Thursday, October 2, 2008

Riding in Trucks with Ultrasounds

If someone had told me eight years ago, when I met my friend Ian’s mom freshman year of high school, that she would lure me to West Africa to do volunteer work, I never would have believed it. If three months ago, as I sat watching endless amounts of TV and freaking out over my future, someone had asked me where I would be in the fall, I couldn’t have told them. And if five days ago, someone had asked what I thought I’d be doing over this week, I’d never have answered that I’d be hanging onto an ultrasound in the bed of a packed pickup, trying to keep from falling out on the potholed road, and keeping a hand free to wave to the hordes of children yelling greetings and pumoi, pumoi, pumoi (white person in Mende), as we moved our organization’s operations from one hospital to another. All the same, I now find myself sitting in a house with my friend Ian’s mom, Helen Weld ( listening to the ward cooks, our drivers, and our caretaker haul water out of our well to take over to the 24 fistula patients we’ve transferred to Bo Government Hospital, as mothers ready their children for school, women sweep, backs bent over brooms made of gathered switches, and roosters crow, each one attempting to outcry the last.

The West Africa Fistula Foundation (WAFF) ( is a non-governmental organization (NGO; welcome to the world of acronyms) that works in Bo, Sierra Leone to socially and physically rehabilitate and surgically repair women suffering from obstetric fistula. Obstetric fistulas, usually classified as Vesico Vaginal Fistulas (VVF) or Rectal Vaginal Fistulas (RVF) are abnormal connections between the bladder and vagina or the rectum and the vagina typically as the result of obstructed labor. These labors can last anywhere from 2 to 15 days and mostly occur in remote rural areas where there is no access to trained medical doctors or not enough money to cover medical costs. The baby’s head and the woman’s pubic bone essentially form a vise that cuts off blood flow to the area, resulting in the death of the tissue, which is sloughed off, leaving holes, or fistulas. In most cases, the child does not survive. VVF and RVF cause uncontrollable incontinence—a woman will be literally leaking urine and/or feces—as well as possible nerve damage that leads to a limp, abandonment by the husband, and social ostracization. The majority of the women we’ve seen are destitute, and most are illiterate and untrained in skilled labor, since they have spent most of their lives toiling in subsistence farming. Many come in nearly dead.

WAFF finds women throughout the country with VVF and RVF, whether through word-of-mouth, referrals from other hospitals, or taking our van “upline” to the rural regions far from the capital city of Freetown. We bring them back to health and prepare them for surgery. In some cases, the VVF or RVF is too extensive to repair, which means that the women must either wait for a specialist to arrive from abroad to do urinary diversions (making a new bladder that has to be catheterized throughout the day through a hole in the stomach) or for us to find a supportive place in which they can live. Luckily, many of the women can have their fistulas repaired.

Dr. Darius Maggi, a retired ob/gyn from Texas, started WAFF in 2004 to address this preventable issue and as well as the staggering rates of maternal and infant death in Sierra Leone and across West Africa (though we don’t have official numbers for SL, all you have to do is walk into a hospital or talk to a Sierra Leonean to see bad they are). WAFF does not stop at surgeries, however. We work under the umbrella of the West Africa Institute (WAI) to regenerate sustainable futures for our female patients and, eventually, the people of West Africa as a whole. Through education and skills training at the ward, and in the future, the implementation of appropriate technologies and agriculture, micro credit enterprises, and a medical center that will bring in people from all over the region, we hope to aid in regenerating communities. WAI and WAFF strongly emphasize training local medical personnel and others to take over its work, so that volunteers from abroad will one day be unnecessary. In this way, WAI and WAFF are not looking to set up shop and simply sustain life as it is. We’ve been calling those kinds of programs “Band-Aid work,” which means that they simply patch up a problem instead of solving it. Rather, we are looking forward to a future in which preventable deaths are actually prevented, people feed themselves nutritional foods that don’t destroy the soil or forests, small businesses thrive without worries about day-to-day survival, and solar technologies break the cycle of dependence on fuel sources that are scarce, environmentally destructive, and incredibly expensive.

And so, I find myself volunteering for an unspecified number of months in Bo for the West Africa Fistula Foundation. I’m doing anything and everything that I can, from typing up reports and entering inventory to hanging off the back of said pickup.

PS - sorry for the lack of pictures...the internet's too bad at present to upload...


  1. No need to apologize for a lack of photos, Jules. All of us with imaginations can see what you're up to and up against, and you paint some pretty clear pictures with your prose. There's even an audio component. I can hear the roosters and the kids yelling. I'd be lying though, if I said that I'm not looking forward to photos. Thanks for all the info. I'm going to lurk around the WAFF website and see what else I can learn. Way to blog, girl!

  2. Yo! Julia! It's good to hear from you! You're in Africa! That's crazy! I can't believe it! Wowzah! Whoopee! Hizzaaah!

  3. yeaaaah, my fellow NGO buddy! lets make a deal, you save west africa, and ill save india. keep on posting and ill keep reading