Malawi 2018

In October 2018, I made my third trip to Lilongwe, Malawi in southeast Africa. This year I attended and taught at an educational symposium, “Plastic Surgery for the Improvement of Obstetric Fistula Repair Outcomes.”

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.

They may be in labor for two or more days without progress, be in severe pain, and many times they lose their baby. 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.

Over the past few years I have been working together with the surgeons at the Fistula Care Center in Lilongwe to determine how best to apply plastic surgery techniques to patients with obstetric fistula in order to improve the chance of healing in the most difficult fistula cases while also maintaining or regaining normal sexual function.

I have taught the surgeons working there how to perform some these plastic surgery procedures, and they have become skilled at doing them on their own. They have also been following patient outcomes, and we have published some of our promising results. After my trip last year, we felt it would be beneficial to have an educational symposium to invite other fistula surgeons to learn more about our approach.

From October 8-12, 2018, we held a teaching symposium in Lilongwe with fistula surgeons from around the world. A total of 15 surgeons attended. Our goal was to collaborate and better define which patients and cases are the best candidates for the addition of plastic surgery procedures and to teach our techniques to the visiting surgeons.

The first day of the symposium was dedicated to didactic lectures, during which I gave two lectures on gracilis flap and Singapore flap techniques in obstetric fistula repair. We also screened potential patients and formulated preliminary surgical plans. The remainder of the week was spent performing fistula repairs together as a team.

During these surgeries I provided hands on teaching of these plastic surgery techniques. The week was a great success and all involved learned from each other. The preliminary results for this series of patients has been promising as well despite the fact that they were some of the most difficult fistulas to treat. The team at the Fistula Care Center will continue to follow these patients and obtain more long term outcomes.

I would like to thank Freedom from Fistula, Texas Children’s Hospital Women’s Global Health Program, Drs. Jeff Wilkinson and Rachel Pope, and all the team at the Fistula Care Center for hosting this great educational symposium. It was an honor and pleasure to be a part of it, and I look forward to returning in the future!

To learn more about obstetric fistula and the efforts to improve maternal healthcare in these areas, visit and consider making a donation.