Resilience in the Face of Despair

Daisy WinnerBlog, Liberia, Medicine

Each year between 50,000 to 100,000 women worldwide are affected by obstetric fistula, a hole in the birth canal caused by prolonged labor without adequate medical intervention. Women who suffer from an obstetric fistula are left with chronic incontinence, and often, a stillborn baby.

The constant leaking of urine or feces means women face humiliation and stigmatization, as they become isolated by family members, friends, and communities. It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa. If left untreated, fistula can lead to chronic medical problems and even death, but surgery can normally repair the injury.

Physician Educator, Dr. Corrine (Cori) Maund has been teaching in Liberia for the last year. Cori had never encountered a case of obstetric fistula until last September, just a few weeks after arriving in Liberia. A group of surgeons visited her hospital to host a “fistula campaign,” providing free surgery to women living with obstetric fistulas.

“I have learned so much about fistulas since arriving in Liberia and as I learn I am reminded of the need for a strong healthcare system that can meet the needs of women,” says Cori.

As she cared for the women recovering from surgery, she heard their painful stories of pregnancy and birth that lead to their injury.

“It was very difficult to hear these women’s stories,” Dr. Maund reflected, “One of the girls, Garmai, was sixteen years old and her story had me in tears.”

Dr. Cori Maund with fistula patients

As Cori recalled, Garmai’s baby died during pregnancy. When she went to seek medical care, she described her labor saying it felt as if someone “ripped it out of her”. She was left with a hole the entire length of her anterior vaginal wall and was uncontrollably leaking urine. She was abandoned by all except her mother.

Garmai’s story isn’t unique in sub-Saharan Africa. Obstetric fistulas most often afflict women living in regions with inadequate medical care, where accessing prenatal care or a skilled birth attendant is often difficult. Obstetric fistulas are often both preventable and, if they occur, treatable – but required skilled medical care.

During the fistula campaign, Cori recalls, “I heard this kind of story time and time again as we interviewed the women. I had to remove myself and cry after talking with each woman and hearing their traumatic stories. It was one of the most difficult days I’ve had in Liberia thus far.”

Garmai had a difficult surgery to repair her fistula, and she lost a lot of blood, requiring a transfusion. And while ultimately the transfusion was successful, Garmai started leaking post-operatively.

“I had to tell her that the surgery didn’t work, and she would need another,” explained Cori. “We cried together. It took her a long time to recover the hope she put in the surgery, but with love and support from her mother, her fellow fistula survivors, and me, she is positive, recovering well, and awaiting her next surgery.”

Due to the stigma of fistula, women often arrive alone without care givers to support them after surgery. While Cori didn’t perform the surgeries herself, she provided the essential post-operative care that patients otherwise might not have received.

After the women are discharged from the hospital, they go to the Fistula Recovery & Rehabilitation Center where they stay for several months and learn a trade or skill to help integrate them back into their communities.

Teaching and training the next generation of obstetricians and fistula surgeons is so important to the health of mothers and babies, especially in low-resource settings. And while the surgery campaign has ended at Cori’s hospital, she still visits the women she cared for at the Center.

“It is always warms my heart to go there and see how joyful these women are despite their circumstances,” says Cori. “They taught me about resiliency in the face of despair. They taught me there is hope for the future. These women from all over the country are courageous and inspirational.”