VVF time

We are now in our 6 week block of VVF surgeries & today was the first of our amazing dress ceremonies! VVF (vesico vaginal fistula), is a birthing injury resulting from obstructed labor. This obstructed labor can last from 3 days up to a week. This pressure causes a hole (fistula) to form between the bladder and vagina (sometimes also the ureters and rectum) causing women to constantly leak urine and sometimes stool as well. In most situations the women ends up delivering a stillborn child. This horrible injury usually results in them becoming outcasts in their community, husbands abandoning them, etc. Many social factors contribute to this: lack of access to trained health professionals (hospitals, Dr’s, midwives, etc), lack of transportation, lack of $ for a hospital delivery or Cesarean section, cultural practices (young marriage of girls, traditional birth attendants).
Last week Monday we had a VVF screening where 67 women came to the ship presenting with urine incontinence. Many of the women were prescreened in the north and brought down to the ship. I was assisting in the screening – taking histories of the women prior to the Dr’s examination. We were able to say yes to approximately 90% of the women, and give them their cards with a scheduled date of surgery. We admitted women that night for surgery the following day.
Because this is such a specialized surgery, and does not happen in the west it’s a learning experience for all of us nurses! Because there are so many different tribal languages in the north communication can be a challenge. A typical conversation with a patient can include saying a sentence to one of our translators, who then speaks French to one of the patients that understands both French and a tribal language. This patient, who is on bedrest postop, then yells across the room to the patient you’re trying to assess. Good thing the culture of Africa is so community oriented because there is no privacy. Everyone on the ward (who understands that tribal language) knows when the lady beside them last had a bowel movement.
After the patient has their catheter removed and is ready to be discharged we have a dress ceremony for them. A new dress is given to them signifying a new life. It’s amazing the transformation – the ladies are gorgeous! The translators lead in a time of worship - singing, drumming, and dancing. The ladies have an opportunity to give their testimonies. One lady’s testimony included how she delivered 2 stillborn babies, and after the 2nd started leaking urine. Her husband left her and she was not able to work at her job. She tried farming, but people would not buy her produce. She would constantly cry, was very depressed, and contemplated suicide. She heard about the ship, was screened and able to have surgery. Another woman testified how her sister would not come near to her but rather throw things at her from a distance. They talked how it was so great to wake up on a dry bed, not in a puddle of urine, how it was great to get up and dance without urine leaking down their legs.
Dr Steve, our VVF surgeon, spoke how today was everyone’s payday. We don’t receive a paycheck here – it’s voluntary, but the stories of each changed women life was our paycheck. I think each person on the ward today agreed with that statement. What a blessing to be able to be a part of this transformation in their lives!