It had been quite an exhausting day at the Fistula Clinic and I was eager to tell David all about it. I shared with him some amazing (and heart-breaking) facts I had learned:
There are only 5 or 6 fistula surgeons in all of Kenya. Even though there are 20 gynecologists for the entire catchment area of western Kenya, only one, our Dr. Hillary Mabeya, does fistula repair. His clinic in Eldoret was the first dedicated center for this major health problem.
There are 3,000 new fistula cases in Kenya alone every year (50,000-100,000 in all of sub-Saharan Africa) and many thousands of women are suffering without even knowing treatment is possible treatment. 2/3 of the births in Kenya among rural women occur without pre-natal care or a skilled attendant at delivery. 1 in every 26 African women will die in childbirth...1 in 26!!! Compare that with 1 in 8,000 in developed countries.
The Fistula Clinic has done 100 surgeries since June 2011 and is on track to do 150 more before the end of 2012.
Total cost is US$450 - $500 and this includes surgery, anesthesia, medicines, supplies and total care for one woman thru the necessary one month of recuperation as she resides at the clinic.
The Fistula Clinic receives no federal money from the Kenyan government. Even though they receive a small amount from AMREF (African Medical and Research Foundation) the great majority of the clinic’s financing is obtained thru private donations and their yearly fund-raiser/gala in SEATTLE. They have contacted “Heifer International”, a very fine and trustworthy charity, for possible financial assistance and recently had an appt. with the Bill and Melinda Gates Foundation.
The clinic has a very long waiting list for surgery. They work as long as they have financing and sometimes must wait for additional funding to come in.
The key to eradicating fistula is education about family planning, providing timely access to healthcare, teaching respect for women and their role in society, proper nutrition and alleviation of such profound poverty.
With regard to female circumcision, many groups are attacking this ritual with a new perspective. Well known in Kenya is the national health program called SETAT which encourages a “Cutting of words, not skin” campaign. There is also male circumcision that boys undergo as a rite of passage to adulthood when they are 10-12 years old. The complication rate for this is miniscule compared to that of the girls.
It was Saturday and our last day in Eldoret before heading to Nairobi. We had been invited to an out-of-town party but would not have returned in time to pack, so we declined. That left the day open and Dr. Mabeya was delighted to see me again, and in particular, the new recruit I brought for his operating room! Dr. Mabeya works with a nurse and an anesthesia tech, who administers a spinal and helps out the nurse as needed. David and I both gowned up and scrubbed, and I assisted the surgical nurse while David assisted Dr. Mabeya. The basic role of a surgical assistant is to assist the surgeon thru retraction and suction, and David readily acknowledged that it made no difference what end of the body he was working on – the basic principles were the same (Yes, that’s him in the picture!). I assisted the nurse with sterile transfers; it had been a long time since I had been in the OR and I was delighted to reacquaint myself with the procedures.
Our patient was a 15 year old married girl who had recently birthed a 13 pound baby and suffered a protracted labor before she was finally taken to a hospital for a C-section. The fistula became apparent immediately after childbirth and she was in despair. She returned to her village and awaited her turn for surgery. She was lucky, her husband had not left her so she had a home to return to after her stay at the clinic.
Most of the women are from small remote areas and come a great distance. They stay at the clinic 4 weeks, keeping a catheter in their bladder to avoid any pressure on the repair site.The urinary drainage goes from red to pink and soon back to yellow. They need a healthy diet, strong antibiotics and quiet time for the body to rebuild tissue and heal. For this reason they are not sent home prior to one month; it is too likely they would have poor nutrition, be expected to work in the fields and have intercourse.
There is an excellent short film “The Walk to Beautiful” produced by PBS for the NOVA series, you can find it on the web. It follows an Ethiopian woman from her small village to Addis Ababa for fistula surgery. I have embedded a link to a preview. Click below on the photo.
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| Dr Hillary Mabeya, a true HERO |
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| David assists with retracting while Hillary operates. |
