It’s been a long hiatus.
But from the time I last wrote, life has moved on, at an alarmingly rapid speed.
I met my boyfriend’s family in his lovely hometown in Florida, a place hithertofore thought mutually exclusive with the the word ‘lovely.’
I studied at increasingly longer and more desperate intervals for my OBGYN oral boards (that dreaded and infamous test where you fly to Dallas, spend a sleepless night in a fancy hotel you won’t be able to enjoy, and then cry and/or throw up after the test.)
The week after, I somehow managed to find out on the antiquated, beginnner’s HTML nightmare that is the board exam website that I had indeed passed. Thank God, because let’s be honest: that’s the reason I passed.
I flew back and forth to The South several more times for interviews, facing interminable security lines, the threat of a snowstorm, then an actual snowstorm that smothered the Northeast, three plane cancellations, three 2+ hour waits on the phone with American Airlines, an overnight stay on a cot in Terminal D in Charlotte with only heat-lamp dried brisket to comfort me, and a last minute standby seat back to good ol’ PA.
And I got a job. A real adulting job – an attending doctor job! – with a real university and a real schedule and income and everything.
Now, I write to you having experienced the sunny reaches of a land and continent previously known to me through only picture and stories: Rwanda.
What was I doing in Rwanda?
Simply put, I’m pursuing a closely-held dream.
Obstetric fistulas – an abnormal hole formed between the bladder and/or rectum and the vagina due to obstructed vaginal delivery, resulting in leakage of urine and feces – is a silent disease, one that rarely strikes a chord of recognition, but nonetheless severely affects over 1 million women worldwide.
Women are isolated, financially unable to sustain themselves, rejected by their families, even left for dead because of their inability to perform everyday tasks and the foul smell of incontinence. Complications like infections, kidney disorders, and even death can result.
Fistulas can be fixed, but for every woman who receives surgical treatment, at least 50 more go without. There is a lack of prevention, lack of detection, lack of medical education and training to meet the great need.
This is where global outreach and partnership wields its incredible impact.
I first learned about obstetric fistula thanks to the outstanding humanitarian journalism of Nick Kristof (whose steps I hope to follow) and to the film, A Walk to Beautiful. I was an OBGYN resident with a naturally feminist bent and an early-seeded inclination towards global health, and so it was as though a lens had shifted, and the world came into focus: this was what I wanted to do.
Most doctors-to-be enter medical school with aspirations to contribute to global health. This is altogether natural: when your life’s vocation is to care, it generally doesn’t stop at your national borders. We have long learned that those black lines on our maps don’t prevent illness from coming in or out either. There is need, there is necessity, there is desire.
But the difficulty is distilling this vague and vaporous notion of improving healthcare in the world into something clearly tangible. There are a million ways to help, but not every one ends up helpful. And for good or bad, the channels of controlling flow between the great global need and great desire to give are narrow indeed.
Global health can be a tricky thing.
How to help, but not displace, local physicians who must deal with continuing care after the foreign doctors inevitably, after varying amounts of time, leave.
How to give quality care, and sustain it, in the absence of outside donations and intervention.
How to navigate the external forces – infrastructure, local and national policies, communication – that pull and push the tide of medical efforts to unanticipated large degrees, shifting you so much further or closer to the shore of your hopes than expected.
This requires great collaboration on the part of people in all fields, those within medicine and those without. No one person or group may be able to manage all the forces required to improve health in a developing nation. But one person’s call to help – connected to another’s, and another’s – may make an incredible difference indeed.
Jamila, 31, another woman treated at Hamlin Fistula Ethiopia, was radiant. “I’m dry!” she declared triumphantly. “I haven’t leaked for six days!”
“Before, I had lost hope,” added Jamila, who had endured a fistula for four years. “I was like a dead person. And now I’ve risen again!”
I was in Kigali with such an organization: the IOWD, a consortium of urogynecologic and gynecologic surgeons from around the United States who work in a continuous partnership with local Rwandan students and doctors to research, treat, and prevent obstetric fistula. I submit myself as your foreign correspondent from Rwanda, as I go back in time to report on my journey from February. My hope is that, whether or not you are in the field of healthcare, in spite of this time of global crises and battles on immigration, I hope that we overcome conflict to recognize the importance of global partnerships in improving life in the world, including our own.