Thrice a year, for the last five years, a team of medical volunteers from the US have been coming to the country under the auspices of the International Organisation for Women and Development (IOWD) to carryout free fistula repairs and train local doctors on how to care and treat the dreaded obstetric condition.
Dr Star Hampton and Dr Saifuddin T. Mama are the team leaders of the batch of volunteers that come in February to voluntarily treat fistula patients at Kibagabaga Hospital.
Dr Star spoke about their activities. Excerpts;-
This is not the first time you have come to Rwanda to voluntarily operate on fistula patients, what fuels this spirit?
Knowing that we can change the lives of two or fifty women on one mission is wonderful, a truly life-changing surgery is very rewarding and important.
So you can swap your place of abode for Rwanda and work here, huh?
I think the concept of moving to Rwanda and making a program is wonderful and it’s needed but like Dr Mama said, each one of us individually has personal responsibilities at the university, spouses, or children, so it’s hard to come stay this side.
Just how applicable is the word ‘volunteer’ in this activity, taking into account air ticket and other expenses; does IOWD foot some of the bills?
We completely volunteer for every little thing we foot all our expenses. When we are home we work very hard, we organise fundraisers and get donations, we raise money with our own fundraisers, bring gifts for the women, and, for the people here, it’s not only the expense of coming but when we are home we do other things for the women as well.
Medical ethics aside, how would you be able to put in 100 per cent in this work when you are not paid, I mean, does it make a difference executing your job when you are paid for it or not?
There is no difference in my mind; we take care of people the best way we can strive for the best outcome we treat them all in an ethical way.
What does it take to be a fistula repair specialist?
In the United States, we go to high school, four years of college, then we go for four years of medical school training. After medical school, one has to go through another five years of training, which is specialising in OBGYN [Obstetrics and Gynecology] and after this almost everyone on the team has done three extra pelvic reconstructive training.
It’s a very long process and most of us have been in practice for at least 10 or even 20 years. Many of us have very specialised experience. However, it’s important to know that when you are first coming with IOWD, the fistulas that we see here in Rwanda are not the same as those in America, so the first time that we come, we always have to work with someone who has experience working in Rwanda.
Does it matter how old the mother is for the operation to be successful?
It’s difficult to predict success of the operation; success is a very difficult word. Success means that the fistula is closed and no leakage continues [after the operation]. Sometimes age doesn’t determine success but I would say age doesn’t impact our decision to treat the patient. Every patient is different, that’s why, as a physician, one must check every patient on an individual basis.
What does it take to do a fistula surgery in terms of resolve since many people say it is terrible, what with the smell and all…
I have no problem with that. There is a lot things with the surgery but what’s important for our team is that we have humour, we laugh together at life not the patients. It’s important for us because we keep perspective that we are helping these women and we must show them passion and friendship.
Any risks associated with the surgery? What are the medical consequences of fistula?
Every surgery has risks big or small anytime you take a patient to the operating. Every surgeon must weigh the benefits and the risks of the operation and we as a team sit every night and discuss if the benefits of the patient are worth the risk and if it’s not we don’t operate if it is worth it, then we operate.
With the medical consequences, if a patient has an illness we find a way of dealing with them like we once operated on a patient who had high blood pressure, but we stabilised her and when she came out of the operation, her blood pressure was already normal.
A fistula is condition that happens during child delivery when in a hole is punctured between two organs or an organ and the outside. Such a hole can be on the bladder or the rectal wall, causing urine or stool to flow from the high pressure side (urinary tract or bowel) to the low pressure side (vagina).
Dr Mama (obstetrics and gynecology, University of Pennsylvania, US), says the most common types are between the bladder and vagina (vesico-vaginal), urethra and vagina (urethra-vaginal), and rectum and vagina (recto-vaginal). But the condition could also occur between the urethra (tube that carries urine from the kidneys to the bladder) and vagina (uretero-vaginal) or the colon and uterus (colo-uterine).
Urinary fistulas leak urine constantly while rectal fistulas leak intermittently with the presence of gas or stool.
Obstetric fistula is most prevalent in developing countries where healthcare such as antennal care and childbirth is still a luxury for many a woman.
Dr Mama says left without specialised medical attention, a victim not only suffers from incontinence, but is also exposed to cancers such as the colon rectal cancer.
IOWD, the US-based nonprofit organisation, has carried out free fistula surgeries on more than 600 women—1,000-plus victims of whom have received various forms of expert care—since April 2010.
A fistula surgery in the country costs at least Rwf250,000, exclusive of miscallaneous medical expenses. But for the free treatment, a team of IOWD volunteers comprising surgeons, anaesthetists, nurses and others, visit the country thrice a year.