VVF Screening

I climbed the steep stairs leading to the aft gangway. Emerging from the ship, I stepped into the bright African sun. Ahead of me stood a weary, but eager group of Africans huddled together under a canopy on our dockside. I was dressed in my blue Mercy Ships scrubs and when the Africans spotted me, looks of anticipation and hope spread across their faces. The chocolate faces in the group all spoke at once. I had no idea what any of them were actually saying, but I knew they were echoing pleas for help. They were hoping I was there to escort them into the ship for their chance to be free from pain, suffering, and a life of hardships plagued with medical problems. I approached a cluster of women with somber faces; I was certain these were my potential VVF women, ready for screening. When I neared them, they stood and huddled around me, as they gathered around me, smiles spread across their faces when the translator told them they could follow me into the ship.

I escorted the group of women into one of our 10- bed hospital wards/ make shift medical screening facility. I recruited a group of nurses willing to help with screening on their day off; between the hospital beds, we set up three tables for history taking, and equipped with a handful of translators, we set to work. We began the tedious process of taking medical histories on our potential surgical candidates. The ward was packed with women and the noise level was anything but quiet. Obtaining a health history can be a complex task under normal circumstances, but this history taking process gave a new meaning to the word complex and forget about patient confidentiality and HIPPA.

I began the health interviews by introducing myself and asking the name of who I was speaking to. After a few minutes, my translator would have a name for me. At the beginning of the day, I attempted to write the names I was told, but quickly I gave up on that and had my translator write for me. The next question I asked was, “how old are you?” I thought this was a simple, easy question, but man was I wrong. I was totally shocked by the number of women I spoke with that had no idea how old they were. It was both stressful and hilarious at times when I would ask this question and my translator, in all seriousness, would tell me an outrageous answer like “she is 11 years old.” By merely at looking at the patient I could tell they were well over 40, but still I would get a blank stare and no sure answer on age. I knew it was going to be a long day! Next, I had to determine if the women actually had a medical definition of a VVF. The trouble with offering “free” surgeries is that nothing in this world is actually “free;” someone is always paying and our funding only pays for operations on women who are leaking urine as a result of pregnancy induced or related fistulas. It made my heart ache when I reached this point in the interview process. Sometimes it had already take 20 minutes to determine the woman’s name and age and then to find out she had been leaking urine since she was 12 and it was a spontaneous issue, not related to pregnancy, meant I had to crush her hope and tell her we could not help, even though our surgeons are capable of fixing the issue, funding did not support fixing it. Although I had a crowd of women waiting to be screened, I could not stomach crushing the hope of the women sitting in front of me. I would continue the interview to see if there had been a misunderstanding in the translation process, which was highly probable.

I had to play nurse/detective to reveal what actually happened in the medical history of my patients. I needed to know how many times each patient had been pregnant, how many babies, they delivered, and how many living children they had. This was a 10-15 minute conversation, at least. Many of the women did not know how many pregnancies they had carried and sadly, many of their babies had been miscarried. I also got really confused several times when someone would report having 6 living children, but only being pregnant twice. I am not a math whiz, but those numbers did not add up. After another 10 minutes I figured out there had been two sets of twins and some adopted children. Are you getting the picture of how tricky this screening process was? I haven’t even mentioned that fact that at times I had 4-5 people in my translation train, just to talk with my patient.

After the medical history was taken, we would send the women to the surgeon to perform a physical exam. The surgeon had to establish if the damage was repairable, or too extensive. The hours were passing quickly and there were still a number of women waiting for screening. We were informed that a few of the women had babies that they had left at home; we decided to move those women to the front of the line so that they could return home to their children sooner. From the corner of the room a sweet, mischievous aged woman stood up announcing that she had a baby at home too, so she needed to be next to see the doctor. It was funny, I looked at her and through my translator said, “You have a baby at home that you need to breast feed, I don’t believe it!” She was shocked by my perception and boldness and soon a sneaky little grin spread across her face and she started laughing. I had my translator teach me the French word for “liar.” I daringly called the lady a liar and all the French speakers in the room rolled with laughter. A bond was formed and my mischievous friend sat down resolving to wait her turn.

The day continued on. I interviewed patient after patient. I couldn’t believe the stories I heard. Some of the women I spoke with had endured such pain, rejection, and hurt throughout their lives. If I had doubted in the morning if I had approached the right group of women standing in the screening line, all doubts were erased at this point considering a horrific, nauseating smell of leaking urine and urine saturated clothing wafted throughout the ward I was sitting in. But no matter how much it smelled, it faded in comparison to seeing the crystal tears of happiness run down the black face of my mischievous friend when I had the privilege of handing her a surgical appointment card. I spent 12 hours in that tiny, little ward that day. When the screening finally came to an end and I escorted the patients off the ship with surgical appointment cards; I was tired and exhausted. While I was cleaning up the ward I looked around the room at the chairs scattered about and I saw the unmistakable remnants of VVF ladies; chairs shadowed with circles of urine. I took a deep breath and said a silent prayer a found comfort in the fact that after their surgeries, the women that had left moments before will never have to be haunted by the shadow of urine stained chairs again.