Nana from Guinea was married when she was 15 and fell pregnant soon after. A month after the expected nine full moons, when she had still not gone into labour, she went to a traditional healer in her village. The medicine Nana was given made her ill and her baby was still inside her. After four more weeks, she started experiencing excruciating pain. Her village funded her trip to hospital, which meant an agonising journey of many hours on a hammock, then in a taxi. The doctors removed her dead baby.
Nana’s legs were paralysed for months afterwards. During that time, she also found she could not control her urine. Because of her incontinence, her husband said he did not love her anymore and did not want her back until she was healed.
Sadly, Nana’s story is far too common in this part of the world. Fortunately, she had parents and, later, a new husband, who cared for her and believed she would heal. She was also one of many women helped by doctors on Africa Mercy, a huge floating hospital ship run by global charity Mercy Ships.
The Africa Mercy – the largest non-governmental hospital ship in the world – docks for 10 months at a time, primarily in ports in West African nations, among the world’s poorest. Staffed almost entirely by volunteers, Africa Mercy brings medical treatment to people who can’t get care otherwise – over the years it has docked in more than 70 countries and provided support to around 2.5 million people. Doctors, nurses and support staff pay their way to stay on board, which means most donations given to support the organisation can be channelled directly into assisting the people who need it most.
Crew members volunteer for widely varying lengths of time, from a few weeks to many years, depending on their availability and areas of expertise. In addition to providing free health care, the ship’s workers assist in establishing community development projects, health education, mental health programmes, agriculture projects and palliative care for terminally ill patients.
World-renowned obstetric surgeons Dr Steve Arrowsmith – who initiated Mercy Ships’ Vesico-Vaginal Fistula programme in 2005 – and Dr Judith Goh are two of the surgeons who volunteer their time and skills for these women.
In 2012 Goh, who is from the Gold Coast, was made an Officer of the Order of Australia in the Queen’s Birthday Honour List in recognition of her work.
“In Australia,” says Goh, “if a mother is having difficulties in labour, depending on the situation, a Caesarean section or an instrumental delivery may be performed without any significant delay.”
In contrast, in developing nations mothers have very little access to such care.
“On average, a woman with an obstetric fistula would have laboured for four days and, unfortunately, a baby does not tolerate this prolonged labour and over 90 per cent of babies will be stillborn,” says Goh.
Mothers also die. African nations have the highest maternal mortality rate in the world, estimated at about 1000 deaths per 100,000 live births. By comparison, in 2010 only seven Australian women per 100,000 died during pregnancy or childbirth.
Husbands seldom stay with incontinent women and society usually shuns them as well. With no husband, no child – if it was her first – and no support, there is little hope for these women to live a normal life. Girls who marry young, sometimes even before their teenage years, are particularly at risk because their bodies are not yet ready for childbirth, a situation made worse by poor nutrition. Their suffering is extreme, and can last many decades. Their self-esteem is non-existent.
In the Africa Mercy’s VVF ward, every patient receives an unlimited supply of unconditional love, acceptance and medical assistance. Every effort is made to restore the dignity so often denied them.
The right care
If the condition is not too severe, surgical repair of fistulas has about a 90 per cent success rate. Sometimes more than one surgical procedure is required; initial recovery from the surgery usually takes about two weeks, but full physical healing can take six months or more.
A Caesarean section is necessary for subsequent deliveries and some African nations are now offering free hospital care for these women.
There are about two million women in a similar situation to Nana, plus about 100,000 new sufferers annually. African governments and international groups are becoming increasingly determined to end this tragic situation. In 2003, the United Nations Population Fund (UNFPA) initiated a programme called Campaign to End Fistula. In 2013, May 23 was designated as the International Day to End Obstetric Fistula.
According to the UNFPA, its mission in addressing this devastating condition is to “ensure that every pregnancy is wanted, every birth is safe and every girl and woman is treated with dignity and respect”.
UNFPA’s top priorities are to educate people about maternal and reproductive health, to provide more access to these services and to improve obstetric care and facilities for women and their babies, especially in emergency situations.
Nana’s fistula was complicated to repair, and she had four unsuccessful surgeries (the latter two on the Africa Mercy). After her fifth surgical procedure, performed by Goh, she was finally given good news.
To celebrate her recovery, Nana participated in a dress ceremony on board Africa Mercy, a special event held for women recovering from fistula surgery and an opportunity for them to share their stories with other women going through the same thing.
“It [obstetric fistula] is both preventable and treatable, and doesn’t even exist in the West,” says Jasmin Biddell, a paediatric nurse at Brisbane’s Mater hospital and an Africa Mercy volunteer.
“It’s comforting to these women to know they’re not the only ones suffering from this condition.”
A mobile medical unit at sea
Mercy Ships is a global charity established in 1978 to provide free care to the world’s poorest people, mostly in West African nations.
Their current flagship, the Africa Mercy, provides about 7000 surgical procedures annually, plus many medical services. Since 2003, Mercy Ships’ surgeons have performed more than 3000 fistula procedures. Each fistula surgery costs about $500.
The organisation is active on land as well as on board the ship. Volunteers have treated more than 539,000 patients in mobile medical and dental clinics set up in the communities near ports where the hospital ship has docked.
They have also trained more than 29,400 local medical professionals in specialised areas including anaesthesiology, midwifery, sterilisation and surgery. See mercyships.org for more information.