dry

Once again, I find myself in the middle of a stretch of nights. This time it's a little different. I've been stationed in B ward, a hodge-podge of cases thrown in and shaken together. Last night I set a new personal record- ten patients, and only three of them were kids. Five of the others were ladies who came in for surgeries to repair vesicovaginal fistulas (VVFs).

Here's the thing- I am a woman from a developed nation. If, someday in the future, I am having trouble delivering my baby, I will have access to healthcare, and I will be able to get to a hospital. Pardon me for going a little statistical for a while, but this is important. According to the WHO and UNICEF, I will have a one in 28,000 chance of dying trying to deliver that baby. If I had been born in Northern Africa instead of the US, (if my heart really was African like some of the Liberians delight in telling me) that chance would jump to one in 210. I really can't comprehend those odds.

But our ladies with VVF aren't among those who die in obstructed childbirth. They are the survivors, huddled and shattered on the edges of society. After enduring up to ten days of labour, the woman is left exhausted and for any number of reasons, unable to deliver the baby. Locked in the birth canal for days on end, every contraction pressing its head against the bones of the mother's pelvis, the baby eventually dies.

Once the baby is finally delivered, (often by force, which causes even more trauma) the mother is left with a broken heart and a hole between her vagina and bladder or rectum. She cannot hold her urine. It leaks constantly, running down her legs, soaking her clothes, effectively shutting her away from society.

I know this is graphic, and I apologize. I would love to sit here and just write happy stories about Abraham and Anthony, but there are other realities to come to grips with here in West Africa. So here I am, trying to understand why women suffer for years on end, unable to be part of society because they don't have access to a surgery that costs, by most accounts, less than 500 dollars.

All of our women on the wards right now are repeats. The chances for a successful closure of the fistula decreases with every operation performed, so report in the mornings has felt like a long, sad string of defeats. Wet. Wet. Wet.

Last night I took care of a woman who's on her third surgery. She wouldn't meet my eyes for the first few hours of the shift as I settled her in for the night, medicating her pain and emptying her catheter. Around two in the morning, I saw her lying awake and went over to her bed. I held her hand for a moment and then slipped my other hand underneath her sheets.

You're dry.
Thanks God.

And she turned over, closed her eyes and didn't wake up until after I had left for the day, secure in the knowledge that, for the first time in many years, she had slept in a dry bed.

I'm on my way back in to work now. Back to my ten patients and my screaming babies and my spinning head. And, hopefully, back to my dry ladies.