Dr. Lauri Romanzi, a pelvic reconstructive surgeon, travels the world repairing, as best she can, the female pelvic organs that nature—or culture—has damaged. See our recent posts, “If Men Had to Go Through Labor” and “The Vulnerable Female Body,” for a glimpse into Dr. Romanzi’s life in Africa and Asia, working on the devastating fistulas, prolapsed bladders, damaged uteruses, and mutilated genitals of poor women, many of whom must walk for days, through dangerous territory, to receive treatment.
Dr. Romanzi, a member of Women’s Voices’ Medical Advisory Board, has agreed to keep a diary, “Postcards from Africa,” to give us a peek into what her life is like in Kenya, Somaliland, the Democratic Republic of Congo, and Rwanda. Here she is in the Nairobi airport, having doffed the hijab she was required to wear in Somaliland. —ED.
Fresh from a month spent training doctors and performing surgeries in the land of grilled camel steak, cactus, and Islam that is Somaliland, here I sit, enjoying a jeans-wearing, hijab-free, no-lounge-available layover in Nairobi’s Jomo Kenyatta International Airport, en route to Panzi Hospital, in the Democratic Republic of Congo. Kenya is rebuilding the international-terminal lounges after the fire that closed the airport a few weeks ago, so we wait for five hours . . . in the concourse.
Options: Pout; Take Action; Go with the Flow. What choice have I, with teenage-Buddha in my pocket? We are one with the cosmos, right here, on our blue plastic chair across from the travel shop.
Step 1: Water, chocolate and biscuits. The Kenyan shop staff speak in the crisp, gentle Kenyan English I’ve grown to admire in the Kenyan anesthesia trainers who, as I sit in their airport, are working miracles in the Somali hospitals of Hargeisa and Boroma.
Step 2: Claim an outlet. Charge up the toys.
Step 3: Put travel Buddha in my lap.
Step 4: Check for wifi – (nope)
Step 5: People-watch, organize, contemplate the risk:benefit ratio of attempting to score a flight change.
Step 6: Remain seated.
On parade through the concourse is a compelling mix of Hajj pilgrims, Kenyan business commuters, a smattering of CIA/soldier-of- fortune types, and European expats on parade. My thoughts drift to the Westgate Mall, whose pre-terrorist photo graced the centerfold of the Kenyan Airways in-flight magazine (harkening back to the days when sidewalk vendors hawked Twin Towers photos after September 11, 2001.) Will Westgate be rebuilt? Will anyone rent the space? Will locals flock in every day for lunch, as they had done for years? Will it be their “Freedom Tower,” or does it spell the beginning of the end of malls, of a normal-business-week public life, in Kenya?
I am en route to the Democratic Republic of Congo, where I am a frequent presence at Panzi Hospital, founded by renowned physician Denis Mukwege. Professor Mukwege, born in Bukavu, is devoted to his homeland and the medical care of women suffering all manner of devastation in the unstable chaos that is today’s Eastern DRC. I’ve had the privilege to work with the obstetric fistula team at Panzi Hospital since 2007 over a series of eight trips, this being the ninth (I think . . . definitely more than five and less than ten, on different passports. I’ve never been good at keeping track of life). To quote Woody Allen, “Eighty percent of success is just showing up.” Showing up the first five times involved only surgery to reconstruct the bladders, colons, uteruses, and vaginas of women suffering fistula. The sixth involved regional needs assessment for fistula surgery sponsored by EngenderHealth and Harvard Humanitarian Initiative.
By going back repeatedly, I learned that fistula is not the only devastating pelvic-floor problem suffered by desperately poor Congolese women who have no money to pay for surgery. Pelvic organ prolapse (vaginal bulge caused by dropped bladder, dropped uterus, and bulging rectum) is an epidemic here that outstrips women seeking care for fistula at about 3 to 1 in the Panzi Fistula Outreach network serving Eastern DRC.
Prolapse is a scourge throughout sub-Saharan Africa, adamantly ignored by international agencies focused solely on obstetric fistula. Obstetric fistula is an eradicable tragedy caused by lack of access to modern obstetric care during labor and delivery, the treatment of which is funded with maximum fanfare by agencies that, paradoxically, refuse to acknowledge that African women in these same fistula regions also suffer horribly from prolapse. For women in these fistula-zones who suffer with prolapse and cannot afford to pay, are they not equally deserving of funding? Are not the surgeons caring for them equally deserving of integrated prolapse teaching and surgical training? And might not that funding and training be incorporated into the funded fistula programs already in place? The women need it, the surgeons want it, so let’s do it.
I’ve seen virgins in DRC coming to clinic with the cervix bulging between the labia (uterine prolapse). What causes it? We don’t really know (that’s called science) but we have some ideas and a little bit of data (more science). Uterine prolapse in young women anywhere in the world is most likely caused by a perfect storm of nature (genetic inclinations to hyper-elastic connective tissue that makes childbirth easier) and nurture (Congolese women start carrying one-half to three-quarters their body-weight on their backs from pre-adolescent age, every day, many times per day.)
What do you tell an 18 year old virgin with uterine prolapse? “We’ll take out your uterus”? That’s crazy. “Here, use this pessary, it’ll hold it all inside and you take it out for sex”? Equally crazy. In remote villages with near 100 percent illiteracy and almost no access to media, this hysterectomy or pessary model guarantees that she’ll never marry, never bear children, never live the life she’s planned the whole time she’s been living. The only answer for her is hysteropexy (uterine resuspension).
On my seventh Panzi assignment, in 2011, quietly circumventing the sponsor’s fistula-only mandate, I included prolapse teaching and training while working with the fistula surgeons. In 2012, each operation performed by the primary hysteropexy trainee, Dr. Shangalume, some 27 young women with uterine prolapse, ages 21 to 37 years, underwent vaginal uterosacral hysteropexy, resuspending, rather than removing, each woman’s prolapsed uterus.
How exciting is that? It’s positively addicting, this sharing of skills.
In Eastern DR Congo, the Panzi Hospital surgical team prepares to do a hysteropexy to resuspend the severely prolapsed uterus of a young woman.
En route to DRC from Somaliland, I’ve just today departed the 1st FIGO Africa Regional Conference on Obstetrics and Gynecology in Addis Ababa. Beloved leaders in the field were there, including Edna Adan, founding mother of and tireless crusader for Somaliland; Dr. Catherine Hamlin, 89-year-old founder of the Hamlin Fistula Hospital in Addis Ababa; and Ethiopian colleague Dr. Mulu Muleta, a fistula surgeon mentored by Dr. Hamlin at the beginning of her career, now one of the current generation’s top fistula surgeons.
Pioneer Edna Adan with Drs. Catherine Hamlin & Mulu Muleta, at FIGO’s first conference in Africa, October 2013.
The FIGO faculty was packed with renowned colleagues, almost all of whom live and practice outside of their home countries; Nigerians, Ghanaians, Kenyans, and Ethiopians living in Britain; Congolese, Senegalese, and Ivoirians working in the US & Europe; American academics from Johns Hopkins and the Cleveland Clinic; and the likes of me, from NYU Langone Medical Center, working in Africa and Asia.
From maternal mortality to pediatric anomalies to the FGM (ritualistic female genital mutiliation)/child marriage/obstetric fistula triumvirate that defines the lives of too many women living in remote villages, FIGO Africa 2013, for all its ex-pat irony, was right on time.
And so was I, successfully exited from Somaliland, via an inspiring international conference in Ethiopia, now safely reinstated, along with Lord Buddha, to my Congolese home-away-from home, Co-Co Lodge, this time sponsored by the visionary Fistula Foundation, ready to continue the program development with the stellar fistula surgeons of Panzi Hospital.