Liberia attacks obstetric fistula

At Camphor United Methodist Mission, about two hours from Monrovia in Liberia, midwives, known as Traditional Birthing Assistants (TBAs), are chosen by their local village or community. The TBAs have formed an association and come to the mission monthly for training.

For a young woman named Patience, it is a bed in a hospital ward and the prospect for successful surgery. For a certified midwife named Melaiah, it is the opportunity to make a difference. And for Bendu, it is a start toward a new life.

Each of these Liberian women is benefitting from efforts to end the little-known but widespread birth injury of obstetric fistula, which afflicts more than 2 million women and girls in poorer nations worldwide.

In July Linda Bales Todd, director of the Louise and Hugh Moore Population Project at the United Methodist General Board of Church & Society (GBCS), and I, as director of the Operation Healing Hope, went to Liberia. We went to learn about how that country on the west coast of Africa was coping with obstetric fistula. We were especially interested in how it was preventing, treating and restoring the lives of victims of obstetric fistula, which is also known in many places as VVF (vesicovaginal fistula).

Operation Healing Hope

Launched in March, Operation Healing Hope is a year-long United Methodist global-health initiative in partnership with United Nations Population Fund (UNFPA). The initiative’s goal is to make obstetric fistula as rare in developing countries as it is in the industrialized world. UNFPA’s target date to improve maternal health related to fistula is 2015, in line with the U.N.’s Millennium Development Goals.

Obstetric fistula affects primarily small and young women and girls who experience prolonged labor without access to emergency medical care.

Linda and I arrived in Monrovia, Liberia’s capital, seeking signs of healing and prospects for hope. We found some good news about fistula treatment in the midst of a country undergoing extensive recovery from 14 years of civil war, which only ended in 2003.

Obstetric fistula affects primarily small and young women and girls who experience prolonged labor without access to emergency medical care. Their babies are stillborn, and the mothers themselves are left with holes or fistulas between the birth canal and bladder.

Such breaches cause continuous flow of urine and sometimes feces, if the rectum is affected. Without treatment and smelling badly, VVF victims lead sad lives of enormous discomfort, social isolation and emotional pain.

3 objectives

We had three objectives for our trip to Liberia:

1. To see what measures were being taken to prevent the conditions that cause obstetric fistula.
2. We hoped to be able to meet those involved in fistula-repair surgery.
3. We wanted to learn how rehabilitation programs were providing survivors with emotional, economic and social support.

It didn’t take us long to find good news about prevention.

It didn’t take us long to find good news about prevention.

At Camphor United Methodist Mission, near Buchanan about two hours from Monrovia, we met with 45 midwives. Each Traditional Birthing Assistant (TBA) is chosen by her local village or community. Those from the health-care catchment area surrounding Camphor Mission have formed an association. They meet monthly at the mission and receive training by certified midwife Melaiah Toby.

We spent about an hour with Toby and the TBAs. We asked them about delivering babies and the difficulties they encounter. The TBAs were familiar with obstetric fistula when it was translated to them as “peepee disease.”

Birth complications

Training that relates to preventing obstetric fistula teaches the TBAs to recognize signs that a mother may be likely to have birth complications. Such difficulties often require emergency measures such as a Caesarean section, which a TBA is not certified to do. Transport to a clinic or hospital is the only option for a safe birth.

Transport to a clinic or hospital is the only option for a safe birth.

Members of the TBA group acted out for us the importance of recognizing signs of potentially difficult births. They dramatized breech birth, under-sized pelvis and prolonged labor. These drams were so vivid that their peers, trainer and guests couldn’t help but laugh enthusiastically as we applauded the performances.

While training TBAs is helping prevent prolonged labors that lead to obstetric fistula, Linda and I realized that such training only pays off when emergency medical treatment is within a reasonable distance, which translates to having a viable means of transportation. At present, the most reliable transport for women in labor coming out of the bush is a hammock suspended on a pole between two strong men. The best option, motorbikes, is in short supply in Liberia as is fuel to operate them.

The Ministry of Health & Social Welfare has set a goal of at least one ambulance in each of Liberia’s 15 counties. The ambulance could get people to a hospital, provided sufficient fuel, replacement parts and passable roads to get them there exist, of course.

John Kennedy Memorial Hospital

One of the main hospitals in Monrovia is John F. Kennedy Memorial Hospital (JFK). It contains Liberia’s first fistula-care center. JFK is near the United Methodist conference offices on Tubman Blvd.

JFK was a must-see for us. We were eager to meet persons involved directly in obstetric fistula treatment, both on the giving and receiving ends. Three wards at JFK are filled with nearly 30 young women and girls waiting for or in immediate recovery from fistula-repair surgery.

Three wards at John F. Kennedy Memorial Hospital in Monrovia are filled with nearly 30 young women and girls waiting for or in immediate recovery from fistula-repair surgery. Public service radio ads brought most of them to the hospital for free surgical services.

We spent close to an hour with the patients and staff at JFK. In chatting with the patients, we discovered that most had learned about possible surgery through public service radio ads broadcast throughout the country. One woman had made her way to JFK from Guinea across the northern border of Liberia. Another had traveled by boat along one of Liberia’s rivers to reach taxi transport to Monrovia.

We were pleased to hear that repair surgery is free. Only one doctor performs the surgery at JFK, though, doing an average of only four operations per week.

The fistula unit will move temporarily to another hospital in Monrovia to enable renovations that will eventually include an entire unit devoted to fistula care at JFK. This is due to a generous donation by Scottish philanthropist Ann Gloag, founder of Freedom from Fistula Foundation.

Fistula Rehabilitation & Reintegration Center

When we left JFK, we weren’t aware that we would be together again with some patients and staff the very next day at an important ceremony. On that day we found the most exciting news about fistula care in Liberia: the Fistula Rehabilitation & Reintegration Center (FRRC) at Jacob Town in the Paynesville area of Monrovia. A report about FRRC several months earlier had helped motivate our visit to Liberia, in fact.

This UNFPA program is largely the brainchild of Dr. John Mulbah. He established the JFK program and now serves with the Liberian Ministry of Health overseeing the national fistula-care program.

The FRRC compound was alive with music and activity.

Located on the edge of Monrovia, the FRRC compound was alive with music and activity on the Friday morning we arrived for graduation exercises. It was the third graduation this year.

As the proceedings began, we realized that seated prominently in the front two rows were the fistula patients from JFK hospital. Their caregivers wanted them to see what could result from their treatment and rehabilitation if they stayed the course.

To begin the graduation, 13 graduates and several trainers entered in a slow dance-like procession singing “We are Marching on to Victory.” The graduates wore dresses made out of the same vivid yellow-and-black fabric design, but each in a slightly different style. This was a subtle reference to their solidarity in recovery and uniqueness in lives to which they would return.

There were, of course, speeches from dignitaries including Dr. Mulbah and UNFPA official Madame Rose Gakuba. Graduates and well wishers gave their own testimonies and tributes.

The highlight, though, came when each graduate was presented with a kit to start her own enterprise in whatever skill she learned at FRRC. Several had trained in soap making, tailoring and pastry baking. One had gained her certificate in cosmetology. Another, Bendu, was the sole graduate in the tie-and-dye class.

From sewing machines and portable ovens to hairstyling kits and soap molds, each budding entrepreneur received the tools of her trade.

Baby quilts

Linda and I visited the FRRC shop where products from the training classes were on sale. I took particular interest in selecting tie-and-dye fabric to bring home. Operation Healing Hope is encouraging our 10 target conferences in the United States to produce baby quilts. I bought several yards of the tie-and-dye fabric to make squares for the study kit that promotes the project. Having fabric in the kit actually made by fistula survivors adds a profoundly personal dimension to the baby quilt project.

Having fabric in the kit actually made by fistula survivors adds a profoundly personal dimension.

I hope to recruit at least 10 congregations in each of our target conferences to create quilts that can be displayed in local churches to help educate about obstetric fistula. Eventually, I hope we can pack up 100 or more baby quilts to send them to the Camphor Mission TBAs to use in their work with mothers and babies.

Operation Healing Hope target conferences include Central Texas, Central Pennsylvania, Eastern Pennsylvania, Greater New Jersey, New England, North Carolina, Pacific Northwest, Peninsula Delaware, West Ohio and Western New York.

Literacy is a part of the rehabilitation program at FRRC, but many of the graduates may not have entirely understood the meaning of a little gift we gave them after I offered congratulatory words on behalf United Methodists everywhere. The gift was a bookmark bearing the Operation Healing Hope logo on one side and a biblical quote from Mark 5 on the reverse side. The quote is from the passage telling about the woman touching the hem of Jesus robe and of his visit to Jairus’ daughter. Jesus’ words form the scriptural basis for Operation Healing Hope:

Daughter, you took a risk of faith, and now you’re healed and whole. Live well, live blessed!
—The Message

Linda and I felt Jesus’ blessing was one we wanted to extend from Operation Healing Hope to everyone we met in our brief visit. This was especially so for those working day by day to address the causes of obstetric fistula, to restore injured bodies with healing and damaged lives with hope.

Editor’s note: You can learn more about the UNFPA initiative on obstetric fistula at Endfistula.org.

More information about the United Methodist campaign is available at Operation Healing Hope.

For information about Freedom from Fistula, go to its website.