Virtually unknown in the United States, obstetric fistulae, or holes between either the rectum and vagina or the bladder and vagina, which develop after difficult childbirth, leave thousands of women in Africa incontinent. As a result, these women, many of whom are very young and very poor, are ostracized from their community. Since 2003, it has been the mission of the International Organization for Women and Development (IOWD) to bring volunteer surgeons and nurses to Africa to operate and care for these women. At the same time, the group trains the local surgeons in these surgical skills.
In 2003, Brigham and Women’s Faulkner Hospital OR nurse Kathleen Scott, RN, traveled to Niger with the IOWD for the first time. “It’s something I always wanted to do,” says Scott. “And I just got hooked.” Since then, she has traveled with the IOWD to Niger and then Rwanda every year until 2010. “It’s a great group. The doctors come from all over the country,” says Scott. “The thing that’s special about this group is that they train the local doctors and nurses to do the work. You leave the groundwork behind.”
In 2009, BWFH Chief of Gynecology Dr. James Greenberg traveled with the group to Rwanda for the first time. He’s returned yearly since then. “The organization has an incredibly dedicated group of surgeons and incredibly high standards,” says Dr. Greenberg. “The group is determined to find the appropriate procedure for the appropriate patient.” In his role with the group, Dr. Greenberg works mostly with medical students and residents on a variety of projects. He’s set up research projects, made an educational video about the proper techniques for doing cesarean sections. Also, he has gone out to district hospitals to perform cesarean sections and other gynecologic surgeries. While he does not do fistula work, he does train Rwandan providers on other procedures in the hopes of improving women’s healthcare overall. “I get so much more out of the experience than I ever feel like I give,” he says.
For Dr. Greenberg, experiencing the healthcare system in Rwanda first-hand has put life in the United States into perspective. “I’m blessed to practice at BWH and BWFH where we have every resource imaginable.” he says. “It helps me to come back and appreciate not only what we have and the resources we have, but also to relook at the way that we do things here. I can see how almost the same processes and procedures we do here are performed there without anything. As an example, in a Cesarean section at BWH, we don’t think about suture material. Suture material for us is like Kleenex. We use as much as we need. In Rwanda, they use three strands. That’s it. And the patients are paying for their supplies. In the United States, we don’t even think of suture materials as an expensive component to our healthcare. We think of MRIs and angiography and ICU care as expensive. But in Rwanda, the most basic supplies like suture material are considered valuable resources.”
The clinical and educational work alone is rewarding enough, but the most important aspect of the trips, for both Scott and Dr. Greenberg, are the relationships forged. “I’ve made a lot of friends in the group that I was traveling with and I have a lot of close friends in Rwanda now,” says Dr. Greenberg. For Scott, it’s the patients. “The women are amazing,” she says. “They are incredibly courageous.”