Now that I am safely tucked at home in my clean clothes, I have begun to reflect on all that I saw in Rwanda. I pulled out my computer this morning and googled Barbara Margolies, who is the founder of IOWD. She is truly a force of nature. She had been traveling and working in Africa for many years when she learned about fistulas. The IOWD initially worked in Niger, but moved to Rwanda in 2010 due to political unrest and safety concerns.
One of the things I did not write about this week is the huge percentage of women we saw who had prior surgeries for fistula, most of them done by local physicians. Another common denominator in our patients was that many women developed urine leakage after a c-section. In Rwanda, C-section is rarely done in a controlled setting; it is often done after a woman has been laboring for hours or days, sometimes after the baby has already died. Most of the women we saw had lost one baby; some had no living children after 4 or 5 pregnancies. Our bus driver asked me why I only had one child, saying that he wanted 3 or 4 “in case one died”.
It’s not clear whether the long labor causes the fistula or if it’s the result of an error made during the c-section (or a combination of both). We saw women whose bladders had been stitched to their uterus, women without a urethra (the tube from the bladder to the outside), and women whose ureter (the tube from the kidneys to the bladder) was attached to the uterus. These women had so much scarring that it was often hard to tell where the leakage was coming from.
This article explains how Barbara wants safe surgery to be possible for every woman with fistula. We spent a lot of time with women who are not surgical candidates because we don’t want them to continue looking for someone to operate–something is not always better than nothing. We hope that safe surgery will be available for all women in the future.