Posts from — September 2010

Macbeth Act III Scene V, The Heath. Thunder. Enter the three Witches, meeting Hecate.

“… And you all know, security

Is mortal’s chiefest enemy.”

Ah, the Dane and his better half

Just about one year ago, I fielded a guest-blogger question posed by Women’s Voices for Change womensvoicesforchange.org and for this entire year, I’ve struggled to answer this simple question, that being; Why, “at this age”, did I begin to travel to East, West and Central Africa as a volunteer surgeon? This website, predicated on the idea that menopause can be a powerful and sexy transition from nurturer to warrior (my interpretation), thought perhaps  age had something to do with my newly minted humanitarian surgical work. I don’t know if  age or stage of womanhood had anything to do with it, really. Any more than I know whether or not the WVFC vision is a universal truth. For some, menopause bears witness to the opening of new doors and empowering opportunities, and for others, not (my interpretation). Pop-culture Cougarism aside, we know, and  have known for all recorded history, the raw power of the ageless feminine, be it acknowledged, celebrated, or denigrated. It’s just there.

Since 2004 (age 45 for the adoring bean-counters among you), I’ve worked in Niger, Tanzania and Democratic Republic of Congo, returning at 6-18 month intervals as able through various academic and NGO affiliations, while serving on the joint fistula prevention and treatment committee of the International Urogynecology Association and International Continence Society. This joint IUGA/ICS fistula committee will be represented by myself and other committee members at the African-based 4th Annual Meeting of the International Society of Obstetric Fistula Surgeons in Dakar, Senegal this December, 2010.

Is this international focus an act of peri-menopause? I don’t know. It is most certainly an uncomplicated act of humanity whose time has come. What does it mean to be human? To create and /or procreate. To raise the children, be they yours or not yours. To envision the future. To be fully present in the present. To acknowledge history. To be, at every point, human. Life is risk and embracing risk allows one to be more fully human. The opportunity to embrace risk does not always come twice; it came, I grabbed it. For me, humanitarian surgical work manifested as a compulsion, not a decision.

Where lies danger? In complacency, I’d say. In the pursuit of comfort for comfort’s sake. In the denial of realities other than one’s own. In the notion that a suburban-raised, New York City-based white, middle aged mother – doctor should minimize risk and horde all the comfort she’s been told she’s due. In the insular reassurance that I (we) deserve, through the random act of birthright, all the advantages of this American life, while the legacies upon which the foundation of this life is made possible are played out through the birthrights of these billions of other souls to whom I (we?) have a duty to not only witness on BBC-America, but to participate in. Participating to embrace all humanity, regardless of birth-site, as “deserving”, deserving opportunity, deserving equally.

Where lies danger? In the false notion that such work represents superiority giving back to inferiority. In the brutal notion that this work must be done in the name of religious dogma and other agendas of cultural annihilism. In the condescending notion that we are better, smarter or wiser than those to whom we render “aid”, and further, that the recipients are incapable of managing without such help in perpetuity.

I go, not to help those who cannot help themselves, but to admire, to learn from, and to hold in awe the surgeons, nurses and patients in whose indescribably difficult lives I’ve had the privilege of participating, however fleetingly, sharing  knowledge and skills, discovering common bonds of human resilience and pure joy, together creating a hybrid wisdom domiciled in a future that renders all such work obsolete.

What else is there to be in this life but embracing of risk that makes us all more fully human?

For me, the answer is simply, nothing.

“Life’s but a walking shadow; a poor player,

That struts and frets his hour upon the stage,

And then is heard no more: it is a tale

Told by an idiot, full of sound and fury,

Signifying nothing.”

related links:

Harvard Humanitarian Initiative in Democratic Republic of Congo

Panzi Hospital in South Kivu Province, Democratic Republic of Congo

International Society of Obstetric Fistula Surgeons

International Urogynecology Association

International Continence Society

(C) Lauri Romanzi, 2010

Where does that Kalagane Ambulance Chair take you? Nyatende Hospital – 4 km away.

Site Visit Nyatende Hospital (referral hospital for Kalagane Health Center)

We spoke with the senior surgeon, Dr. Vincent Cibavunya.

He has been there for 10 years. He has 6 MDs working with him at Nyatende now.

This is a Catholic hospital, beautifully constructed and impeccably maintained with a stately, separate maternity building.

When Dr. Cibavunya arrived, almost all deliveries happened at home with high infant mortality and stillborn rate and many fistulas.
He did a study to determine that the major factors were cultural bias against hospital birth, ignorance of the benefits of obstetric care, and financial barriers (all over Congo, women pay on average 7 USD for vaginal birth and 15 USD for Cesarean Section).

He instituted an outreach program with his doctors and nurses and local churches and pastors going village to  village and house to house, to explain the benefits of obstetric care and hospital birth. This continues with monthly staff meetings with the regional health center clinicians.

He also worked with some group to create a sort of health care credit union that allowed a reduction in all OB fees.

Today, 85% of births in the Nyatende cachement area occur in Nyatende, infant mortality is very low and fistulas are a rare occurrence. Another MD who has been there 3 months states he has yet to see a fistula. When they do have a fistula, he states they always refer to Panzi Hospital www.panzihospitalbukavu.org.

Prolapse is more common, with about 10 cases per month at Nyatende.

Incontinence is also reportedly rare.

Most surgeries performed at Nyatende Hospital currently are partial thyroidectomy for goiter, and lots of ENT, nasal polyps etc.

Kiel Bonhomme, Dr. Tina Amisi, Dr. Cibavunya, Dr. Tchango, Dr. Romanzi

WHO, UNFPA, USAID and any number of fashionable Stateside and European fundraisers are throwing millions of dollars with the attendant beauracracy and fanfare at the seemingly unstoppable tragedy of fistula caused by lack of basic obstetric management in third world settings around the globe. Seems Dr. Cibavunya forgot to read these myriad reports, having singlehandedly recognized and dealt with this exact problem in his cachement area with a few dollars, a few local institutions, and a lot of common sense. Hmmm.

Within 40 years of the advent of general anesthesia in the mid-1800’s, the world’s first fistula hospital, founded in New York City by Dr. J. Marion Sims, was rendered obsolete, razed, and replaced by the current Waldorf Astoria Hotel in 1893.

Well into the 21^st century, it is time, and as demonstrated by Dr. Cibavunya, it is well within possibility, to implement the rudiments of modern obstetric care that will preclude the need for expensive, stigmatizing, tragic, single-focus fistula centers – we need only apply the obstetrical practices and standards of care available in North America and Europe at the end of the 19^th century.

Hats off to Dr. Vincent Cibavunya and Nyatende Medical Center, South Kivu, Democratic Republic of Congo.

(C) Lauri Romanzi, 2010