I spent my 24th birthday at a hospital in Butare, Rwanda, meeting sad yet hopeful women awaiting fistula surgery in one of only three places in the entire country where this is possible. After months of reading patient histories, personal tragic stories, UNFPA reports, maternal morbidity statistics and health delivery system studies—anything tangentially related to O.F—I was actually standing in the maternity ward looking into the promising and serene eyes of a woman who had been leaking urine for more than two years. She sat timidly on the edge of a worn mattress, holding a beautiful baby boy, born in the bush despite her fistula. It was only as I touched his tiny head that she smiled radiantly; a smile that conveyed her dignity as both a woman and a mother.

When we met Dr. Kakoma, the head of obstetrics and gynecology, we were immediately impressed by his passion and knowledge. The Congolese surgeon actually shocked us when he said that only one urologist serves the entire population of Rwanda (almost 9 million people). But as Seth described our organizational plan to change the fistula world, Dr. Kakoma’s face lit up with excitement and he began talking rapidly about all the possibilities a few more resources would enable here in Butare. The National Teaching Hospital currently maxes out at around 50 surgeries per year, a drastically low number considering that 10 rural districts refer into this relative center of excellence. We believe our operational expertise and some investment could improve this amount up to five fold. Such dramatic change could be accomplished through training staff and adding infrastructure necessities such as more instrument kits, an expanded ward and potentially a fistula operating theatre. Dr. Kakoma connected us with a couple young surgeons who gave us a thorough tour of the facilities.

Despite their commitment and skill to conduct operations, surgeons in Butare are challenged daily by limited hospital facilities as the maternity ward is grossly under-funded. The uneven floors, broken beds and cracked walls are jarring to the senses but at the same time the miracles that are being achieved with such little material resource are incredible. The scrubbed up surgeons expressed the challenges of working with only one instrument kit, insufficient catheters, too few beds and an inadequate supply of medicine. Despite the tough conditions, these dedicated few have committed their lives to serving the mothers of this country and only made modest requests for instruments and training that would assist them in doing their job better. Their hearts were clearly with the women, but in a country trying to rebuild after such recent devastation by a horrific genocide, resources and government healthcare assistance are not exactly in abundance. As we left Butare, it was clear to us that this was one place that could surely benefit from some assistance.