulty
of following up and our desire to know and treat them if there is further
leaking. Highlights for me continue to be the people of Congo as well as the long-term
team who work in Vanga. I love coming year after year to see them, to hear how
their families are doing. I was able to see a patient healed from her fistula a
few years ago and a nurse who reported resolution of pain after following my recommendations.
A couple stopped me to say thank you for a consult I did years ago for
infertility. They were proud to tell me they have 4 children now. Working
cross-culturally will always be a dance, and when the music changes, so must
the dance. It is my sincere hope that we continue to work for the good of the
poor and suffering among us, so that they can feel deep down in their souls
that they are not forgotten by God.
