Dr. Heather vanRaalte

Dr. Heather vanRaalte

Letters from Ghana

Heather vanRaalte spent two weeks in Ghana, Africa, in July of 2006, where she volunteered on the Mercy Ship performing vesico-vaginal fistula repairs. The following are excerpts from her emails home. To learn more about Mercy Ships go visit their website.

Day One

These fistulas occur in women, many of whom were just teenagers when it happened, who had "obstructive" labor. The average labor is about four days in these patients and after such a long time of pushing the tissue between the vagina and bladder/rectum gets severely damaged and can form a connecting hole or fistula. The problem is unfortunately quite prevalent in sub-Saharan Africa and without repair these women are considered "worthless" in their societies. They cannot work, cannot produce a family and are often sent to live alone on the outskirts of their villages, most divorced by their husbands and families.

So I was accepted for a fistula repair training program through the Mercy Ships and the WFF, the Worldwide Fistula Fund and am now here for what looks like a pretty intense 2-week line-up of surgeries. All the surgeries and hospital wards are on an old Italian cruise ship which has been converted into a hospital. And we're staying there too as it sits here docked at the port in Tema, Ghana. Though it's docked, I was surprised to find the boat still has quite a bit of movement. It's strange to be rounding on patients and then see the horizon bobbing up and down through the port-holes on the wall. Apparently that's even odder to experience when you're in the OR operating and look through the port-holes.

Week One

I saw the OR's and the patient wards and met all our patients (though more are coming tomorrow). Pretty amazing women. They have endured so much just to be here, most of them traveling the furthest they have ever been from home in order to have the surgery. Though the official language of Ghana is English and everyone from near where the ship is docked speaks English, most of the patients come from more rural areas up North and we have to communicate through the regional translators that have volunteered to come live on the ship during the fistula surgeries and recoveries.

Week One

Today was a "dress ceremony" where 5 women who are being discharged tomorrow after having their fistula surgery are given new dresses to wear (ones that are no longer soaked and stained of urine, like the ones they came in) and they celebrated with dance and song and prayers towards the success of their surgery and healing. It was pretty amazing to see just how much an impact this makes on their lives and to see the excitement shine through their smiles and eyes. Many of them kept saying they were celebrating a "new life" and they haven't been able to part of their communities for many years until now.

The ceremony was in the morning, but I just went up to one of the decks and there was more music (drums and singing) and all the fistula patients were up on the deck dancing and singing again for about an hour to continue the celebration. It makes you realize just how special a day this is for them (and just how boring our discharges are at the hospital at home).

Week One

Today I got a lecture about the background and surgical techniques of fistula repair. Dr. Steve Arrowsmith (former director of Dr. Hamlin's Fistula Hospital in Ethiopia, founder of a fistula hospital in Nigeria which he ran with his wife for four years, and currently a urologist in New Mexico). He states one of the problems now is that they have more physicians interested in volunteering for repairs, but inadequate training and trainers to perform the surgeries correctly, efficiently, ethically and with reliable outcomes. So I'm actually getting prepared power-point lectures and videos besides the time in the OR, so that I will really be learning and learning from one of the most experienced fistula surgeons around. Not to much lounging on the cruise ship...I guess that's why the decks aren't lined with chaise lounges here on the boat and the bar has been converted to a post-office.

Week One

I was looking at the charts they have lined up for this week and they all have post-it notes stuck to the front of them that say "Dr. Heather". It's kind of funny to see. But pretty reassuring that the week will be productive in the OR. The OR is tomorrow after a morning of completing the screening process for the remaining surgery slots next week. They have already warned me that the morning may be difficult because we will have to turn a number of people away that need the surgery. People that have spent much time, efforts and money to make it to the ship and do not have a possibility for a repair otherwise. I am not looking forward to that.

Week Two

So it's been about a week here in Ghana and, though I haven't left the boat yet (my first trip off is tonight), I have seen a whole new world in the bottom of this big ship where the wards and OR's are located. The women we have operated on and helped through recovery are some of the toughest women I have met. Nothing fazes them. No whining from the wards. I guess this surgery is really nothing compared with what they have already been through. There are very few resources in general...certainly no IV poles...just a nail in the wall over each cot to hold the bags of fluids or antibiotics. And when the patients need to get up from bed, there is no nurse call button...they just get up, carefully stack the IV bags on top of their heads and off they go. No big deal. I just think of how many people back home complain because they are attached to an IV (suspended from a nice metal pole with wheels). Such different worlds.

Week Two

So far we've completed a full week of surgery. They saved all the "easy" cases for me to do on my own...so my success rate is 100% dry so far. That of course is terribly biased and the more complicated, "disaster" cases (many of whom have had 3-4 prior attempts at surgery) are not doing as well and our success rates are more like 60% from the week. The surgeries seem to range from 45 minutes to 4-5 hours and you really don't know what to expect until you have started.

Week Two

My last patient of the day today (the 45 minute one) kept trying to move her legs after the surgery, but as she was under spinal anesthesia her were numb for some time. Finally the anesthesia wore off and she began to move her legs. She stood up and gave me a little dance and said, "I've been waiting for 5 years to be able to dance again". It was so wonderful to see, that I forgot for a moment she was not supposed to be out of bed yet and had to coax her to get back into bed until tomorrow. Some others have become quite ill after their surgeries and we even had two ICU admissions. The ICU is the section of 2 beds closest to the nursing stations that has a sheet around them...as opposed to the beds that are just all crammed on against each other with no available sheets. As of this afternoon, fortunately, everyone is out of the danger-zone of their recoveries and seem to be doing well, at least for now. The ICU sheets are now drawn open and the ancient appearing cardiac monitor could be unplugged and put back under the sink for storage.

Back in PA

I have now returned home and enjoying the things I really missed like hot showers, recognizable food, and of course, my family, friends and co-workers. It was an incredible trip and I am already making plans to return next year. The women in Ghana taught me more than I expected, with lessons extending far beyond our sterile environment in the OR. Their determination, courage and hope will be a lasting inspiration.