Anyone who has spent any time in a hospital knows that the food there is usually pretty terrible, but what if there were no overcooked carrots or flavorless Jello? Can you imagine traveling a great distance for medical procedure that required hospitalization and having to bring along a cook for your entire hospital stay just so you could eat?

Holy Family Hospital, like the vast majority of comparable hospitals in the region, does not have a cafeteria or regular food service for patients. This means that a community of informal caregivers formed behind every ward with clusters of people sitting together preparing the meals their loved ones would later consume. People laughed and kids played and it seemed a world separated from whatever affliction had brought all these strangers together. I happened to walk up on a lively group of women pounding out some fufu, a local favorite made by beating cassava roots with the end of a six foot stick. One of the women had the most beautiful native fabric wrapped around her and when I non-verbally asked permission to photograph her, she jumped up and ran away. A few minutes later, the young lady returned having replaced the vibrantly patterned local fabric-wrap that had inspired my interest in taking a picture with a pink tank top imported from somewhere in the West. I paused to consider the wardrobe change and was brought back to attention by the young lady now yelling at me to take the picture as her hand danced around the pounding staff that formed the fufu.

Like the families who had come to support their loved ones, John Kelly had a relentless dedication to both Glenda and Isabella. I followed him around as he frequently checked on both ladies. Isabella’s procedure was relatively simple and she started a full recovery almost immediately. Glenda’s post operative status was much less stable. Her surgery had been major and despite having consumed liters of fluid, Glenda’s catheter bag remained empty. Every couple of hours, John would look in on Glenda, and every time her face seemed to get more and more bloated. John picked up the frequency and intensity of his intervention, giving instructions to the nurses and even Glenda’s husband, who didn’t speak English, but seemed to absorb the exact meaning of John’s every word.

Mr. Devotion, the name I gave Glenda’s husband, was far and away her best nurse. He always seemed to be there comforting Glenda at her sickest and he never left her side. In fact, he even chose to spend his nights sleeping on the floor underneath her bed. Unlike many fistula patients, Glenda was never forced to endure her fistula alone because Mr. Devotion stayed with Glenda through her 16 years of leaking urine and feces. After about 30 hours of worry, we found Mr. Devotion giving John the thumbs up sign as he sat next to a full catheter bag.

As Glenda’s condition stabilized, I started looking at and thinking about all the processes that had brought these women to Holy Family Hospital and had finally resulted in their fistulas being repaired. I met with the hospital administrator, Father Ofusu, and reviewed the hospitals cost and operating structure. With all these components, I began hypothesizing ways to cut significant cost out of the process and how we might scale up a treatment and training program to other parts of Ghana. In my research, I realized that Glenda’s Ghanaian insurance covered the cost of her procedure, but that Isabella would have to pay for her procedure out of pocket because she was from the Ivory Coast. I estimated that even with John’s donated surgery Isabella would still need to pay almost $200 – a fortune in her world. I decided to intervene.

I went to the women’s ward and first spoke with Glenda and Mr. Devotion. After discussing how happy we all were about the surgery’s success, I handed Mr. Devotion 10 ceedees (just over $10). This covered all their cooking cost for the entire hospital stay and left them a bit extra. They were both very happy to receive the cash support and thanked me profusely. I snapped a pic, wished them luck and headed across the ward to Isabella and her sister.

With Isabella, I had to speak through two interpreters, so things took a bit longer, but the 10 ceedees had a similar effect. When I told Isabella that OperationOF would be picking up the tab on the surgery, she first didn’t understand. After I confirmed that, like Glenda, Isabella would not have to pay for her procedure, Isabella finally broke her gaze from the floor and hit me with an enormous and radiating smile. After seeing what a brilliant and contagious smile Isabella had, I told her that the surgery was actually not free. Her puzzled look returned. I went on to explain that Isabella had to fulfil two conditions for her side of the deal. The first was to find more women who need the surgery and refer them to us and the second was that she had to smile as often as possible because her smile made the world a happier place. After 30 seconds of translation, Isabella looked me in the eyes and nodded affirmatively with a smile of absolute and pure joy that continues to move me.