helen weld public health

Thursday, April 17, 2008

WAFF TALES. . .

BE PREPARED…THIS IS A LONG ENTRY!

I can already feel the angst of departure from this special community of people at West Africa Fistula Foundation. Despite knowing them for just a short while, they already feel like friends.

Arriving to the Foundation in the morning is one of my favourite times of the day. The cheerful and beautiful nurses exude a refreshing air of merriment as they transfer shifts. One of them is getting married this week and they are excited by the upcoming festivities. They giggle in anticipation of seeing me decked out in traditional dress!

It is a rather cosy scene in the ward, despite knowing how much suffering all these women have endured. They are awaiting surgery or here for the usual fortnight of postoperative care. The previous day’s post op patients are getting progressively better. Due to a shortage of beds, many have to double up in a single bed, but they don’t seem to mind. There is no complaining, they are all grateful to have been delivered to the refuge that WAFF offers. They have all lost at least one child and all have vesicovaginal fistula (VVF) and some have recto vaginal fistula (RVF) as a result of having had an obstructed labor, leaving them constantly leaking urine or feces, or sometimes both. This leads to social isolation. To be blunt they are virtual leaking septic tanks. One can only imagine what they have also had to endure as a result of the civil war and the atrocities of the rebel forces. It would be wonderful to speak their languages, but most speak only tribal dialects. One young woman, a homeless orphan, needs more sophisticated surgery than WFF can offer. She has found her niche as she can translate many of the dialects into Crio for the staff. There is a former patient who had surgery last year who now does laundry. Most of the women hang out outdoors in the afternoons and braid one another’s hair and chatter amongst themselves. Their camaraderie is palpable as they share one and another’s plight.

WAFF’s in-country triumvirate at the “top” consists of Gwen Alghali, Dr. Alyona Lewis and Samuel Pieh. I feel privileged knowing all of them.

Gwen Alghali, the administrator and one of WAFF\s founders, has been wonderful helping me sort out the plans for my birthday celebration next week. She has many connections in Freetown and knows exactly where to go for the best deals. She and her husband Olu are my current hosts and are ensuring my comfort and good health.

Dr. Alyona Lewis, WAFF’s medical director and surgeon, is a gem of an individual. She is truly extraordinary and inspirational as she dedicates her life to these women. I relish the time I can be with her. There is much to learn from her insights and sensitivity. She is a true advocate for the women of her country and has such a tender and compassionate bedside manner.

Sam Pieh, the country director and my first host, has wisdom, humor and love for humanity which makes everyone feel a sense of security in his presence.

I have had the opportunity to accompany the WAFF staff on two trips Up Country to drop off or retrieve women. There is a network of chiefs and other focal people in remote communities who find these women and refer them to WAFF. Going on these trips has been very enlightening in terms of seeing where these women come from and also seeing some remote areas of Sierra Leone. There is much remaining evidence of the war and poverty is very apparent.





























Mr. Peacemaker, a medical assistant in Kabala in the Koinadugu District, is a colorful character who had collected 5 women for this trip from Guinea for WAFF’s services. He was obviously very caring and ready to help these women. It was absolutely heart wrenching that one girl who he had referred was assessed as a more complicated surgical case which resulted in leaving her behind. Seeing her sitting under a tree with her little bag packed for Freetown when we drove off was an unforgettable image. Luckily, she will be coming to town soon to see Dr. Maggi.





























Last weekend we went to an area in the interior of the Bombali District north of Makeni. We had one woman, Fatmata, who we were taking home and another, Hawa, taking a break from her post op time, to accompany us to her village as PR person and to help spread the word about WAFF.





























Both women were obviously excited and exuded a sense of confidence as they were out in the world in their new state of being “dry”. We left Fatmata at the chaotic bus station in Makeni as her home was another 3 hour drive to the east. She was thrilled to recognize friends in the market as we bought her ticket. Leaving her there made me feel as though we were releasing a rehabilitated bird to soar out into the wild.

We progressed onwards down a rough road for about two hours to Hawa’s village. Her smile got progressively larger as we reached her home territory and she waved and shouted to friends working out in the fields. When she first saw her daughter it was VERY touching.

The village of Kagbere was ready for our arrival thanks to the groundwork done by Wullamatu, one of WAFF nurses who had arrived the night before. We were officially greeted by the Paramount Chief Kandeh Finoh III, an impressive man, dressed in a golden brocaded suit with a velveteen quasi leopard skin fez-like hat. He has been a wonderful advocate for the women from his chiefdom who suffer from obstetric fistula.



















As we approached the open air under cover area there was a large group of women congregated to welcome Hawa home. The Paramount Chief had also assembled about 25 pregnant women to hear our presentation to raise education and awareness about obstetric fistula prevention. It was a fantastic scene. After about ten minutes of singing, dancing and whooping , everyone from the team gave a speech including me! Hawa gave a moving testimonial, as well as Manjay, another woman who’d had surgery in February. We were also able to distribute prenatal/postpartum infant kits, prenatal vitamins and hygiene kits.

We then went to the health clinic and did the screening and assessment of four women with fistulas. Their stoic behaviour during the very uncomfortable examination is remarkable. They just grit their teeth and wince, but never make a peep. All were deemed good surgical candidates by Nurse Jackie and would accompany us back to WAFF.

After a meal with the chief we all piled into the van for the five hour trip back to Freetown. As we drove out two live chickens were shoved through the window as parting gifts. It was a day to remember!

There is actually much more to relate, but enough for now. I am now half way through my stint here and I imagine my remaining time will be jam-packed.