The Silent Tribe

My problems seem oh, so small as I read nurse Amy Jones' post in her blog, "Throughaporthole".  Give God the glory!

There are 2 million of them and their tribe is growing every day. Each year there are 500,000 new cases globally. The total annual surgery cases completed is not even 1% of that figure. Scary. These figures come from the WHO, who we generally trust as health care professionals. However, they think that they are underestimating the problem. Other studies suggested these figures are grossly over estimated. The truth is, it would be easier to find every MI5 agent in the country and invite them to your Mum’s for afternoon tea within 24 hrs than it would ever be to ever quantify the silent tribe. No one really knows their number or location.

The tribe is only made up of women, some 12 years old with their life ahead of them; some are 89, blind and have recently had a stroke. They are from 44 different countries and they don’t know anyone else in their tribe. They are loners. Each of them pushed out from their society, abandoned by their community, and forgotten.

They are bound together by the same debilitating, degrading and disgusting condition. Why? Because they became pregnant. They conceived a child far away from medical care, they struggled in labour, and when then finally decided to go to the nearest hospital, it was too late. For some, hospital means a 2 day drive; for others it’s 4 days. Being in Labour for 4 days in many cases means death for both the mother and child. It almost always means death for the child.

For those who don’t reach the hospital their baby dies inside and will eventually come out some days later. For those who reach hospital they will have a cesarean section if they saved enough money for the sutures, otherwise they will have spent all their money on transportation for nothing and their fate will be the same as those who stayed at home. For all three, the women who stayed home, the one who made it to the hospital but could not afford a cesarean and for the one who had the cesarean there outcome looks much the same. A dead baby and a broken uterus. The women in the village may get an infection and die but then that could happen in the hospital too.

Each of the women will have holes. The pressure of the babies head on their tissue will have created an area that had no blood flow for sometime and therefore necrosed and dropped away leaving an opening. Sometimes between the vagina and the bladder; sometimes between the rectum and the vagina; sometimes it’s a small area; sometimes its large. Regardless of the size of this new hole, it’s effects are similarly terrifying. The woman finds that as she tries to recover from losing her baby and being in labour for days, that she is also incontinent. The new hole means that urine and the occasional faeces now comes from the vagina which doesn’t have the muscular ability that the urethra or the rectum has and the bodily fluids run out like a continual stream with no ability to be stopped.

No baby, soon no family, no friends, no job, no house, no identity. Before they know it they are in the tribe. Alone. Silent.

We call it Obstetric Fistula. When the women are told by our screening team that there is something that can be done they are shocked. When they come to the ship they are embarrassed, alone and silent. When they leave they are chatty, smiley and have another chance at life. Most obstetric fistulas can be fixed quite easily with a 30 minute surgery and only cost around $200-$400. The Africa Mercy has already been operating on these women and healing is slowly happening. We have established an Obstetric Fistula clinic, now in full swing, full of patients. The clinic will stay open and functional here in Toamasina when this ship is long gone. Freedom From Fistula will take over when we leave and the healing can continue.

Photo Credit Justine Forrest, MGB16359 Ninina ready for her VVF Dress Ceremony

Photo Credit Katie Keegan – OBF Dress Ceremony Portraits

Photo Credit Katie Keegan – OBF Dress Ceremony Portraits

Today I met the 16 nurses who I will be training to take over this clinic, to fill it with life and experience and excellent skills, step by step. They are Malagasy; this is their country and they have just embarked on something quite spectacular. They will offer hope daily that doesn’t depend on a ship. As they heard the rules, the vision and the sacrifice they each signed on the line that says “I do” and now we officially have 16 Malagasy Obstetric Fistula nurses-in-training.

This excites me. Yesterday was a different story as I sat and held the hand of a 17 year old girl as she wept out her pain and sweated out an infection in the local hospital. She is 11 months pregnant. That sounds funny, doesn’t it? 11. It took her a month to decide to go to the local hospital 4 days away. Her baby was already falling out in bits but she began to get sick, an infection was brewing. Now she lays there no crying baby, her husband has left and until yesterday she didn’t know that anything could be done about her new problem of leaking urine all the time. Now she knows. I just hope she lives to see it.

Tomorrow has a lot of potential. A stones throw away from this woman lies a clinic and Malagasy nurses that will soon be experts in all of this and their treatment free and long lasting.

Hope is here.