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Dr. Heather vanRaalte

Letters from Liberia

Heather Van Raalte recently returned from two weeks in Liberia, Africa where she volunteered on the Mercy Ship performing vesico-vaginal fistula repairs. The following are excerpts from her emails home, during the summer of 2007. To learn more about Mercy Ships visit their website.

Arrival

Greetings from Liberia, Africa! I've been here now for nearly one week for another VVF (vesicovaginal fistula) surgical mission with Mercy Ships. For those who don't know about the ship, this trip marks the first stop for the 'new' ship. It's an old rail ferry that has been converted into a medical facility with 6 OR's and several wards, including a real ICU ward this time. (The picture is a photo from the docks of the old ship, on the left, and the new ship, on the right... The old ship "Anastasis" left the dock yesterday for its final voyage to India to be retired). All the patients and staff stay on the ship and that enables a great deal of quality control to the process of doing surgery in a third world country, which may otherwise have unreliable resources... including, of course, the basics like water, electricity, sterilization, medications...

Screening Day

I arrived on Sunday night and we began the final screening for the fistula surgeries first thing on Monday. By 8am there were at least 60 women lined up outside. Screening lasted all day in a MASH-like tent out on the docks. The have

the screenings off the boat for a few reasons... one is that all of our patients are all a little messy... they all leak... and there are many puddles created during the screening process...another is that once you bring a patient onto the boat... once they've walked by the OR's and the wards, it is hard to tell them they have to leave if you can't help them. Only a few were not candidates and needed to be turned away (most for other medical conditions that were too severe to make it through a surgery or for fistulas caused by an active cancer). The rest were assigned an OR day divided over the next three weeks. We'll have two rooms running, so we're able to get more surgeries done than last year.

In a couple of the photos you can see the patients carrying pieces of paper... the white form is a pre-screening form... the yellow form is a medical history, exam sheet and consent form... once you're given a yellow form to carry, you will be scheduled for surgery. Just looking out across the women waiting, you could really see a difference in the expressions of the patients carrying a yellow form (as opposed to the white one)... they often held the yellow form with two hands in front of them... like it was now an important ticket with some promise of hope to take them to a new place.

A different place

The patients here are much different than in Ghana (my trip last year). I think they are more scarred both emotionally and physically... many of them delivered during the war when they did not have access to health care... many have been raped and/or abused...some are recently returned home from refugee camps. In general, I think their problems are much worse. They all have similar stories of childbirth.... have been abandoned by their husbands and families... almost all of the women arrived alone.

The official language is English....but it's Liberian English...so we still need a translator. For example....to ask if a patient is having any leaking, you say "You pee pee free?". All relevant anatomy is described as "the place"... so in translating the operations, the translator often says "They will go and fix the place" and somehow that's really enough. A little or mild or soon or short is all the same... "small, small". "Foot" is the word for leg. "Hand" is the word for arm. After a few awkward attempts of my own I always get the translator to speak English with me now.

We have completed 12 surgeries so far and the ladies are getting used to life on the ward now. The ship is air-conditioned and the patients aren't used to that kind of environment, so they are walking around with blankets around their shoulders or huddled together. The engineers are trying to adjust the temps (apparently it's more complicated than turning a thermostat)... and it seems a little better today. The other concern, which is more worrying, is that a GI virus seems to be passing through the ward as of last night. So far 3-4 women are having some problems. Hopefully, it won't spread through the whole ward...but if it does that could be big problem. I'm washing my hands like crazy...hopefully it won't get to me. Next week is a much busier week than the last with some of the more complicated patients/longer surgeries waiting ahead.

Day off

Today is my one day off and I was going to venture out to a nearby beach with some of the nurses....unfortunately the roads have been washed out this morning as there are monsoon-like rains today. Might make it into a soggy town for lunch, but that'll likely be it. At this point, I'd rather be drenched than stay ship-bound for the two weeks straight. The boat is big...but not all that big.

A gift

I'm nearing the end of my trip here in Africa. The last few days have been challenging with long, difficult cases. We've now filled up two wards with patients. For the most part, things are going really well. There have been a few heart-breaking cases where we've done as much as we could do and then needed to abort the case. But the remainder of patients are well onto the road to recovery. The new hobby on the ward is knitting and it's really funny to see a bunch of Liberian women in their tropical printed skirts knitting big wooly hats. One of my patients made me a nice hat yesterday... when we were making rounds she called me over and pulled it out from under her covers as a surprise present. I wore it around all afternoon and got quite a few compliments from the Liberians and quite a few laughs from the ship's crew. I've got one more case tomorrow morning before leaving for the airport at noon... no time to waste loafing around on board here.

Dress Ceremony

Today was our First Dress Ceremony, when the first groups of women were discharged home. The women are given a new dress for the ceremony to go home in; replacing the soiled clothing they arrived in. The ceremony is a great event and I'm disappointed I'll only get to see one before I leave. For the ceremony today, each woman stood up, sang and danced in front of everyone and then told their stories of what life was like before their surgery... of their plans for their new life... of their fears, hopes, joy and faith. It's completely overwhelming to be part of... it's witnessing pure joy. The women are so changed from when I first met them on the docks on screening day. On the docks they arrived alone and barely made eye contact. They didn't smile. They had expressions of worry, fear, and sadness. Today the women that were going home could not stop making the rounds to shake everyone's hand, give hugs and smiles freely.

I asked one of the patients, Anna, what she was going to do once she returned home. She told me she is going to 'go to sleep at night without crying and wake up in the morning smiling every day'. She then added that she plans to visit all her friends and family, because she hasn't been able to visit with them for many years. She is a beautiful 19 year old... her fistula occurred with her first childbirth at age 14. Her baby was, of course, a stillborn. I'm excited and nervous for Anna... she's probably home by now... I wonder what it's like to go home as a 'new person' after five years as an outcast. I'm told the women are readily accepted back by their families and communities once their problems are fixed. I wish I could follow her back home.