Mercy Ships: Contonou, Benin
Vesicovaginal Fistula Surgeries (VVF)
May 24th – June 8th, 2009
WEEK 1
Day 1 – We arrived last night (May 24, 2009) into Contonou, Benin. It’s my 1st mission trip and Dr. van Raalte’s third with Mercy Ships. Our plane landed at 7:20 pm and the airport was crowded, unorganized and scorching HOT!!! There was no air conditioning. But we made it through. The ship is really nice. It’s one of the most technologically advanced hospital ships worldwide, and it’s AIR CONDITIONED!!!!!
Today was screening day. We were driven to a Hospitality Center where the women with vesicovaginal and/or rectovaginal fistulas have been housed for the last 2 weeks waiting for our arrival. The drive there was heart breaking…dirt roads, shacks, dirty water…but people live under these conditions. The center was located near the ship in an old, rusted building where tents were set up. Some of these women had driven for 2 days or walked for 10 hours to get there.
We first took a tour of the Hospitality Center which consisted mostly of tents and then we were directed into the exam room which had an old, rusted basic exam bed and minimal supplies…speculums, catheters, dye, gauze, etc... We used a flashlight as our light source. It was extremely hot even though it was air conditioned. We screened 39 patients…37 of whom were surgical candidates…of those 37 we only have time to operate on 30. Telling these women that they have to wait until the next round of doctors get here or turning them completely away was emotionally overwhelming. Their stories are heart breaking. Most are illiterate, married young and developed these fistulas after prolonged obstetrical labor lasting anywhere from 2-5 days followed by a cesarean delivery of a stillborn child. After developing their fistulas, most are divorced by their husbands and disowned by their families because they are “broken and useless”…they no longer can work or bear children. Some have been living with their condition for years…a very common problem in third world countries. They don’t have access to health care. The look in their eyes of hope to cure their “disease” was touching. Thus far it has already been a humbling and eye opening experience.
We start operating 1st thing tomorrow morning.
Day 2 - We got a mini orientation to the ship’s ORs. They are quite nice for a hospital ship facility. Our first case of the day had to be cancelled because the patient started experiencing a psychotic episode. There was a question of underlying cerebral malaria. Our second case took 8 hours to complete. It was challenging. A large portion of the bladder, including the trigone, was missing secondary to many years of ischemia and necrosis. The ureters had completely detached from their insertion point into the bladder and the urethra was severely stenotic . Circumferentially, the tissue was extremely tethered from scarring. There was absolutely no normal anatomy. It took all day on a ship that kept rocking with warm ORs (air conditioner problem) but we did it!!! We reconstructed a new bladder for this patient, re-attached her urethra and re-placed both ureters to the best approximation of their original location.
Day 3 – 5 We continued performing surgeries these two days. Great cases!!!! Lots of distorted anatomy and pathology. The bladder reconstructions we have performed are amazing!!! I’ve learned quite a lot.
Day 6 – Today we went to the crafts market in Contonou, Benin with 8 other people making our group a total of 10 people. One of our group members drove and hence we were able to see the town roads. The air was foggy and polluted. The roads were crowded and noisy with no organization or adherence to traffic laws. The crafts market was interesting…not very crowded. There were little shops set up one next to the other with no windows at all. The shop owners would come up to us, grabbing our hands and just insist on selling their products. They were very persistent. Lots and lots of bargaining went on… After a few hours there, everything started to look the same. But at the end, everyone was happy and left with souvenirs.
Day 7 - Today was quite interesting and overpowering at the same time! Every day that I spend here I realize exactly how privileged we are and how we take many things for granted. Heather and I took a boat tour to an area about 14 kilometers outside of Contonou, Benin called the Stilt Village. This is a village where people live on water…the poorest of the poor. They live in shacks built on a river. Their bathrooms are little holes connected to the river…they also swim and bath in this same river. Women with infants strapped on their back, children and men go fishing as their food source in this river. As we toured through this village, children would swim up to us asking for money. It was absolutely heart breaking… It’s something you see on TV or read about in a magazine. But it exists and I’ve now personally seen it with my own eyes.
WEEK 2
Days 8-12 – The surgeries we performed this entire week were incredible! Very challenging and gratifying. The pathology that exists here is not found in the USA. And in the end, to see these women DRY without any leakage of urine…to see the bright smiles on their faces was priceless!!! They had HOPE again. There was a dress ceremony at the end of the week for the women who were being discharge home!!! It’s a ceremony where they celebrate their new lives of “dryness” and “hope” in new African dresses. There was lots of dancing and singing. Then we got to hear the stories of each woman individually. What their life has been like, how they got here and what they look forward to in the future. They can now return to their homes, families and towns and be part of their societies again. This is their GOLDEN TICKET back to a normal life. All in all it has been a life-altering experience for me as well!
Day 13 – Today we visited the Orphanage in Contonou, Benin. Upon arrival at the Orphanage, the children greeted us with such happiness…shaking our hands and saying hello. We spent about four hours with them…singing, dancing, coloring and simply talking to them through a translator to see who they were and where they came from. The Orphanage was in a very old, worn-down and rusted building. A few of the children had active malaria and looked sick. One little girl was burning up with a fever from the malaria and had labored breathing. She went to the bathroom and was using the sheets we gave the kids to color on as toilet paper. My heart broke into pieces… We spoke to the directors of the Orphanage about her needing medical attention and they said they had already taken her to the doctor the day before and she was on medication. She needed the basics…water, cold environment and medical treatment…most of which were not available to her. It was emotionally tough to watch. I wonder what will end up happening to her…how she will recover. Another 17 year old boy was completely blind from congenital cataracts. Before we left, we gave each of the children new shoes. It was as if we gave them the world. Basic things that we take for granted in our own lives. As we drove away, they came running toward our cars saying goodbye. What happy spirits they had living in the conditions they live in…we are so fortunate and must reach out to help those in need.
Day 14 - Today was my last day on the ship. I had rounded on all our patients and leaving them was much harder than I had ever imagined. We had also met a lot of great people. Made a lot of wonderful friends. Even though our journey was only 2 weeks long, it was difficult to say goodbye…bitter sweet…
Day 15 - I arrived to the U.S. today. It’s wonderful to be home but a large part of me was left in Benin, Africa with all our patients and friends on Mercy Ships. We take so much for granted in this country…the clean air, roads, green grass, the organization of how things run here, the resources available to us, etc… We have so much to be thankful for… And most importantly, we have the ability to help others. So why not touch someone else’s life in anyway one can?!?! Kindness is the most important gift one can give to another.