In September 2017, I made my second trip to Lilongwe, Malawi in southeast Africa. The women of Malawi, and many other poor areas of the world, have minimal access to maternal healthcare. When these women encounter a situation where they have obstructed labor, most have no access to an emergency cesarean delivery. These women may be in labor for two or more days without progress, be in severe pain, and many times the baby dies. Due to the prolonged pressure from the baby’s head in the birth canal, some of the tissue can die and an abnormal connection can develop between the vagina and the bladder. This abnormal connection is called an obstetric fistula, and it leads to continuous incontinence. Because they are always leaking urine, smell badly, and may not have normal sexual function, many of these women become outcasts from their societies and families
During my last trip to Malawi, I focused on collaboration with a few of the surgeons there treating obstetric fistulas. My purpose was to help improve their patients’ outcomes by adding plastic surgery techniques to their repairs and teaching them the techniques. Since the last trip they have continued to do some of the plastic surgery procedures on their own and have been seeing promising results. The goal of my trip this year was to reinforce the teaching and fine tune the techniques.
This trip was only a week long, and we hit the ground running the day after I arrived. The great team at the Fistula Care Center had already screened numerous patients and arranged to have the most difficult cases ready for us to tackle together that week. Over the course of five days, we performed sixteen operations, eleven of which required plastic surgery procedures. I was able to perform and demonstrate the flap procedures and observe the fistula surgeons doing the flaps as well. By the end of the week, I felt confident that they could perform the plastic surgery portions of the procedure independently.
I would like to thank Drs. Jeff Wilkinson and Rachel Pope for all of their hard work and leadership on these projects and their dedication to the fistula patients. It has been an honor and a privilege to collaborate with them. I look forward to the opportunity to return next year.
Despite having gone through a horrific personal event and being made an outcast in their society, the women we are helping are resilient, motivated, and appreciative. They deserve only the best care possible. To learn more about these amazing women, the struggles they face, and the effort to improve maternal healthcare in these areas, visit freedomfromfistula.org and consider making a donation.