On Sunday, March 4, Leah Moynihan shared with us the story of her recent mission trip to Rwanda. Each year, Leah travels to Rwanda with the International Organization for Women and Development (IOWD) to help provide medical services and specialized surgery at no cost to underserved women and families. This year, the Oldtown church collected soap for Leah to bring with her to Rwanda along with a small financial donation.
Before I begin, I want to thank the church and Kelly for your support of my mission this year. It was so nice to feel your love and support as I prepared for this trip and while I was traveling. With the church’s help, I was able to pay for health insurance for a family of six as well as a CT scan of a woman who needs surgery. I still have some funds remaining from the church, and I will report back when we find a way to use them.
I am a nurse practitioner who specializes in women’s health. I became interested in global health when I joined my current practice in 2014. One of the physicians I work with has been doing global health work for many years, and I was lucky enough to join her for my first mission three years ago.
This mission is run by a group called the International Organization for Women and Development, or IOWD. It was started by a woman named Barbara Margolies, who lives in New York. She was inspired by her experiences teaching English in Niger. She learned about a group of women who lived in a compound at the national hospital because of their terrible urine leakage, some of whom had been there for twenty years. When she came home and learned that surgery was available to treat this problem, she resolved to make a difference. There are now three IOWD missions per year, and the mission has expanded to provide care for children with urologic problems, women with cancer, and women with other gynecologic problems. Each mission comes to Rwanda for two weeks and treats as many patients as possible; most groups operate on between forty and fifty women over that two week time.
The American staff on the mission is made up of physicians, physicians in training, nurses, medical students, and other volunteers. All of us pay our own way and take vacation time away from work. We each bring fifty pounds of medical equipment, including anesthesia, antibiotics, surgical instruments, gloves, and masks. We stay in a hotel near the hospital, and every morning we take a van from the hotel to the hospital.
We work with Rwandan medical students, nurses, doctors, and many others. They act as interpreters and care for the patients before and after we leave. They make this mission possible. It is a pleasure getting to know these people, learning about their lives, their families, and their dreams. Despite living halfway around the globe, we have a lot in common.
We work out of a community hospital called Kibagabaga in the heart of the capital city, Kigali. This hospital provides maternity care as well as general medical and surgical care to those who live in the surrounding area. The hospital is a series of covered sidewalks attached to buildings that surround courtyards. All of the rooms and offices are open air, and even the operating rooms have open windows. The daytime temperatures are in the mid-80s, which feels perfect coming from the frigid February of New England. Rwanda is at a higher elevation than many of the surrounding African countries, so the temperatures are never terribly hot.
The women of Rwanda are notified that we are coming by way of a radio announcement; it encourages any woman with fistula to come for free care. These women stay in two large tents set up behind the hospital, and they are interviewed by Rwandan medical students as they arrive. This interview helps the students to prioritize who should be seen first, based on the severity of the problem. We want to see the most complicated patients first so that if we do a big surgery, we will be around to care for the patient as they recover. Patients with less complicated problems may not have surgery until the end of the mission and will be managed by the Rwandan medical staff after we leave.
While the women are at Kibagabaga, they are fed and only have to care for their own needs. Many women bring their infants and toddlers. I imagine that staying at Kibagabaga is like a vacation in some ways — they don’t have to tend to animals, pull weeds, walk miles for water, or cook for their family. They are surrounded by women who have the same problems and understand the shame of living with fistula. They watch each other’s children and help to care for each other. IOWD is supported by donations and also by the Rwandan Ministry of Health. The Ministry covers the costs of the operating rooms, Rwandan staff to assist in surgery and in post-operative care, food for the patients, housing for the patients and transportation costs, without which, women would NOT be able to come to Kibagabaga for help.
As of May 2017, the IOWD teams had examined 2,697 women and performed 885 surgeries. These surgeries change a woman’s life; before surgery, she lives in shame, smells terrible, and may be shunned by her family or even her entire village. She may be ashamed to leave home and may not be able to work to provide for her family. Many of these women’s babies have died in childbirth, and their husbands may also have left if they are not able to have more children. Infertility is one of the many possible consequences of childbirth injury.
After surgery, 90% of our patients are dry, meaning they no longer leak urine, and can re-enter the workforce and stop living in shame. The joy they feel is clear when they come back for a post-op visit; they are smiling, wearing clean clothes, no longer fearful of leaving a wet spot when they sit.
I wanted to tell you a story of one of these women, but instead, I will tell you the story of a young man we helped on this most recent trip. This was an email written to me by Barbara Margolies, the founder of IOWD.
Here is a story of Martin… an 18-year old boy who came to see Dr. Dave McDermott, IOWD’s pediatric urologist, about 4 years ago. He is very poor and comes from the East Province and has NEVER been to school! His mother was with him… the first and only time we ever met her. They were so poor that they didn’t have insurance… so we paid for them for the year.
Martin was wearing a dress… a black dress… his hair was cut very close to his head and he was wearing combat boots. We weren’t sure what he was… a boy or a girl. But he did have bladder extrophy… his bladder was OUTSIDE his body! He wore the dress because he was leaking all the time and got his clothes wet… besides clothing irritated the body badly… his genitals were deformed… so was he a boy or a girl?
We had him tested… he was a boy and wanted to be a boy.
It took many years, and many talks with Dr. Dave, and Dr. Africa at Kanombe Military Hospital, before he finally decided to have the big surgery that Dave was offering. In October, he came to Kibagabaga Hospital… dressed in boy’s clothing and he had grown his hair… he finally looked like a boy! And how handsome he is! He told us he wanted the surgery… so we told him to return in February (this year) and Dave operated on Martin. Before he left home, Martin told us that his brother and mother and father told him they hoped he would die and never to return to their home!! Nobody could believe that parents could say to their child!!! But they did!
Now, Martin has NEVER been to school… too much bullying all his life. He told Dr. Arlene that if he could go to school, he is sure he would be smarter than all the children that have made fun of him all these years! And I bet he is right!
I spoke to my friend Radegonde (personal advisor to Madam Kagame)… and I spoke with the Minister of Health, Dr. Diane Gashumba. Dr. Diane actually went to the hospital to visit Martin… but didn’t tell anyone who she was!! Martin put the blanket over his head when she came to his bedside… finally she got him to relax and talk with her… he told her that his mother was the cruelest of all!!!!
I was very worried about Martin… where will he go after he is released from the hospital? Radegonde just wrote to me… you will smile when you read this:
My crazy Barb,
I am happy to announce you we have found a place for Martin, in SOS Kigali. There is also an auntie who may take him. NCC is going to do an assessment and we will evaluate. I prefer SOS as they have also psychologists to take care of his mental health!!!
I really care for Martin, you are not alone.
I am thinking of open a place to take care of similar cases.
You will advise me! Thank you!
I know this is not the end of Martin’s story… it is just the beginning of his life… Radegonde will make sure he starts school… he deserves good things. And he wants school so badly! And we will be able to visit him in Kigali and offer emotional support!!!
For now, Martin remains in the hospital, but he should be dismissed soon. He has learned to adjust to his new situation, and nobody can make fun of him anymore!!
The moral of the story? Well, we know we cannot solve all the problems of the world – not even all the problems in Rwanda – but if we stand together and take time, and we help others, we can make a difference in their lives, one by one.