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.
