In the African country of Rwanda, radio advertisements sponsored by the Ministry of Health announce upcoming medical missions when U.S doctors will provide local treatment for women. The missions, organized by the International Organization for Women and Development, Inc. (IOWD) in Rockville, NY, send teams of surgeons three times per year to treat women suffering from injuries caused by childbirth and other gynecologic problems.
In February, VM gynecologist Linda Mihalov, MD, and urogynecologist Blair Washington, MD, joined the 10-day Rwanda mission to both perform and teach surgery. During the country’s 1994 genocide, thousands of educated professionals perished, leaving a shortage of experienced medical practitioners. Without access to training from volunteers, Rwanda’s budding medical community could never address the population’s growing need for medical treatment.
Most of the women who travel long distances to the participating hospitals are suffering from fistulas, an injury caused by prolonged obstructed labor. Without access to medical intervention, a baby who can’t pass out of the birth canal can remain there for days, cutting off the blood supply to tissue that separates the vagina, bladder and rectum. When the tissue dies one or more holes can form, through which a woman will leak urine, feces or both. The condition often makes the woman an outcast, abandoned by her husband and even her family. Most women have no way to pay for surgery and must wait for the visiting medical teams.
“It’s primitive conditions, so VM donated a lot of supplies to help us,” says Dr. Mihalov, who was new to the program this year. “We don’t have a lot of instruments, suction or electric cautery, among other things. I had to double as a scrub tech, because there wasn’t one.”
Dr. Mihalov mainly performed surgeries to remove fibroid tumors, repair vaginal prolapse and treat other gynecologic conditions, while Dr. Washington exclusively operated to close fistulas. More than 200 women came to the hospital to be evaluated, and 46 fistula repairs were completed by Dr. Washington and the team. Some women’s injuries are so extensive or complicated by botched operations that there’s nothing the surgeons can do. These patients take an emotional toll on the medical team members who want to help, but the patients appreciate even small attempts to ease their suffering.
“They are so grateful to be helped,” says Dr. Washington, who notes that women who can’t be cured surgically are offered specially designed waterproof undergarments. “They have none of the resources we do, which gives me a sense of purpose. It reminds me why I went into medicine.”
Rwanda’s Ministry of Health is closely monitoring the success of treatment provided by IOWD volunteer teams. Surgery outcomes are documented and patients receive follow-up care during subsequent missions. In the three years Dr. Washington has volunteered with IOWD, cure rates, or the percentage of women who regain continence, are consistently high. For many of the mission’s patients it means a second chance at life.
“I am renewed by the dedication and camaraderie I experience on these trips,” says Dr. Washington. “They always bring me back to center.”
A version of this article was originally published on VM’s internal news site.