More than Fistula

Helai Hesham

Fellow in Female Pelvic Medicine and Reconstructive Surgery

PGY-6

More than Fistula

After a month of working and doing research at the Freedom from Fistula Foundation in Lilongwe, Malawi I realized that we do so much more than surgical repairs of fistula. When you find yourself in a new setting, you often focus on what you want to see first. My initial thoughts and views of the fistula clinic centered on their surgical and research acumen. I was hoping to learn all the could be learned regarding preoperative and postoperative care. To see and learn what surgical techniques are best for which patients. To find which research goals could help the center grow and progress. What I didn’t initially look for was how these patients were also being taken care of holistically. Although I wasn’t looking for it, to not see the supportive care and education that was also provided for these women would be impossible.

Fistula surgery and recovery in third world settings provide a unique situation where many patients must stay inpatient for weeks within the fistula center. These weeks are not spent laying in a bed recuperating from surgery though – they are full of education and therapy.  Many women who deal with fistula are often ostracized from both their communities and families. They are usually without any financial security and live in outskirts of town.  A physical assault to their bodies turns into an assault on their financial and social worth. The Freedom from Fistula Foundation understands this dynamic and works hard to empower these women as well as fix their fistulas.

I saw first hand the educational and work opportunities that were taught daily in the classroom in the back of the clinic. The classroom was used to teach literacy and to impart skills that these women could then use to provide a living for themselves once out of the center. There were a few different projects that I was able to observe - the first was the pad project. Women were taught how to create reusable cloth pads that could be used for menses. The women could sell these to other women in their communities. This was helpful not only financially to the fistula patients, but also to the communities that would then have access to a source of sanitary pads. Many girls in the communities would stop going to school once they began menses due to social stigma and this would be one way to combat that practice.

Other forms of education were also happening daily - including sessions regarding fertility and need for contraception after surgery to ensure healing. Patients were also taught why fistula occurs and how to reduce the possibility of others getting obstetric fistulas. One of the most empowering roles that were also given to willing patients was the role of patient ambassador.  Patient ambassadors would be women who were post fistula repair. They would return to their villages and educate other women regarding fistula but also make sure that women who have fistulas know of the option for repair at our center. Patient ambassadors would often return after referring patients and discuss how they feel they were uplifting their communities and how important their roles were to empower women. The more time I spent at the fistula center, the more I realized that these women weren’t just healed surgically, but they were given the tools they needed to survive and thrive.