Myer, Emily

Medicine - GYN/OB

Fellowship

Rwanda

During the elective I will be working with the International Organization for Women and Development in Rwanda. I will be a part of a team specifically managing obstetric fistula. My primary goal of the rotation is to gain the skills and knowledge to perform complex fistula repair in a low-resource setting so I will be well equipped to do this in the future. Additionally, I will learn how to be part of a diverse international travel team and learn the comlexities of working with a new team. During this elective I will plan to continue caring for and teaching patients. 

Collaborating Institution: International Organization for Women and Development

I was a part of a two-week mission with the International Organization for Women and Development to repair obstetric fistulas in Rwanda. Obstetric fistulas are uncommon in the United States but in developing countries like Rwanda they are not uncommon. Women with fistula suffer with continuous leakage of urine. They smell of urine, a stench that drives their friends and family away. In Rwanda there is not easy access to diapers or incontinence pads but instead women use cloths to collect the urine, or just let the urine leak through the open bottom of their skirts. They have to hand wash their urine-soaked clothes in the stream as most homes don’t have a washing machine or running water. Living with fistula in Rwanda is not easy.

Our patients came leaving their homes far away and stayed in a tent during our two-week mission and for the recovery time (2 weeks - 1 month). They waited for months for us to come, and were waiting at the hospital until it was their turn to be examined and receive surgery. These women had patience.

During our two-week mission we examined more than 150 women and operated on more than 40. It takes a lot of team work to get through so many patients. We were fortunate to work with Rwandan medical students who took histories form all of the patients and interpreted for the examination and counseling of all patients. I was amazed at the cooperation between the local hospital and our team. This was the seventh year IOWD had been to this location and the longevity of this relationship was evident. I was surprised to find how well the operating rooms were well stocked with supplies our team and previous teams have brought. The operating rooms had cystoscopy camera towers that were essential as all of our patients had cystoscopies performed. The resources available thanks to donors to the IOWD was so helpful and made the mission that much smoother. Though the equipment was older, and the suction was intermittent, and the OR lights were too low to be useful -there was working equipment, there was suction, and we were prepared with headlights. It made me realize how different our expectations are in the US when we can made do as well with much less.

Recovery tent 

One of the things that struck me the most was the strength of our patients. Many of the patients we saw with fistula had obstetric complications resulting in fetal death. One would never know by the smiles on their faces that these patients were sorrowful mothers who just lost a little one, and in the process developed a fistula as a daily reminder of the tragedy. One would never know by the joyful songs they sing that many of these women were alone and ostracized from their friends and family. As a new mother myself, I could only imagine if I was in the same situation I wouldn’t handle the situation with such strength and dignity. The Rwandan women are strong. Most of patients were survivors of the genocide of 1994. They saw their friends, parents, siblings being tortured and killed before their eyes. In the genocide it was Hutu against Tutsi. But for our patients in the tent it was stranger helping stranger, bonded over the fact they had fistula and were getting treatment. These women worked and lived together peacefully during our mission. And I think the fact they were all together in one big tent helped them heal - physically and emotionally. At home it seems everyone has a private room, takes narcotic pain medications, has delayed return to bowel function after surgery and it is a struggle to get them up and ambulating. In Rwanda our patients stayed together, no one takes narcotic pain medications (or needs them as they report no pain with acetaminophen and ibuprofen), bowels are working on the day after a large laparotomy surgery and the women are walking around carrying their catheter bags happily on the day after surgery.

My time in Rwanda proved to me that working in a different environment with different resources does not mean a compromise in patient care, outcomes or quality of care that can be provided.

Patients outside of recovery tent 

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October 2020

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