Happy V-Day Y'all

Happy Valentine's Day everyone!

I am sitting here with Jamaal playing Fishwrangler on Facebook - how is that for a romantic day? hahahah. Later I'm making him dinner...and dessert, so that should be fun....and fattening, as I plan on making some chicken fettucine with salad, bread, and red velvet cupcakes :) All new recipes for me (well except salad, that's straighfoward).

Lately I've been posting a lot of junk about helping others blah blah blah blah.
However, I just want to post one more thing and then I'll shut up with the do-gooder crap....for a couple more posts at least.

Today is V-Day, and "V-Day" took on a whole new meaning when I went to Smith - it was a day where most of us trekked to the Vagina Monologues that was performed to raise awareness of violence against women throughout the world. Oh and also embracing words like "cunt" lol. Now Eve Ensler has focused her campaign specifically on the Congo, where civil war and upheaval has created situations that are incredibly dangerous for women, where rape and abuse is running rampant, and the violence with which these crimes are committed have sometimes fatal results, and if not fatal, are always emotionally damaging and sometimes permanently debilitating. This particular campaign caught my interest not only because it is focusing on the women of Africa - which I believe to be Africa's greatest resource - but also because a close friend from high school and college's mother in law in an OB-GYN who has traveled on a hospital ship to repair fistulas caused by rape and abuse as well as traumatic childbirth. Her emails are so touching - it's hard to ignore what is happening all the way across the ocean. Anyways, her email is posted below (and if you have a sensitive stomach, details about recto-vaginal fistulas might be a lil' too much, just to warn you).

But before that, here's the link to V-Day in case you want to read more about what's happening in the Congo. Some of the videos are just priceless as Eve Ensler dives right in with some of the Vagina Monologues material - the African ladies do a lot of giggling.

Ok, I'm off the soap box for now, and I'm off to relax with Jammy Jam, a great vagina appreciater. LOL. Ok TMI. (He just saw that and said "OH MY GOODNESS you are SO dirty.." ha ha ha)

Here's the email from "Rainy"

M/V Africa Mercy
March 21, 2008

Hi, again,

I am just finishing up my 3 weeks of obstetrical fistula surgery training on the Africa Mercy and heading home. It has been an exhausting, humbling, but totally worthwhile experience. The surgery has been harder than I anticipated, but Steve Arrowsmith has been a great teacher, and I have learned so much.

More about the Africa Mercy: Fistula surgery is only a small part of what goes on every day on the ship. One full-time and other short-term maxillo-facial surgeons do cleft lip and palate surgery and removal of head and neck tumors, some of them incredibly huge. I am amazed at what they can do – take a rib to construct a new jaw, create a new nose when disease has destroyed part of a face, remove enormous goiters. Reconstructive plastic surgery, including burn treatment, is done several times a year. As we are finishing up the fistula surgery, an orthopedic team is already getting ready to start next week. And all throughout the year, about 30 patients a day have their cataracts and other eye problems fixed.

Teams of other volunteers go out into the villages to help provide clean water and sanitation. Others do construction. Health education teams are involved in HIV prevention and work in communities to end female genital mutilation. Abuse against women, including rape, is a topic that is getting a lot of attention as Liberia struggles to recover from civil war. Other outreach teams help people start small businesses, like raising rabbits. Dental teams go to local clinics, often treating life-threatening tooth infections. Crewmembers sign up for weekend trips to play with kids at a local orphanage, visit disabled people, or teach bible classes at local churches.

Many of the volunteers on the ship serve in important support roles that keep the ship running but they do not have direct patient contact. There is a nice program onboard called "Adopt a Patient." When patients are admitted for surgery, their names are placed on IV poles in the café area. Crewmembers are encouraged to take a name and to visit that patient regularly. They come down to the wards and play with the children, polish the women's fingernails, or just sit and visit. Sometimes they take groups of patients outside on the upper decks. Patients and crew love the interaction, and it helps the non-clinical volunteers to remember that they are vital members of the mission too.


Monrovia: Interesting fact – Liberia was founded in the 1820s by freed slaves who were sent back to Africa from the United States. The US president at the time was James Monroe, so that explains the name Monrovia and why the official language is English.

Although my free time has been very limited, I have been able to go ashore a couple of times. One Saturday, nine of us walked together to a local market. Believe me, it was a very sad picture; everything is falling apart. There are open garbage pits between buildings and trash strewn all over the roads. Once in a while a patch of straggly grass grows in the dirt. We stopped at a tiny tee shirt store, and we found ourselves surrounded by little boys, who thought it was great fun to pose for our photos. They got a kick out of seeing the digital pictures right away. Then we walked on to the market. The booths were piled high with stuff – bins of shoes, stacks of brightly colored fabric, household items, tools, you name it. There were wheelbarrows filled with loose grains and sugar, with a scooper on top so you could buy just what you need. Vendors sat under umbrellas for relief from the sun. Old cars and trucks whizzed by, and men were pulling loaded carts by hand. We certainly stood out with our white skin, and many people waved at us or yelled out greetings or thank yous.

On Sunday, I went to church with Captain Jon, his wife, and some other crew members – a deckhand from Scotland, an Xray tech from the Philippines, and a nurse who will soon be working at Boston Children's Hospital. It was a nice, simple church, with a brightly painted altar. The choir sang traditional songs like Amazing Grace but with their own flair – drums, clapping, and moving to the beat. The parishioners were wearing fancy colorful native dress. After mass, Captain Jon drove us around downtown Monrovia. There are bullet holes in the light poles and bridges, and the roads are worse than in New England after a bad winter – you could lose a car in the potholes. The outer walls of a lot of buildings are missing, ripped apart by mortars during the civil war. Slums line the waterfront. It is a busy, dirty city. There is one nicer section of town, with the embassies and a few hotels and restaurants, but even that area isn't pretty. Where does one begin when the whole country has been destroyed?


Meet some patients: When I was corresponding with a ship administrator before I arrived, she wrote, "You and Dr. Steve have many special patients waiting for you! These women are going to break your heart – their stories are overwhelming!" She was right. Here are a couple of their stories.

Mamie (pronounced "Mommie") is a 36 yo women who lives in a small village about 4 hours away by bus. Seven years ago, she was in labor for her 2nd child. She had pain for 2 weeks, with 4 days of hard labor. She was taken to a hospital and the doctors pushed her dead baby out. Then Mamie started to leak urine and feces. The day it happened, her husband left her and went to live with another woman in her village. She wouldn't go out of her house and she didn't want anyone to visit. She lives with her brother and sisters in a small house made of palm fronds. She says that they are very poor, and there are a few months each year when there is no food to eat. That explains why she is so painfully thin.
Three years ago, she went to a hospital, where they were able to fix the hole between the rectum and the vagina, but she continued to leak urine. Last year, she came to the Africa Mercy, and this time the hole between the vagina and the bladder was successfully closed. But she was still wet. On screening day we found that, although her fistula had been fixed, her urethra had been damaged during the long labor, so she can't control her urine flow. We did a sling operation, where a piece of strong tissue is taken out of the leg and threaded under the urethra to give it support. Sadly, she isn't dry yet, and Steve is already planning a new strategy for the next time that he comes to the ship.

Garmai is a 44 year old woman with more energy and faith in God than most of us will ever have. She was 18 when she was pregnant for the first time, and her labor lasted five days. She finally went to a government hospital where she delivered a dead baby. Then she started to leak. She didn't know what was happening to her. She didn't want anybody to know what happened to her, so she shut herself in the house. She considered killing herself to end her misery. Her husband stayed with her and supported her. She says that God blessed her with 5 more children, a miracle after what had happened to her, so she finally decided to get out of her house and start living again. She went to bible school, and now she is the pastor of a church called "Love Sanctuary of Praise."
Garmai's 5 children and 4 grandchildren live with her. Her two brothers were killed during the civil war, so she took in their children, plus a few other kids that needed homes. She doesn't get paid, but she preaches the bible and people give her what they can - sometimes food, sometimes clothes or money. Her husband has a job, and somehow they manage to feed the 20+ people who live in her house - another miracle, she says.
Garmai has been wet for 26 years. She had 3 previous fistula surgeries, all on the Mercy Ships, but the repairs keep breaking down – the tissue is so damaged that it doesn't heal well. This time, after the fistulas were closed, a graft of nearby tissue was placed on top of the stitches to bring in a new supply of blood for healing. So far, she is dry.
And get this – Garmai has a 7 month old grandson whose name is "Dr. Steve" ! (they pronounce it "Dotta Stiv.") He came to visit her one day, and I have pictures of Dr. Steve holding Dr. Steve.

Esther is 26 years old, but she looks 17. In 1999, she went into labor "in the bush" but the war was going on and there was shooting outside. She was told that her bones were too small and she had to go to the hospital, but there was no way to get there. Two weeks went by before she was carried a long distance by hammock to a government hospital, where a C/Section was done. But it was too late. The baby was dead and urine started to run down her legs. She came to us 9 years later. Her fistula was relatively simple, and she went home dry.

Dress Ceremonies: Mercy Ships, and other fistula centers, have a tradition that when a group of fistula patients is ready to go home, they are given new outfits and everyone celebrates with them. We have had 2 dress ceremonies while I have been here. Each woman receives a lovely native dress and matching head scarf. Nurses, other crewmembers, and the rest of the patients crowd together in the ward while each patient tells her story, punctuated by shouts of "Praise the Lord" and happy cries. After each story, there is joyous dancing, singing, and clapping, accompanied by the beat of a drum. Later, the women go out onto the gangway for photos. It is a very moving ceremony. It is great to make a fuss over them and tell them how beautiful they are, because they have usually been treated as the lowest-of-the-low since they developed the fistula.


Some happy follow-up from last year: Those of you who got my emails last year might remember that, when I was working in a clinic in Yepocapa, Guatemala, I did some teaching with 3 medical students. One of them, Raúl, is now an intern in Bolivia. He just wrote to tell me that he was on call one night when a woman came in ready to deliver with a breech (buttocks first) presentation. The gynecologist was tied up doing a C/Section, so Raúl had to deliver the baby. He remembered all the steps I had taught him in the class, when we practiced deliveries with the baby doll I bought in the market. He wanted me to know that I had saved a baby's life in Bolivia, even when I wasn't there!


Mark your calendars! An excellent 90 minute documentary film about the fistula problem in Africa, called "Walk to Beautiful," will be shown on the PBS show Nova on May 13th. The film was done by the BBC at the Fistula Hospital in Ethiopia, and it has already won several awards. My mentor, Steve Arrowsmith, is featured at the end of the show. I have seen it twice, and I guarantee that it will make you cry. (Please note that Rainy was incorrect in saying that "Walk to Beautiful" was done by the BBC. Several commenters have pointed out her ERROR and someone from Engel Entertainment commented so I guess I'd better correct this before it gets ugly or anyone thinks I'm trying to give BBC all the cred. The film is NOT a BBC film, Engel Entertainment is wholly responsible for every aspect of it. There it is. I'm not sure if this really matters to anyone specifically beyond the people who've pointed it out as a mistake, but I'm happy to make the correction as I cut and pasted this email directly from the one forwarded to me by my friend's mom in law and have not had the opportunity to see the movie as of yet and correct it myself. BBC = NO Engel Entertainment=YES.)


Final thoughts: When I decided to get involved with fistula surgery, I thought that my 27 years as an obstetrician-gynecologist would give me the skills that I needed to learn these new procedures. But in fact, this surgery requires skills and techniques from urology and general surgery as well as OBGYN. I was overwhelmed at first. After 3 weeks of total immersion - 36 surgeries, preop and postop care, dealing with complications (including thyphoid and malaria!) – I am feeling much more comfortable. However, I also know how much I don't know. I would need a lot more training before I could work independently. So I may be see a lot more of Africa!

I have thoroughly enjoyed my time on the Africa Mercy. It has been so interesting to work with other volunteers from the United States, Canada, Australia, New Zealand, Scotland, England, Holland, Germany, Hong Kong, the Philippines, Ghana, and the Congo. They really live their faith and love what they are doing. And it has been such a privilege to know these incredible African women who trusted us with their lives and told us their stories.


Love to all,
Rainy