One of our Hope for Our Sisters board members is currently serving overseas with another non-profit, Mercy Ships, and one of the areas of focus for this group is treating women with fistula. Here is a blog post she authored, interviewing a friend about the great victories and joys, but also the emotional burdens, of working with our beautiful sisters. “Photo credit to the Mercy Ships Communications Department”.
I wasn’t terribly familiar with fistulas prior to working with Mercy Ships. I had heard of conditions that caused women to leak urine and feces, but knew very little of the reasons for the problem, or the enormous magnitude. The World Health Organization estimates that over 2 million women are living with untreated fistulas between Asia and sub-Saharan Africa; this statistic doesn’t include poor places in northern Africa, or South and Central America. In the interview that follows with a friend, she told me that a gynecological surgeon from the US told her that in his 40 years of practice, he had only ever seen one case of fistula, and it was caused by a medical error. Fistulas are entirely a problem of poverty.
Meeting these women, even just as a nurse encountering them outside of the ward, changed me. In February 2017, I joined the Boston-based organization Hope For Our Sisters, Inc. as a general team member, helping with mail-outs and prayer chains, assisting with the website revision and attending events. Later that year, I was asked to join the Board of Directors. It has been an incredible gift, and provides an outlet for my heart to serve these women from afar. (If this sounds familiar, it’s because I blogged about it not too long ago.)
Many times in women’s health, we share the stories of our most down-trodden, disadvantaged sisters and their victories through surgery to become dry. But women’s health, unlike many other specialties, doesn’t always have a happy ending. It’s black and white – women walk away dry, or wet. They are healed, or they are resigned to a life of rejection, shame and isolation. While we are better when we dwell in joy and hope, there is a real and serious emotional toll for the providers who work in women’s health. These nurses, doctors and surgeons see miracles, surely, but they also are called to the terrible task of telling women there is nothing more we can do for them – their defect is too big, or their scar tissue is too tough. We offer them prayers and support, we hope that even in their trials they have encountered the love of Christ and know, in their hearts, that they are cherished beyond measure, even when their villages drive them out, their husbands leave them, their families abandon them.
My dear friend, Mary G., has worked in women’s health for the last three years with the organization we both serve with abroad: Mercy Ships. Mary loves Marvel Comic Movies, her coffee, sleeping in and FaceTiming with her family. She is faithful and committed – she traveled to Utah and Maine in the span of one month to attend both my wedding and our friend Jarah’s. She has been a shoulder to me in some of the hardest hours of my adult life. And, above all, her heart for these women is beautiful to behold. I have had many conversations over the years with Mary about “the ladies”, as we call them, and the highs and lows of caring for this special population.
I would challenge you, as you read this, to pray in a special way for the people caring for our sisters. Their job is so hard, and they do it with so much love and grace. This season in Cameroon has been particularly difficult for the women’s health providers. There have been many women who have had multiple repair attempts already, with a subsequent build-up of scar tissue, forcing surgeons to try “last-ditch” methods with success rates as low as 20%. Women who cannot have their fistula entirely corrected surgically have even less options now than before. Manufacturers used to create “urethral plugs”, which didn’t heal fistula, but did allow women with continued incontinence to release their urine in more timely and appropriate settings, versus leaking constantly. Production of urethral plugs has stopped, because “no one needs them”… meaning, no one who can afford to buy them would need one, because it’s only poor women in Africa who need them. One of our annual fistula surgeons, Dr. Norman, has just a handful left to provide to women who cannot be helped surgically. Imagine how he, and nurses like Mary, and our team leader, Tam, will feel when the last of those are gone. What do we offer women then? What sustainable option, beyond diapering if a woman can afford it, is left?
Cara: Mare [as I call her], tell me a little bit about your nursing background and your initial impressions in being assigned to women’s health back in Madagascar.
Mary: Ha! My background was in medical/surgical nursing, specifically in orthopedics and trauma. I saw a lot of geriatric hip fractures. So when I was assigned to women’s health, I was excited, but nervous because of the different population. I just didn’t know what to expect. In general, the nursing care was very familiar – catheters, IV, pain medications – all of that was the same. Yet it was harder because fistulas are something you don’t see at home, ever. You don’t know anything about it, so you don’t even know what questions to ask the patient or what to focus on at the beginning.
Cara: It’s been 3 years since you started. Now, when you encounter these women for the first time, what are some of the things you’ve learned to do, or to take in?
Mary: I always try to GREET them specifically as a person. The relational aspect has become so much more important to me and I try to really talk directly to her and just be friendly. In so many of their situations, these women are not treated with kindness. There is just a sense of unfairness to this all. It’s not fair that they suffer with these problems that don’t exist in my country. It’s hard dealing with the injustice of it.
Cara: Do you feel like certain women over the last 3 years have changed you?
Here, Mary paused. We were sitting in the cafe on Deck 5, where there is a wall plastered with images of the women’s faces. Next to each smiling woman is a single word she gave us to describe herself both before, and then after, surgery.
Mary: [looking at the wall] I love all of their faces. There are so many stories and so many different things they deal with. There are just so many of them, and so many different lessons I’ve learned. Sometimes its the more middle-aged ones that surprise me, the ones in their 40s who developed fistulas around 30 years ago, who have been wet longer than they were ever dry – their perseverance and their ability to love other patients around them, it’s inspiring. They reach out to each other, even when they’re suffering, too. It’s hard to describe. There was a middle-aged woman in Madagascar with a fistula who met one of our teenage fistula patients at a screening site. The teenager had no family or guardian to come with her to the ship (a requirement for Mercy Ships for patients under the age of 18). The older woman took this girl under her wing and came with her to the ship as her caregiver even though they had just met hours before and she was going to have surgery herself. That action of love and service in the midst of her own suffering was a great example to me.
Cara: Do you feel like there are certain attributes you would ascribe to them at certain phases (pre-op, waiting for the catheters to come out, post-op)?
Mary: It sounds weird to say, but that they’re strong. It doesn’t sound like enough, but they’re resilient and strong, in the good news and the bad. These ladies are so tough. We had one lady here in Cameroon who had an abdominal approach, and so that’s a big incision, so much pain, and she was up 3 days post-op trying to dance in the hall with the other ladies. We tried to get her to stay in bed but she just wanted to be up and dancing.
Cara: Are there specific prayers you find yourself praying for these women?
Mary: There are always prayers in my heart for what will what happen when they go home. Many of them are vulnerable to having a fistula happen again, like by getting pregnant. They’re going back to the same situation where the fistula started so the likelihood of recurrence is high. Especially the young ones who came form abuse, and who are going back to abuse; I pray for safety and change.
Cara: What do you feel like have been some “themes” of women’s health for you?
Mary: I feel like I think often of how overwhelming, just how HUGE, the problem is. It’s not just women having fistulas – it’s people as a whole not having access to health care and care throughout pregnancy. It’s a problem of poverty. How do you even approach it? We can fix the hole, but not the problem that causes the hole. Yeah, a lot of them have a potential of it happening again, or it happening to someone else they know. Other nurses that I’ve done exit interviews with have talked about needing a more specific debriefing process for women’s health, because it can be so difficult to cope with the things we see. Some days, though, are more hopeful because some leave dry and are so empowered and will teach others how to prevent it. It all depends on the day.
Here, I steal one of my favorite interview questions from Jen Hatmaker, whose podcast “For the Love” is funny, poignant and relevant. Every week, she asks this of her interviewees and gets a variety of answers, from silly to serious.
Cara: When it’s 1:30pm and you’re preparing for a 2:00pm evening shift, and you’re tired and heartsick and broken and burned out, what is saving you right now?
[Our ladies aren’t allowed to climb stairs for about two weeks post-op, so they shuffle up and down the hospital hallway for hours each day, carrying their urinary catheter bags and singing songs of praise and joy.]
Mary: The singing. It’s something so special to them. Even when I’m laying in my bed, I hear them singing in the wards, and it’s so helpful and it’s so sweet. It’s so unique to women’s health. The women in Beds 1-4 the other day were still on bed rest, and Bed 2 started humming, so then Bed 1 joined and then all 4 were singing together. It’s all so sweet. Moments like that make me keep on trucking.
For more information about Hope for Our Sisters, please visit http://hopeforoursisters.org/.