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The Work of the Heart

Repairing Bodies, Restoring Spirits in the Congo

At a small hospital on the eastern border of the Democratic Republic of Congo, Dr. Cristophe Kimona and Dr. Esenga Lifokata work with some of the most disenfranchised members of Congolese society—women who suffer from fistula.

Dr. Lifokata remembers one in particular. Decades-old damage from a difficult childbirth had left a woman in such pain that “she could not even sit in a chair,” recalls Dr. Lifokata. At HEAL Africa hospital, supported by EngenderHealth’s Fistula Care project, Dr. Lifokata’s team did more than repair the woman’s body; they restored her spirit. “The woman left healed, learned sewing, and left with a sewing machine,” remembers Dr. Lifokata. “This was a woman who was stigmatized and without society, but she left with joy, and that gave me a lot of satisfaction.”

A woman “without society” is an apt description of a woman with fistula. Usually, during a prolonged, obstructed labor of a stillborn child, trauma opens a hole between the woman’s birth canal and her bladder or rectum, leaving her leaking urine or feces constantly. Such trauma can also be caused during rape or as a result of a poorly done cesarean section. She is often ostracized from her community because she smells or has survived rape. Abandoned by her husband, housed apart from her family, and prone to multiple illnesses, she lives a solitary and painful life. Many women choose to eat and drink very little to stem the leakage, leaving them thirsty and weak—all while mourning the loss of a child.

Fistula often happens when a pregnant woman does not receive timely or quality medical care. In the eastern Congo, where women face the constant threat of attack from rebel groups that destabilize the countryside, traveling to a facility to give birth may also be treacherous. Instead, many women give birth at home without trained support, laboring for too long, with the baby’s head cutting off blood supply to delicate genital tissue. If and when women do reach medical care, it is often too late.

But, in the hands of a well-trained surgeon, the majority of fistulas can be repaired. The surgery is complicated and the training complex, so Fistula Care, which represents the U.S. government’s largest investment in fistula treatment and prevention, is working with two health centers in the Eastern Congo—HEAL Africa in Goma and Panzi Hospital in Bukavu—to train more surgeons to do the work to which Dr. Lifokata has devoted his life.

Fistula Care provides training in fistula surgery and safe delivery, along with critical equipment and supplies, such as scalpels and sterilizers. And because so many women who seek care are malnourished, the project offers nutrition support, including renovating a kitchen at HEAL Africa for the women before and after surgery. “Adequate nourishment before surgery makes a big difference in the outcome,” said Bethany Cole, senior program associate for Fistula Care. So far, Fistula Care has supported nearly 2,000 fistula repair surgeries in eastern Congo.

To prevent fistula, Fistula Care also trains providers to offer family planning counseling so that women can space births, which gives their bodies time to heal following surgery and allows women to perform better during delivery.

Looking to understand how best to meet the needs of Congolese women as the program expands over the next three years, EngenderHealth recently brought together surgeons from around the country. Many said it was their first time being in the same room with everyone working on fistula.

“Fistula surgeons and health care providers working in the Democratic Republic of Congo are incredibly dedicated,” Bethany said. “Many work in remote, low-resource settings and provide care to women who are often unable to pay for health care services.”

But for these doctors and nurses, welcoming women back into the world of health and acceptance is reward enough. “I get paid when I help a woman with fistula get better and she greets me, ‘Bonjour, Doctor,’ and smiles,” says Dr. Kimona, a surgical trainer at HEAL Africa. “It makes me happy inside.”

Dr. Lifokata agrees. “It is the work of the heart.”

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