Where do I begin? I guess I should talk abut how I ended up here.
A few years back, I watched an episode of Oprah featuring women with fistula. What is fistula?, you ask?
Obstetric fistula occurs in many developing countries. It is a hole between a woman’s birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder (called a vesicovaginal fistula or VVF) and sometimes between her vagina and rectum (rectovaginal fistula, RVF). This hole results in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their inability to have children and their foul smell
After watching this show, I knew I wanted to do something to help. Fast forward a few years later, a friend introduced me to the director of IOWD, and that’s how I ended up in Rwanda
After traveling from Houston via Washington DC and Brussels, I ended up in Kigali with the rest of my team on April 20th. On April 21st we went to check out Kibagabaga hospital. We found out we had a case scheduled, so we got busy and did our first surgery. It was a success!
The hospital is located in Kigali, Rwanda. The women come from all over Rwanda, mostly from rural areas. They come in large numbers, and have to be evaluated one by one by the IOWD surgeons ( the surgery team is made up of obstetricians and urogynecologists). Not all patients can have surgery, and this is very depressing. The surgery candidates undergo an exam under anesthesia (EUA) and cystoscopy (cysto) and the decision is made regarding what surgery the patient requires.
As far as our anesthesia team was concerned, we intended to give the best care to every patient regardless of the scarcity of resources. We had one working anesthesia machine, and halothane gas which most of us have never used. Talk of a steep learning curve! We did most of our cases with subarachnoid blocks (spinal)- where we inject local anesthesia in the patient’s spine and that numbs the body from the waist down. It was an interesting experience because the patients did not speak English, so we relied on the hospital staff to interpret what we were saying.
Doing anesthesia pre operative interviews was one of the highlights of my trip. It enabled me to learn more about the women, and relate with them. It was funny how most of them thought I was Rwandan ( think the East African forehead did me in) , and would speak to me in Kinyarwanda.
One of the most interesting things was that we used every resource we had to the maximum. We wasted nothing, and never complained when we had little to work with. It was an eye opening experience because we all realized we waste a lot in the US. We had one working autoclave machine, and therefore we used chemicals to sterilize equipment between cases. Everyone helped out, regardless of rank and title. It was not unusual to see one of the surgeons mopping the floor between cases. Did I mention we ran out of sterile gowns on our last day, and the hospital washing machine was broken?
We would arrive at the hospital around 8 am and work until around 5pm. By day 4, I was feeling emotionally and physically exhausted. I was more emotionally drained than I had prepared myself for. There was no time to sit and complains about being exhausted. The women needed us, and so we all soldiered on.
I got the opportunity to visit the women’s hospital at Muhima hospital. I was following the anesthetists at Muhima to learn how they do things. We had one urgent Caesarian section delivery for a baby in breech position. If I recall correctly, the baby was around 30 weeks gestation. When the baby was delivered, we heard a single cry, and noted that the baby was blue. Dr M, (one of the obgyn doctors on the IOWD team) and I took the baby to the NICU. When we arrived in the NICU, we didn’t have oxygen, so we decided to just help the baby breathe with room air. After a couple of minutes we ‘borrowed” oxygen from another baby in the NICU, we were also able to get some suction working, which helped quite a bit. I now know firsthand what they mean when they say God takes care of children and fools….. That was my first ever neonatal resuscitation. After what felt like hours, the baby was breathing on her own, and looked better. The memory of that resuscitation will stay with me forever
By the end of the trip we had operated on over 35 patents, and that was such a blessing. It was sad that we could not treat every patient with fistula. But one thing I know for sure, is that the women we helped will live a much better life than they did before.