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After a fantastic dinner, courtesy of Dr. Lucia Visser, the local OB/GYN who has looked after us brilliantly, I was sure I would sleep like a baby last night. But between the heavy heat, my excitement about the surgeries, and the melodious pre-5am start of the African morning symphony, I barely slept a wink. John Kelly, who runs on some sort of endless supply of high octane enthusiasm was tapping his feet and ready to go before I could pull my sleepless body out of bed. I cleaned up quickly with a very cold shower and hustled to catch John as he peddled towards the operating theatre into the rising sun. My “morning jog” in pursuit of the biking John Kelly had me trying to conceal my huffing and puffing during the pre-op morning staff meeting.
Before I talk about the surgeries, I just want to note that I have changed the names of the patients to protect their privacy. Both have consented to their stories and pictures being used in the blog, but out of respect for these incredible ladies, I have also tried to generalize personal details. Each of the fictitious names starts with the country of origin for the two patients: Glenda from Ghana and Isabella from Ivory Coast. I also want to note that both of the fictitious names I have chosen are the names of women in my own family (my aunt and cousin, respectively). I feel that this personalization is reflective of the deep connection I feel to the millions of women suffering from the indignities caused by OF.
Glenda was definitely the more complicated of the two cases. This forty-something mother of two from a rural part of northern Ghana had had an obstructed birth with her second son that caused both a VVF and an RVF. While a great many babies die in obstructed birth, Glenda’s second son lived and actually just turned 16 years old. This means that Glenda has leaked urine and feces for almost two decades. Yet, despite her dire circumstances, Glenda was a cheerful woman quick to smile and seemingly unfettered by the fairly major surgery before her. I try to imagine what it must be like to have endured such an awful set of circumstances for so long, and its honestly difficult for me to understand such profound strength.
John washed up with the other attending surgeons and assistants and they went right to work, first putting in the local anaesthetic that would keep Glenda from feeling what would be a 4 hour procedure. In addition to closing Glenda’S VVF, John also removed scar tissue obstructing her bladder and then went on to close her RVF with tools that were too short for the procedure. As the rest of the room (myself included) was shifting around in a standing exhaustion, John was doing a very complicated surgery with his fingertips. Incredible.
As soon as John finished, the head nurse suggested we do the next procedure the following day. John refused saying that he would change into dry scrubs (his were drenched in sweat), have a cup of tea and move on to Isabella. And that is almost exactly what Dr. John Kelly did. (Besides the tea, we had crackers, and Kelly chatted with Dr. Ali a bit regarding surgical techniques before we headed back to the OR)
During her examination, Isabella didn’t understand a word of what the interpreter said. This petite woman came from a tribe in Ivory Coast and no one knew how to communicate with her. This meant Isabella had to endure the invasive examination in complete absence of reassurance or even simple information. I can only imagine what an absolutely frightening experience this must have been for her. She sat up after the examination a bit dazed with her feet dangling several feet from the floor. As John helped Isabella off the table, she ruffled a rubber mat on the table and instead of looking where her feet would land, she reached back and tried to right the little wrinkle she had made. This really touched me. Despite her own complete disenfranchisement, Isabella was still incredibly concerned with ruffling this little mat.
Today was the day for Isabella to get her life back. She had been pregnant four times over the years and not one of the children had survived. As if this devastating fate had not been enough, Isabella had lived with urinary incontinence for 10 years. Rare was the instance that you could catch Isabella’s eyes – she almost always stayed completely focused on the floor before her. It was as if her shame disallowed her to even look people in the eyes. But her surgery was over almost before it had even started. It took John Kelly only 45 minutes to close Isabella’s fistula. 45 minutes – that’s literally a morning run on a Tuesday before work. 10 years Isabella had suffered. 10 years she waited to get her dignity back and it only took 45 minutes to do it.
This reminded me of why I left my former life: because years of suffering really can be ended in just minutes.