Dry Skirts

I walk into the ward. It’s still dark, as it’s only 7am and the curtains are still drawn around each bed. After we pray together as a group, the day crew set to work as the nurses hand over the patients from night shift to day shift. The patients stir and the lights are switched on and curtains pulled back. In each of the 20 beds are 20 women, all who have come for this Women’s Health specialty.

It’s actually been many years since I’ve worked as a nurse in the VVF (vesico-vaginal fistula/obstetric fistula) specialty, but I’ve always loved attending the Dress Ceremonies for the women who come through surgery now ‘dry’. However, I have never left a dress ceremony with dry eyes.

Each woman’s story has its own heartache. Today I read the histories of my patients, most of them pregnant by their husbands by the age of 16 or for some, earlier. The people of Madagascar in general are quite small. Many of the adults weighing in under the 45kg mark, but these women are tiny. It seems quite obvious to me why they have fistulas, but the point is that they do and for many of them, they have lived with the stigma of it for years. Facing the reality that 99% of them will never have a chance for treatment.

 

For those of you who might not have heard of the obstetric fistula, it is a hole between the vagina and the bladder or rectum, that is caused by prolonged obstructed labour, leaving a women incontinent of urine or faeces or both. Sometimes an obstructed labour may continue for three days or even up to seven, by which time the baby’s head has caused such pressure and restricted blood flow to the mother’s soft tissues that the tissue dies creating a hole which leaves the mother incontinent of urine and/or faeces. During the obstructed labour the baby most often also dies, leaving the woman childless and with uncontrollable and unending flow of waste.

In underdeveloped countries such as Madagascar, many women have very limited access to medical help or healthcare and when in need, either for an ‘at risk’ pregnancy or in active obstructed labour, help can be either too far a distance or too expensive to be used.

I have heard that WHO estimates that there are 50,000 women in Madagascar with obstetric fistulas and more than 2,000 women who develop fistulas every year.

“Every day, 10 women die from complications related to pregnancy and childbirth in Madagascar.”

The workload is huge and when I look at the numbers, I wonder how we could ever put a dent into it, when in fact we are treating the end result of lack of medical care and so the number will not change if the healthcare system doesn’t move forward, but it does matter to that one woman. A woman having her fistula repaired means she is no longer leaking urine and can live in a normal society again, no longer rejected by her family and friends.

Just see this story from a beautiful woman in Congo during last outreach’s Women’s Health specialty.

So, as I worked amongst the women in the ward today, my heart sort of expanded in my chest. They are dearly loved women, precious and vulnerable, holding hope so tangibly. Many of them have already had a successful surgery and are now ‘dry’, no longer waking up in the morning in a wet bed, who can walk the hallways with dry legs and can rise from a chair with a dry skirt. Isn’t that one of the most beautiful things you’ve ever heard?! That’s life restored!

Unfortunately they aren’t all happy stories. I had one of those women under my care today. In fact I had to send her home ‘wet’. There aren’t really words to explain how sad it was. This particular one has lived 19 years out of her 35 years leaking urine. She travelled for three days to the ship for help and we looked and said it wasn’t possible. There is not enough tissue to close the hole.

I wonder so many questions about these women. How does their heart feel sitting in the ward, knowing that they are not the only one in the world who has been leaking urine for years, who has lost a baby in labour, whose husband abandoned them after she lost the baby, who hasn’t been able to work in a good job or walk through the market without people saying terrible things about them?

The hope in that hospital ward is so high and yet, it feels as though it could be crushed in the single word “wet” or explode with joy at the word “dry”.

The first of the successful surgical repairs discharged from the ward today. They will come back for their celebratory Dress Ceremony in the coming week and oh how we will clap and dance and sing, bursting with joy for each of their dry skirts.