I am in Kigali, Rwanda with the International Organization for Women’s Development, a medical humanitarian organization that travels thrice yearly to this country to address a problem that affects women in many parts of the world—obstetric fistula. Women with this condition are perennially incontinent and become outcasts from their families and communities.
Saturday is the first day at Kibagabaga Hospital. I join local physician Dr. Tarsi and IOWD doctors Stacy and Cece on maternity rounds: maternity ward, post-op, delivery room. I choose not to go into the OR where a laboring woman is rushed for a C-section after several hours of pushing. (In the end, her baby dies as a result of her ruptured uterus).
I’m struck by the quiet in this part of the hospital which, in the US, would be filled with wailing babies. Not a sound. The mothers are subdued, speak quietly, respond with slight head nods and barely audible answers to the queries of Dr. Tarsis. The babies are responding to their mothers’ calm.
The hospital is a lovely one-story building that surrounds a verdant courtyard, but the accommodations are ghastly. The mattresses are cracked and shredded and patients must bring their own bedding. There is no kitchen, so families must provide food, not always possible depending on the circumstances of a person’s confinement. The wheelchairs are hybrid affairs concocted from bicycle tires and plastic outdoor furniture. There are no stretchers or gurneys—patients routinely walk into the operating room, often naked. Post-op has no monitoring equipment. Bandages that cover C section incisions stay in place for at least 6 days, (whereas they would be removed after one day in the US) due to the stark differences in access to hygiene in this part of the world—wounds need extra protection. The supply cabinets are practically empty.
IOWD brings crates of donated supplies but modern equipment is expensive and needs regular maintenance. IOWD’s stays are 2 weeks long and equipment breaks down between visits or disappears.
Although the American group of about 28 medical personnel attends to all gynecological issues and has even treated injuries resulting from genocidal violence, the main focus is obstetric fistula. Sadly, because of recent government indifference, the usual swarm of women waiting to be evaluated by the IOWD staff has not appeared. On other missions 300 women might be waiting for triage. This time, only 30 women are present when we show up at 8 am. The Executive Director of IOWD , Barbara Margolies, is furious and successfully schedules a meeting that afternoon with the Minister of Health (have I mentioned that Barbara is a true force of nature?) who reverses government inaction and promises to announce the presence of IOWD over national radio. It’s not assured, however, how much impact that will have in a short period of time for women who must plan and pay for a trip to the capital city.
Barbara also invites Landredet, a member of the Rwandan parliament to visit the hospital this afternoon and by the time she leaves, Landredet has agreed to set up a meeting so that Barbara can address the women’s forum of the parliament to explain why it is so important to train local surgeons in the correct way to not only repair fistula but to also prevent fistula by practicing proper technique when performing C-sections.
MULABEHO for now.
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