When the patients file in on the first day of Women’s Health admits, I can smell the ones that are leaking the worst. Soon, I would look into the eyes of a young wife that reflect back to me a heart-breaking reality.

This week has reminded me of how lucky I am to work on the Africa Mercy, on B Ward, with these precious little women. They often don’t even come up to my chest. A few of them are the size of children.

That’s part of the problem. Two contributing factors of obstetric fistula are poverty and the low status of women. When girls grow up malnourished and get married too early, the cards are already stacked against them.

In spite of the need, or maybe because of it, I am full to the brim with joy to take care of these women. It is my privilege and absolute honor.

Nursing obstetric fistula in Madagascar
At the dress ceremony celebrating successful surgery

When I tell their stories, it’s not because I want a pat on the back. I don’t even deserve any praise. Nurses on the Africa Mercy have life pretty easy. Even though I’ve spoken about how challenging it is, and my complaints can seep through on Facebook, it usually stems from my own selfish requirements not getting met.

It’s sobering when I think about how much my patients have been through, at no fault of their own. I ask myself what I did to be so “blessed” by being born in a culture and time where opportunities rain down. [I’ve also asked if it’s a blessing or a curse…] I did nothing to deserve what I’ve been given.

Women On the Wards

Recently, I was the nurse in charge on a day shift. Our team leader, Steph, is always in charge during day shift, but she was out on the dock screening new Women’s Health patients. There I am, fresh and green, minimal experience with third-world Women’s Health patients, in charge of B Ward that day. One of my duties was to round with the doctor on all the patients.

We stopped at Pela’s bed. She is 16. She looks 12. A very pretty child’s face with peaceful brown eyes. A Foley catheter snaking from under her covers. An older husband beside her. How much older? I don’t know. I’m sure he wasn’t 16. Usually, ages don’t stick out to me. On this day, though, her age seemed impossible to miss.

I was looking into the eyes of a wife, like myself, but we couldn't be more different. Click To Tweet
The Reality For Women in Developing Countries

She had a Vesico-Vaginal Fistula (VVF) repair. The women who have this repair typically have a story similar to this:

She labored for days unsuccessfully, and no infant was brought forth. The infant is stuck inside her and either due to lack of money or access to healthcare has no way of getting a C-section. The infant dies in the birth canal. Since the tissue between the bladder, the birth canal (vagina), and the rectum is fairly thin, the pressure of the baby’s skull against the pelvic bones eventually ceases all blood flow to the pinched tissue.

Without blood flow, the tissue dies. Dead tissue is useless.

The location of the occurring fistula (hole) determines whether she will leak urine or stool constantly. The smell, the inability to bear children, being deserted by her husband, and a stillborn infant… these are the results.

This is the reality of most of the women on B Ward. Including 16-yr-old Pela.

Our differences were brazenly obvious.

I have access to maternal healthcare and I have over TEN options that come to mind to prevent pregnancy. Ideally, these are choices I make with my husband, but in my country most women could easily prevent pregnancy temporarily or permanently without her husband’s permission or knowledge.

As the doctor rounds, he does some education with her and her husband about the importance of abstinence to prevent damaging the newly healed tissue. Husband looks a little uncomfortable, and the other ladies on the ward giggle at him. He asks through the translator when they will be able to have children again.

All I can hear is, “When will my wife, who has the body of a 12-yr old, and has been destroyed by labor and tenderly stitched back together, be able to have a baby again?”

Honestly, I do not blame or resent him; it was an honest question… but does anyone else shudder?

The answer is yes, she will probably be able to conceive a baby again. The difference will be the absolute necessity of a C-section for all future pregnancies.

The stark contrast between my circumstances and hers were suddenly so gaping wide I almost started crying right there. There are weekly stories that have left me at a loss for words.

I've felt almost hopeless, although even a threadbare strand of hope is enough. Click To Tweet

These women’s bodies have been wracked with such physical devastation that the presence of joy on B Ward is a miracle in itself.

All week as I’ve worked, I’ve left so incredibly joyful. I get to interact with these women. Some of them have had surgery that hasn’t been fully successful. Some of them are still leaking urine. It is these same women that I have seen smiling, laughing at my Malagasy, teaching me how to ask, “Did you poop today or yesterday?” When the ward photographers come by, they beg to have a picture taken with me.

What is happening on B Ward is indescribable.

But we need your prayers. Witchcraft and the world of darkness is no stranger here. The Enemy must be fuming at the physical healing taking place, and even more raging angry at the emotional healing happening. Women come with dark pasts after turning to evil sources to protect themselves or bring them healing. We need a cloud of prayers from all over the world to come cover the hospital on the Africa Mercy.

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