twenty one

The ladies are back.

A Ward has been filled with a sense of anticipation for the last few days as women wrapped in their best lappas have shuffled in and out, answering endless questions about their medical histories. The stories vary, but the end result is the same; I was pregnant, and now I am wet. Some ladies come with babies and little children, but these are the rare ones. Mostly, they share the same thing. The baby died. It was inside for too long and it died and now I am wet. When I meet their eyes, I read fear and rejection and despair and this unquenchable, overwhelming hope.

(Just know, as a caution, that I'm going to get slightly graphic in this paragraph. Not so much information for the kids.) Women with obstetric fistulas (we call them VVF ladies, as an umbrella term) are the modern-day lepers. During a prolonged and difficult labor, the pressure of the baby's head against the bones of the pelvis causes soft tissue to die. When the baby is finally born (almost always dead), the woman is left with gaping holes between her bladder and vagina. The rectum or urethra or any combination of all three can be affected. This, effectively, tears a woman's life apart, because when she develops a fistula, a woman becomes an outcast. Often, she is turned away from her family. Her husband leaves her and she lives on her own outside the village, smelling of urine and feces. Unable to stop the flow of her humiliation.

Maybe you've never heard of vesico-vaginal fistulas (VVFs). I'm not surprised. It's a problem that's almost unheard of in the developed world, where woman have access to medical care and hospitals and cesarean sections when things go wrong. Here in developing nations, it's estimated (by the WHO) that fifty to a hundred thousand women every year develop fistulas. There are over two million living with fistulas. And there are only about thirty thousand surgeries being performed every year.

You do the math.

We're standing in the gap in one of the biggest battles you can imagine. We've screened and selected twenty-one ladies. Twenty-one, in the face of a hundred thousand. I look at the statistics and I want to cry, knowing how many more will go to sleep tonight, weeping her shame as the bed underneath her grows wet again.

But for these twenty-one, we are offering the world. We are offering love where they have known rejection, acceptance where they have known disgust. We are going to try and put back together the ruined pieces of their lives, and I've got a front row seat.

The first lady came back from surgery this morning. She rolled into the ward on the OR stretcher, grinning at anyone who would look her way. I grabbed her chart and flipped to the operative report. Words like excellent, and full closure stared up at me, and I grinned as her nurse tried to straighten out the absorbent pad on the bed. The nurse smiled back at me. We might not need this.

Because this lady, and twenty more, might go home dry.

(For more on VVF, there's an amazing documentary about the fistula hospital in Ethiopia. If you've got a big enough stock of tissues, go check out A Walk to Beautiful.)