Stories of Healing and Hope in 2025

We did 52 operations in 7 days. But summarizing a fistula campaign in numbers can take away the humanity of it. I have struggled to know what to write for my patient-centered blog post this year. Obstetric fistulas are the same problem we have addressed for the last 10 years with a lot of the same tragic circumstances. However, each woman has her story, and part of the healing process for the women is for them to share their experience with others. We need to acknowledge what they have been through. But, speaking for myself, sometimes the enormity of what these women face is not felt as acutely when I cannot imagine what they are going through.

Buckets provided to patients for personal hygiene

The daily reality of women suffering from fistula was brought into focus earlier this year when I was talking to a mom about caring for her elementary-aged daughter who is delayed in her ability to be toilet-trained due to a known medical condition. She described the constant buying of diapers and products to help keep her daughter dry. The mom had to apply cream to keep the skin from breaking down. This became more complicated when the child became more active, was going to school, and simply was growing bigger. She then said, “I think I know just a tiny bit of what your fistula patients go through, except they suffer for years. And they may not be able to afford or have access to diapers and just use cloth rags. It’s a very difficult situation.” Indeed. 

Grinder for seeds to make a protein packet seen after cooking in the leaf

You may also be able to think of an elderly parent that becomes incontinent in their later days. It is a lot of work to care for them, to keep them clean and dry, and to make sure they don’t have sores or breaks in their skin which can cause infection. Now imagine this person is not a child nor the elderly who would expect to have someone to care for them, but rather is a caregiver herself, a mom of perhaps other children, or a wife who is expected in the African culture to care for the home and her husband. Keep these pictures in your mind as you hear about two of the women who we helped this year in our fistula campaign (shared with permission, written by members of the fistula team).

This is Malosa Kipitshi. In 2007, she was married and pregnant with her first child. Later that year, after many hours of labor, she experienced a traumatic forceps-assisted vaginal delivery that her baby sadly did not survive. The day after delivery, she notice that she had become incontinent of urine. Despite hoping that her incontinence would improve over time, she continued to experience involuntary leaking of urine due to a vesicovaginal fistula causing a permanent connection between her bladder and vagina. This malady changed Malosa’s life forever; after an unsuccessful attempt to repair her fistula with surgery, her husband decided to leave her, and she was forced to remarry. She had a successful second pregnancy with her now-husband and they share one child together. While Malosa expresses gratefulness to have found a husband who wanted to start a family with her despite her incontinence, she shares that their relationship has been clouded by her condition. She does not share a bed with her husband and is not able to attend church with her family due to great embarrassment about not being able to control the passage of urine in public. Her entire family has abandoned her, not wanting to be burdened by her medical needs and the inconveniences that her condition brings. When Malosa heard about the opportunity to receive surgery at Vanga Evangelical Hospital, she was motivated to give surgery a second chance, knowing that the expenses associated would be covered by the generosities of the Fistula Foundation. Now that she has received her surgery, and has so far regained her continence of urine, she is beyond excited to share the good news with her family and community members. She even told us that she is planning a celebration in her village to announce her healing and begin her reintegration into the daily activities that she has long avoided. Malosa agreed to share this story because she wants other women with fistulas to be encouraged that they too could one day receive a healing surgery that would give them back their freedom. She is thankful to everyone at Vanga Evangelical Hospital and to the Fistula Foundation for offering her this opportunity to live life to the fullest after 18 long years of hiding herself and her condition.

This is Matum Makakiri. In 2021, she and her husband were ready to welcome their first child into the world. After a seemingly uncomplicated vaginal delivery to a healthy baby, Matum’s doctors decided to send her home with a catheter for 20 days. This was likely to prevent excessive stretching of the bladder which could worsen any pressure experienced by the bladder during childbirth. Unfortunately, when it was time for her catheter to be removed, Matum was found to have a vesicovaginal fistula that rendered her permanently incontinent of urine. This was devastating for Matum, who was a new mom and just beginning her adult life. Her condition was deeply embarrassing for her, and so she avoided all public gatherings and appearances so that others would not have to be bothered by the smell of urine that was always with her. She even refused to attend funerals of close family members in order to avoid humiliation. This became especially difficult for her when in 2024, at the age of three, her only child passed away due to severe anemia. The surgery she received at Vanga Evangelical Hospital to repair her fistula was a life-changing event in Matum’s life. While she wants her husband to know that she is grateful to him for staying by her side despite her incontinence, she acknowledges that a successful repair of her fistula will allow them to try for another child in the future, something that was not a priority while she was suffering from the leaking of urine. She looks forward to going to church again and telling the people in her village that she has been healed.

                       

Saving a life

Fistula surgeries are an interesting sort of operation. They require expertise in both the female anatomy as well as the urinary tract. It is a blend of urology and gynecology, and it is highly beneficial to have input from both. Dr Paulin is our Congolese urologist and is a full time fistula surgeon. He performs transvesical operations and ureteral reimplantations which are beyond my scope of practice. I am the complement as I perform prolapse and vaginal surgeries beyond his scope. The main operating room in Vanga has two tables, allowing for simultaneous operations and easy conversation and help. We have a friendly banter as we perform surgeries throughout the week. “Pas de conflit!” is a common phrase we say with a smile, usually after a playful dig at the other’s perspective.

One evening after a long day of fistula surgeries, Dr Paulin stayed late to perform a purely urological case. This man had received 10 pouches of whole blood, had 4 operations, and still the source of bleeding had not been contained. The worry etched in the face of his treating doctor showed the gravity of the situation- he was very likely going to die. Paulin was not deterred. Even if he died on the operating table during his 5^th operation, this would not be different than the certain outcome if left without further intervention. He had to try.

Early the next morning, prior to starting our fistula surgeries, I went with Dr Paulin to see the man post operatively. He was not only alive, but he was doing very well! The urine draining from his catheter was completely clear, without a trace of blood. Surgery had been a success. The smile on the treating physician’s face stretched so wide I didn’t think his lips would move back enough to talk. In a later meeting with the staff doctors, Dr. Paulin recounted the details of how he had to create a flap to cover an area which was impossible to stop bleeding from due to its location at the bone. He mentioned that it would not have been possible without the special catheter that we brought from the US. When I questioned him, he couldn’t resist the temptation to dig, saying a phrase that translates to,  “The gynecologists brought something that they didn’t even know the value of!” A normal catheter costs up to $2. This one is over $100! This catheter saved a man’s life. Our coming to Vanga this week saved a man’s life. God orchestrated timing of it all: the donation of an item to us, the journey of our team to Vanga, the delivery of this item to the OR staff, Dr. Paulin’s readiness to take on a challenge, Dr Paulin’s quick thinking and remembering seeing that item in the pile of donations. In that timing, God allowed us to be part of saving the life of a papa, a husband, a brother.

Jehovah Jireh- God provides.  

Admittedly, part of the preparations for this year’s fistula campaign were more haphazard than other years. We started to gather supplies later than usual as we were unsure if the campaign would even happen. Some needs were not expressed until the last minute. Some essential items needed specifically for fistula surgeries include ureteral catheters and 3 specifics types of sutures on special needles which allow us to get around tough corners in tight spaces. All three of us searched for as many of these as sutures and catheters as we could possibly find. I found only one box. Dr Madeline only found one box. Dr Paulin only found one box. He also brought as many catheters as he could find. As a testament to God’s provision and guidance in this campaign, we used EVERY SINGLE catheter Dr Paulin found and had no further need. And the sutures? All three of us had brought a box of a different type. We had all we needed.

Travel Advisory

Two weeks before our scheduled departure for our fistula campaign, DR Congo made world news. Goma, a city in the East of Congo with significant international presence despite its troubled history, had been overtaken by M23, a rebel group widely-known to be backed by Rwanda. Many lives were lost, horrendous tragedies unfolded, and a world largely distracted by chaos in Washington DC and Gaza and Ukraine suddenly remembered this country. Eastern Congo is a sort of place where conflict never really ceases, much like some areas in the Middle East. There are large deposits of highly-valuable minerals sought worldwide. Tribalism is rampant. Sexual violence is common. Terrorism of innocent villages to pillage and feed scores of men who are fighting is the norm, unfortunately. While none of this is new, the capture of Goma and the sudden advance of M23 caused protests and some destruction in Kinshasa, the capital located far away in the West. A travel warning went into effect, and the level 3: AVOID UNNECESSARY TRAVEL soon shifted to level 4: DO NOT TRAVEL.

What to do? Preparation for a fistula campaign begins months in advance, and scores of women were preparing to walk, float, and ride dugout canoes, motorcycles and planes to get to Vanga. Some of them were likely already waiting. Although Dr Paulin performed over 70 fistula surgeries last year without me, he was counting on my support. Fistula campaigns can be brutal in terms of workload, and the reality of the situation is that postponing the campaign this year would mean cancellation. We did that in 2020 during Covid, leaving 12 women waiting for our arrival, and I did not want any of these precious women to have to wait indefinitely for a chance at a cure.

Anxiety set in for me. I do not take travel warnings lightly. Already, Dr. Tim and Kathy Rice were not able to host us personally this year due to an unexpected stay in the US for healthcare. On top of this, I felt the weight of responsibility of directing the GYN resident and the medical student on my team. So, I prayed for clear guidance. I consulted my African friends, especially those with government connections or impartiality (without any involvement in the campaign). We have contacts at the US Embassy in Kinshasa. Word on the street was that things in Kinshasa, through which we travel on our way to the village in Vanga, were completely calm and normal after the initial unrest. Calm but tense. No one could guarantee that chaos would not return at any time, thus the travel ban, but every contact consistently said that life was going on as normal “for the moment.”

As I went about those last two weeks, my shoulders were granite slabs I carried around. If we needed to cancel, earlier was better. If we were continuing, there were so many tasks and messages, packing and supply-gathering to do, and I felt completely overwhelmed. Should I take this lack of peace as a sign from God, or was this unusual anxiety a sort of resistance from an evil source? Evil would not want hope and healing to reach these vulnerable women. With one week to go, I checked in more intentionally with my US team. Their responses through text brought the clarity and peace I needed. “If you feel comfortable then so do I!” and “If the travel advisory stays at a level 4 then I can’t get elective credit for the trip but that’s not a big deal to me.” Wow. I was so grateful to have their resolute responses.

Somehow, in the midst of single parenting that last week due to a work conference for Ryan, we were able to pack eight of nine suitcases full of surgical supplies. Tuesday, the day before our departure, I drove to pick up one last stash of supplies for the final bag. As I was driving, I glanced up at the message flashing on the highway sign: “WINTER STORM WEDNESDAY. TRAVEL NOT ADVISED.” We were supposed to drive to the airport and fly on Wednesday mid-day, and the snowstorm was to hit 2 hours before our scheduled flight. Sigh. What’s next? Oh, the warning about possible Ebola, the warning about Monkey Pox… it’s no wonder people have a hard time working in Congo. Not to be deterred, we called our travel agent and changed our flight to 0-dark thirty, adding not only 6 hours of travel time, but also peace of mind.

It was with extreme fatigue, yet satisfaction, that we arrived in the village on Friday. Travel was as smooth as I have ever experienced in  the Kinshasa airport, navigating the city of 17 million, and the formalities for the regional flight to Vanga. We collapsed, exhausted, in the guestrooms of the empty house of Dr. Rice. This was after walking from the airport, taking a short tour, and greeting the very excited staff of Vanga hospital. Sleep came quickly and deeply. Finally, prior to sunset, we took the courage to venture out again. We needed to greet the women suffering from fistula who were waiting for us. We had barely rounded the corner of the building where they all slept when we were greeted by excited cheers. As they streamed out of the large simple cinderblock room and filtered in from gathering firewood for the evening meal, they broke out into a song of greeting, dancing, clapping, smiling. And I cried. I couldn’t help it. The granite slabs dissolved and became my shoulders again. This. This is why we came. These women were why “WE MUST TRAVEL.”