Let me share a story with you, one that touched my heart.
Selina is a young woman, maybe 30 years old. About nine years ago she was pregnant with her first baby. When her labor pains started, she stayed in the village with plans to deliver at home. (Many of the women in PNG deliver at home. Perhaps some choose to do so because it is their custom. Others have no choice because traveling to the nearest health center or hospital takes hours or days.) Selina labored for three or four days but the baby never came. Finally she was able to get to a health center and was transferred in to a hospital. A c-section was done, but it was too late for the baby who had already died. A few days after the surgery Selina began leaking urine. She has been incontinent of urine for nine years and she has never been able to have another baby. She has been to several clinics and has spent too much money, but no one has been able to help her.
Selina was feeling very discouraged so she went to church and prayed for the Lord to help her. Then she came to Kudjip Hospital. She was seen in clinic today by Dr. Becky Wallace, one of our docs who is sponsored by the World Medical Mission post-residency program. Dr. Becky listened to her story and followed up with an exam. During the pelvic exam, urine spilling down into the vagina from a hole that connected the bladder with the vagina. (The picture below is Dr. Becky with Selina. Becky is tall compared to me, but Selina is under 5 feet in height.)
What Selina has is called a vesicovaginal fistula, or more specifically an obstetric fistula because the cause was related to pregnancy and delivery. When a mother is in labor and the baby is too big to fit through the birth canal, we call this obstructed labor. It is easily managed by doing a c-section but as in Selina's case this is not always possible in a timely manner. Unless the obstruction is relived, pressure from the baby's head causes tissue of the mother's birth canal to lose it's blood supply. The dead tissue falls away and leaves a hole between the bladder and the vagina. Urine continuously leaks out through that hole and causes incontinence. Many women with fistulas suffer not only from the condition, but also from shame and isolation.
The problem is rarely seen in developing countries because women have easy access to hospitals and c-sections if needed. Vesicovaginal fistulas are not uncommon in places like Ethiopia and Afghanistan. And I have now seen my third case here in PNG. It is estimated that there may be 2 million women around the world suffering from obstetric fistulas. There are many roots to this problem: poverty, limited education, poor nutrition, early pregnancy, inadequate health care, lack of basic infrastructure and roads.
But it is not all gloom and doom. There is hope for many of these women. In Ethiopia, there is an entire hospital dedicated to obstetric fistulas and more than 25,000 women have been treated. This hospital is also training doctors from other developing countries to perform the corrective procedure. Dr. Jim, our surgeon here at Kudjip, has done some of these repairs in the past. Selina has been referred to surgery clinic, and I do hope that she comes back for the consultation.
Selina's story reminds me of a similar one in the Bible. There was a woman who had been bleeding for twelve years. According to Old Testament law, a woman who was bleeding was also considered to be unclean. Those who were unclean lived in isolation because those they touched would also become unclean. They were not permitted to take part in community life or worship in the Temple. The Gospel of Luke (written by a doctor :) says that "no one was able to heal her." Perhaps she had spent her life savings seeing doctor after doctor in hope of a cure. Then she heard about Jesus, this rabbi who performed miracles and healed the sick. Could he be the Messiah, the Promised One? But she was unclean and she dared not approach him publicly. Luke writes that "she came up behind him and touched the edge of his cloak, and immediately her bleeding stopped." She believed in Jesus, and because of her faith she was healed.
For more information on obstetric fistulas, follow the links below:
eMedicine "Vesicovaginal Fistulas" for the healthcare providers out there.
Fistula Foundation gives some great info for the general public.
Addids Ababa Fistula Hospital in Ethiopia was one of the first to treat OB fistulas.
"Hospital by the River" is the story of the Hamlins and their work in Ethopia.