Lauri Romanzi is a urogynecologist—a surgeon who has spent her career putting back together, as best she can, the damaged parts of the female pelvis that nature or culture has devastated. Now she’s doing the repairs not only in the United States, but also in Africa and Asia.
Being female can be hazardous to one’s health. Obstructed childbirth, common in developing countries, can keep a woman in labor for a week, killing the child and tearing a hole (fistula) in the mother’s urinary or colorectal tract that constantly leaks urine or feces through her vagina. Or her uterus or bladder or the posterior wall of her vagina can prolapse (move down below its normal position). Or she can develop incontinence of urine or feces for any number of reasons. And, if she’s born in the wrong country, culture can demand that her clitoris and other intimate parts be cut, or even cut away, when she’s a young girl.
“When I was entering medical school in the early ’80s, there were very few women in obstetrics and gynecology,” Dr. Romanzi says. “I thought, ‘We really could use some smart girls in the specialty.’ And it was great fun delivering babies. But my talents and interests were surgical. I found oncology surgically intriguing, but there’s lots of morbidity associated with it, and you have to be capable of helping patients through the grieving process; that’s just not one of my skill sets.”
Dr. Romanzi gives some of the credit for her expertise at repairing torn body parts to her aunt and her grandmother, a tribe of seamstresses. “Personally, I think that [my surgical skill] is because as a child I was around a lot of seamstresses who could whip up a suit or reupholster a living room with one hand tied behind their back,” she says. “I learned a lot about the fine points of tailoring from these women. In doing my surgery I often think about things like the taking in of darts, putting in facing, using bias tape, and the merits of using a hemstitch vs. a basting stitch. It all feels very familiar.”
Shortly after she finished her ob-gyn residency at Kings County–Downstate Medical Center in Brooklyn, the subspecialty “urogynecology” was starting to come into its own. This is reconstructive surgery on otherwise healthy patients: “You’re not dealing with death and dying, you’re dealing with body parts that aren’t working properly that need to be put back together or treated non-surgically in a way that makes them function normally again,” Dr. Romanzi says. In 1995 she completed fellowship training in the newly minted specialty of urogynecology (now called “Female Pelvic Medicine and Reconstructive Surgery”). This was her kind of work.
Dr. Romanzi and colleagues aboard the hospital ship Africa Mercy.
Two years ago, at age 52, Dr. Romanzi closed her Manhattan office to spend a trial year working in Africa as a reconstructive pelvic surgeon. She spent a month aboard Mercy Ships in Togo, then another month at Edna Adan Maternity Hospital in Somaliland, then in Senegal, then in Nepal, then three months in Afghanistan, then back to Somaliland and back again to Mercy Ships, “sharing skills, building capacity, creating new and sustainable possibilities in each place.” (Dr Romanzi’s article “If Men Had to Go Through Labor” lays out the plight of rural African women suffering through obstructed labor.)
After that trial year, she chose to fully devote the remainder of her career to global health. She was offered a part-time post as Clinical Associate Professor in the Department of Urology at NYU Langone Medical Center, where she returns periodically for clinical work and conferences. “I chose not to wait until retirement to do this work in developing nations,” she says. “It was time to do what my international colleagues requested of me—that I take them as seriously as they take themselves. I chose Yes to this work, and I chose Now. Or rather, Yes and Now chose me. There was no other humane or ethical course of action.”
Dr. Romanzi’s main areas of interest are in Somaliland, the Democratic Republic of Congo, and—a new commitment—Rwanda. She was recently appointed by Yale University as a visiting associate professor in the Clinton Global Initiative’s Human Resources for Health Rwanda program, which addresses the country’s most challenging health care obstacles.
In Africa, she teaches and operates in several hospitals constructed as low-rise buildings separated from each other by walkways; this layout is designed to minimize the spread of infection. “Walk into these wards and you’ll find 30 or 40 beds, each outfitted with the same supply of buckets and blankets and bottles and extra sheets. I actually prefer this to the individual, hotel-style rooms we now have in the States. I have to say that the esprit de corps in a ward of dozens of beds is the same everywhere. There’s a sense of community; the patients watch out for each other and take care of each other, and they learn so much by being in close proximity to each other! Of course, in the States, all of this is a massive violation of our 1996 health-insurance law, but I do honestly believe that when most patients are suffering some version of the same condition, there is a lot of therapeutic benefit in having them in contact with each other as they move through the process.”
What many of Dr. Romanzi’s patients are suffering from is obstetric fistula (a condition that modern medicine has eliminated in wealthy, industrialized nations). Many others need treatment for prolapse. And some are suffering from culturally inflicted genital mutilation.
The African doctors she works with are highly competent; she came to understand and respect their expertise on her first trip to Africa (to Niger, in 2003). “These crackerjack Nigerien surgeons taught me quite a lot about fistula surgery. In exchange, I taught them about managing prolapse and urinary incontinence both medically and surgically.” Her goal: “to make my participation obsolete, such that the surgeons and allied health clinicians don’t really need international consultants anymore.”
These doctors (and there are many women doctors in Africa) are dedicated. “They’re making $200 to $300 a month. That’s not a lot of money, even in developing nations. In Tanzania I have a colleague who paid his way through medical school designing dresses. He still has a clinic, but he gave up his medical practice. He told me, ‘If I stopped designing dresses, I’d have to close my clinic.’ In Tanzania, evidently, everyone knows that if you want to be a doctor you’d better have another source of income, because you’ll never be able to live off your salary . . . you’ll starve.”
Women awaiting treatment at the Edna Adan Maternity Hospital in Somaliland.
And the patients? “Some are very demanding, and some are suspicious,” Dr. Romanzi says. “As a New Yorker, I like that—I like a patient who challenges me. But the overwhelming majority of patients, particularly those living in remote locations, are so grateful for access to good care.”
In general, Dr. Romanzi says, patients whose fistulas have been repaired can usually be re-integrated into their communities, but not always; there’s a great variation based on culture and the country. “And you also have women who have suffered so greatly at the hands of their communities that even if they’re returned to fully normal function, they often don’t want to go back to that village.
“You also have women who cannot be fixed in a normal way. This is very painful, because these women are functionally crippled in one way or another. A good reintegration program will have room for them . . . giving them a chance to live with other women with post-repair difficulties.”
How exhausting is the work? “In these settings,” Dr. Romanzi says, “it’s very regimented. You get up in the morning, you do your surgery, you round on your patients, you do a bit of teaching, you eat, you go to bed with a good book, and then you get up the next morning and do it all again. You get one or two days off per week, depending on the culture. The work is so intense, you just focus—you’re very in the moment—and then you go home and put your feet up for a while. Then you go back and do it again. I don’t really find it exhausting. I find it invigorating.”
Dr. Romanzi and colleague at the Edna Adan Maternity Hospital in Somaliland.