WU physician giving new lives to outcast mothers

| Staff Reporter

A professor of obstetrics and gynecology is building a hospital in Niger dedicated to repairing vesicovaginal fistulas in African women whose injuries in childbirth result in a lifetime of loneliness and poverty.

Lewis Wall of the Washington University School of Medicine has led a multi-pronged campaign to repair obstetric vesicovaginal fistulas—ruptures in the wall between the bladder and the vagina that can result from obstructed childbirth. This tends to occur in young mothers with underdeveloped birth canals who do not have access to Caesarean sections. It’s an easily repaired injury that, if left untreated, can cause incontinence, which sometimes makes the victim an outcast for life.

“The thing that draws me to it is…the paradigm of innocent suffering. These women have this condition as a result of no fault or behavior of their own,” he said. Rather, it is the result of poor obstetric care.

Fistulas are not a concern Western mothers face because at-risk pregnancies are delivered through C-sections. But C-sections are not available in much of Africa, and since girls frequently marry as young as 14, obstructed labor is more common. The delivery can last days, result in a stillborn baby, and leave lasting damage to the mother.

Because they typically smell of the urine and sometimes feces that constantly trickle from their vaginas, these women are often divorced by their husbands, cast off from their villages, and find themselves unable to find steady work. In short, their lives are ruined by an injury that can be prevented by decent health care and cured by a $300 surgery.

But this problem has received little attention in the past “because the victims are the most voiceless of the voiceless,” as Nicholas Kristof, a prominent New York Times columnist, wrote in a blog post about his Sunday column on Nov. 1 about Wall’s new fistula hospital plans.

Wall is changing this state of affairs. The government of Niger recently approved his proposal for a fistula hospital. Once $850,000 has been raised, the 40-bed facility will be built next to an existing hospital for lepers.

“One of the reasons we’re working with this leprosy hospital is that a lot of the patients require significant psychosocial and economic rehabilitation,” much like with leprosy patients, he said.

In addition to fixing fistulas, the hospital will both educate women on ways to rebuild their lives once they leave the hospital, and run a microfinance program.

Women may also need physical rehabilitation for lower limb paralysis that can occur during obstructed surgery, called “foot drop,” and sometimes require treatment for malnutrition because of their prior poverty.

The foundations of the hospital are already in the ground, and fundraising and construction are underway. Wall expects to be there in December to perform surgeries in the small fistula unit already in operation in the leprosy hospital.

Building the hospital is far from the end of his campaign, however. Wall has also drawn up a plan to build 30-40 fistula hospitals worldwide that would cost $1.2 billion over 12 years. The goal is not just to repair fistulas, but also to improve obstetric care to prevent them from occurring.

To advance this plan, a meeting convened in Washington, D.C., last Sunday and Monday of not-for-profit and charitable organizations “interested in putting fistula on the government’s foreign aid agenda in a much more substantive way than in the past,” Wall said. “It’s in the early stages, but it’s a broad, bipartisan coalition to push that forward that’s starting to form.”

In addition, he is active in the Washington University community. In the spring, he will be teaching the undergraduate courses Anthropology of Human Birth and Anthropology of Maternal Death. In the past, he has taught courses such as The Female Life-Cycle in Cross-Cultural Perspective and Anthropological Perspectives on the Fetus.

Mitch Jenkins is a pre-med senior who took Anthropology of Human Birth with Wall in the spring of 2009. The course covered the physiology and public health aspects of maternal health issues.

“It definitely showed me how prevalent an issue maternal health is,” he said. “I don’t think I grasped how big of a problem that is.”

Wall also works at Barnes-Jewish Hospital, runs a practice focusing on reconstructive gynecological surgery, teaches medical students and residents, and serves on the hospital’s ethics committee. He is also president of the Worldwide Fistula Fund, which has already funded fistula surgery centers.

Wall’s interest in women’s health began not as a doctor, but as an anthropologist. After graduating from Oxford as a Rhodes Scholar, he spent time in Nigeria working as an anthropologist on a Fulbright Scholarship. But this initial foray into the field convinced him that he there was more urgent work to be done as a doctor, and he entered medical school at age 27. Now, he promotes women’s health on many fronts as an anthropologist, doctor, teacher and activist.