This is from a friend of ours.Dr.Rainy Bello.
I have written many articles of her on the blogster.
Some of you may remember.
She is doing volunteer work,as she is retired.
Dr.Rainy Bello,has done many work for the women.
Mostly in Guaetmala and work for a while in Seattle,WA.
This is her first trip there.
Will keep us informed of the happenings.
Hope that you will enjoyed this news letter.

Hi, everyone,

I am writing to you from aboard the Africa Mercy, a hospital ship docked in Monrovia, Liberia. This is my first time in Africa, and it is also the first time that I have done international medical work outside of Latin America. I am here training to do obstetrical fistula repairs, a whole new experience and challenge for me.

The Africa Mercy is part of Mercy Ships International, a Christian charity that brings "hope and healing to the poor." About 450 people work on the Africa Mercy. Every person is a volunteer, from the ship's captain to the person who serves us in the dining room. They have all completely paid their own way, either with their own funds or by getting sponsorship from families, friends, or their local churches. Most volunteers stay several weeks or months, but some of them have been on board for years.

Ten new volunteers were with me on the plane from Brussels to Liberia last Sunday night. They included Greg, an anesthesiologist from Boston; Ishbel, a nurse from Scotland; Liz, a nurse from Texas; Eddie, from Hong Kong, who is a new baker for the ship, and Steve Arrowsmith, the surgeon who is training me to do the surgery. When we landed at the Monrovia Airport, it was hot, steamy, and chaotic. After everyone found their luggage – except ME! – we were driven to the Port of Monrovia, 1.5 hours away, where the Africa Mercy is docked. The ship arrived here for this newest mission last month, and it will stay for about 9 months.

Where Am I?: Liberia is a small country in West Africa. If you look at a map of Africa, there is a wide hump on the left upper half of the continent. Liberia is in the lower left (west) corner of this hump. It is on the Atlantic Ocean, just above the equator. The capital, Monrovia, is on the coast.

The country is basically a mess. Since the early 1980s, there has been corruption and civil war, with massive killings, starvation, rapes, and other atrocities. The political situation has been much more stable for about 3 years. Security is now provided by a large UN peacekeeping force. The country's infrastructure is gone – almost no electricity, running water, etc. Buildings are in shambles.

Health care is non-existent. Most of the hospitals were destroyed in the civil war. There are only a few dozen doctors in a country of 3.3 million people, and most of them are in the capital. In the United States and Western Europe, a woman's lifetime risk of dying in childbirth is about 1 out of 4000. But in Liberia, her risk is 1 out of 6! And the survivors are often left badly damaged.

Unfortunately, it was dark when we landed, so I couldn't see too much of the countryside. But it looked pretty desolate. There were lots of people walking along the road, in complete darkness. We passed an occasional cluster of houses, some cement and some with woven reed walls. We passed several billboards welcoming President Bush, who was here on his recent Africa trip. Other signs promoted fidelity, abstinence, and condoms. As we approached the city of Monrovia, it was bustling with traffic, and lots of people were outside in the heat. The ship was all lighted up, an impressive sight as we pulled up to the dock.


The Africa Mercy: The ship brings a complete surgical hospital to the countries in West Africa that invite it in. It has 6 operating rooms, recovery room, an ICU, 4 patient wards, laboratory, pharmacy, and everything else you need to run a hospital, except more compact. There are also, of course, the living quarters and everything else needed to support the large volunteer crew who keep it running smoothly.

I have a nice cabin, all to myself. It has 2 bunks, a tiny bathroom, and lots of storage space. I have 2 big windows and a small refrigerator. Most crew members share cabins with one or more people, so I am very lucky that they recently decided to give the doctors private quarters! There are quite a few families on board so there are family suites for them – and lots of little kids running around. There is even a school on board for the 50 children who live here.

I attended orientation and safety/security meetings the first night. We toured the decks, so now I am able to find the dining room, the ship shop, the snack bar (very important!), the laundry area, the hairdresser, meeting rooms, computer area, administrative areas, etc. We learned about emergency alarms (and where our muster stations are for fire or other emergencies), and about life jackets and life boats, in the unlikely event that we have to set sail quickly. There was even a quiz at the end!


My Work: Have you ever thought about what would happen if one of us needed a Cesarean Section and there was no place to go and no one who could do it? Fistulas are a disease of poverty, because it affects women who do not have access to obstetrical care and who are weakened by chronic disease or malnutrition. If the baby's head is too big for their small pelvises, these poor souls will labor at home for days (sometimes over a week!) The baby's head gets lodged in the birth canal, crushing the vaginal tissue against her pelvic bones. Most of these women with "obstructed labors" die, but the survivors eventually deliver a dead baby when the head has softened. If that weren't sad enough, they now find themselves leaking urine out the vagina – constantly! Some of them also leak feces. The crushed tissue has died, and now they have permanent holes between the vagina and the bladder or the vagina and the rectum – sometimes both. The urethra can be damaged or torn too. They are messy, wet, and they stink. Some of the women also have nerve damage in their legs so they have trouble walking. Nobody wants them around, and they are often banished from their homes. They have not only lost their child, they have lost their dignity.

For a women in Africa, this is the worst thing that can happen. A woman's job here is basically to make her husband happy, bear children, and do heavy work. A woman with a fistula can't do any of these things anymore. They are often abandoned by their husbands and sometimes their families. Everyone assumes that they must have done something very wrong, so God is punishing them. Since most of them occur from the delivery of their first baby, there will never be any children to take care of them when they are older. It is so sad.

Most fistulas, about 85%, can be completely closed with one operation. Some women need more than one operation before the repair is complete. The more damage there is, the harder they are to fix. And some women will never be dry – there is just too much damage.

There are an estimated 2 to 3 million women in Africa with obstetrical fistulas!!! The 15 or so hospitals on the entire continent that are dedicated to repairing fistulas do less than 2000 repairs a year total. And it keeps happening to more women every day. Private and government hospitals don't have the space or resources to take these patients – the women have no money, they take up bed space for weeks, and there is always some other emergency to take care of. And there aren't enough trained surgeons – gynecologists, urologists, or general surgeons – to even make a dent. We get no exposure to fistulas in our training because it just doesn't happen anymore. In fact, there was a fistula hospital in New York City in the 1800s, but it shut down around 1900 because the problem went away with good roads and better maternity care.

I have been wanting to get involved in fistula surgery for years, especially since I now have more time for volunteer work. But I couldn't find a training program to take me, until now! Mercy Ships started doing fistula repairs about 5 years ago. The surgery is done on board 3 – 4 times a year, and the fistula surgeon always brings a trainee along. The surgeon this time is Steve Arrowsmith, a urologist from New Mexico, who also happens to be the Fistula Program Coordinator for Mercy Ships and the vice-president of the Worldwide Fistula Fund. He is here in Liberia for 3 weeks, and I am his trainee!

Dr.Steve Arrowsmith is one of the most experienced fistula surgeons in the world. He and his wife, a family practitioner, and their three daughters lived in Africa full-time for 6 years as Christian missionaries, both in Ethiopia and Nigeria. Now he is back in the states, but he still makes several trips to Africa each year. He is very passionate about the problem and he feels that it is his calling to continue to do the surgery and train other surgeons like me.

Screening Day: On the first day, Steve and I had a screening clinic in a tent on the dock. The women waiting to see us were a colorful bunch, with brightly colored dresses or skirts and elaborately tied head scarfs. It was definitely the first time that my "waiting room" was singing and clapping to the beat of a drum! Some of the women already knew "Dr. Steve" from previous surgery, and they greeted him with huge smiles and hugs. There are many languages in Liberia, but a lot of the patients speak Liberian English. It sorta sounds like English, but I can't understand much. I did learn a few phrases: If you want a patient to wait outside for a few minutes, you say, "Wait small." If you want them to move lower on the examining table, you say "Dress down." Sorry is "sorry-o." (And sexual intercourse is apparently "Mama-Papa Business!")

We saw 38 patients, and we scheduled 34 of them for surgery. Our patients ranged in age from 18 to 50. Their labors had lasted 2 days to 2 weeks (can you imagine??) They had been wet for 1 to 20 years. Most of them have no education. I learned the exam technique pretty fast. Each woman was asked if she is wet all the time, day and night, and if it started after the delivery of a baby. Then we did a pelvic exam, including quickly inserting a small catheter into the bladder and pushing in a syringe of blue-dyed water. If she had a fistula, the blue liquid poured through the hole and into the vagina.

Let me introduce you to our first patient, named Matu. She is 23 years old and she cannot read or write. She had her first and only baby when she was 14. She delivered at home "in the bush" It was a 4 day labor, and "the baby died inside her." Finally it was born. Then she started to leak urine. It came out day and night, running down her legs. She also had feces coming out of the vagina. She went to a hospital here in Monrovia where some fistula repairs are done, but it didn't work; she still leaked urine and feces. Now, 7 years later, she came here to Mercy Ships. At the screening, she pulled a towel out from under her dress. In the operating room the next day, the hole to the rectum closed easily, but the bladder side was very scarred. It was a very difficult repair, and she bled a lot. In the recovery room, she not only continued to bleed, but she started leaking urine all over again. So we took her back to the operating room. There was a pause to pray for guidance and wisdom. This time, the repair was tighter, and she stopped leaking. Back in the recovery room, she needed a blood transfusion. A call went out to the crew, and soon there was an engineer and a young woman from reception lying on stretchers donating blood for her. She is now dry, walking around the ward, carrying her catheter bag, with a big smile on her face.

So I have just finished my first week of fistula surgery. The OR crew that we work with are lovely, dedicated people from around the world. Steve handles the very complex cases, and he is patiently couching me through some of the simpler ones, as we try to free up the scar tissue and close the holes. I am doing things that I have never seen before – creating flaps of skin from the thigh into the vagina to cover raw areas, taking grafts out of the leg to place under the urethra for support. This is a whole new world of surgery for me, and it is overwhelming at times. At the end of the day, we usually sit down and have a teaching session. I am always impressed at Steve's knowledge and experience.

In case any of you were worrying, I miraculously got my luggage on Thursday.

I am enjoying living and working on the Africa Mercy and meeting these remarkably brave women who are here for life-changing surgery. I am learning new things every day.

I guess you really can teach an old dog new tricks!

Till next time,
Rainy