November 25


First Fistula Repair at Kisumu County Hospital!

Fistula team and lindsey around the new equipment


A recently published analysis from a team at the London School of Hygiene and Tropical Medicine estimates there are over one million women suffering with obstetric fistula. Because most fistula sufferers are young women—many still in their early twenties or even late teens — they are likely to live with their condition for upwards of 25 years. The world capacity to treat fistula is currently estimated at 16,000 fistula repair surgeries per year. As you can see our worldly capacity is incapable of supporting the need to treat the number of women suffering. This is why partnerships such as the 3-year(2014-2017) initiative, Action on Fistula, between the Fistula Foundation and Astellas Pharma EMEA is intending to transform the lives of women living with obstetric fistula in Kenya by improving access to care and building the long term capacity for fistula repair surgery.


Many of you are aware one of my objectives in working with the Fistula Foundation has been to help Kisumu County Hospital (KCH) set up a process and begin routine fistula repair. This hospital will be part of the overall project goal to create a National Fistula Treatment Network that supports routine fistula surgeries at 5-7 hospitals across Kenya.


The last time I blogged about this project we were having our stakeholder meeting to work through and agree to an overall process for the obstetric fistula client flow within the hospital and back out to the community. I can tell you it has been quite a task getting the right people together, the numerous barriers that arise and simply the pitfalls of organizing people and process! I do know this, I will be putting together a sustainable document that will walk someone through the steps we took to get to this point, the learnings we had through the process and standard deliverables we have in place to allow more efficiency and standardization for establishing the next public hospital within the network.


One of the key learnings in this project for me is to not let” perfect” get in the way of “good”. I find I want to work out all of the kinks, get things in place and ensure we no longer have any unfinished pieces before I pull the trigger. I struggle with this because to me often times there are no reason why this shouldn’t already be taken care of or I want the end user to have a flawless experience. I can’t help it, people and their experiences mean a lot to me; especially these women who have traveled so far and suffered so much.


But this experience hit me hard realizing I can no longer hold on to this wanting perfection because I am not a superhero and am unable to control everything! Shocking!! The reason why it has taken me this long and many lessons on this to finally be learned was a couple of incidents that happened in this project. I had been running around trying to get everything ready for the arrival of our first potential fistula repairs. They got in much later than we anticipated and this simply reiterates the barriers of just getting to the facility. When they arrived we were starting to process their paperwork in hopes to get them screened and repaired the next day. As we are trying to connect with the physician for screening, I am realizing they haven’t eaten, you can see how uncomfortable they are because they have been leaking and one of them has traveled with an infant! I ask the nurse about their dinner and cleaning up. She tells me they haven’t arrived with their own spoon, cup, bowl, soap and basin! WHAT??? I am beside myself! I went through the process, everything I could think of to have this seamless. I failed to really see the process in the WARD of the basic caring needs; it never crossed my mind that the hospital doesn’t supply these things. I would never have thought one would need to come packing quite a bit of things to just be in the hospital. I think about what I consider essentials for just one night away from home. It never ceases to amaze me how each day I can continue to be deeply humbled. I am writing this and tears are forming in my eyes because there is so much I take for granted in my everyday living that it is shameful. At this point the women have no food, nothing to care for and clean their bodies; this is not acceptable to me. So, we women spring into action (Nerea, nurse in WARD 6, Sarah, Fistula Foundation communications person and Seline, outreach coordinator for WADADIA- they were the ones traveling with the women to get them here) I went and got food and the others tackled the other items the women would need. The weaving of women is such delicate and beautiful work! I felt at peace leaving them for the evening and just keeping my fingers crossed.

screening at KCH

The next day I find out we didn’t have the dye needed for surgery and a few other items. They were suppose to show up that morning and were held up en route. Plus, somehow the supply list was altered and things were missing. I do feel a bit helpless in this because I am not a medical person and would not notice these details. This drives me even more to have standard lists in place- we are doing fistula surgeries in other locations so we should already have some of this standard work in place. I decide, with the physician, to track down these items at another hospital so we can get the repair started. This is huge for me to keep my composure because this is the kind of stuff that makes me want to tear my hair out! These are things we could avoid but I realize I need to move forward and go with the flow (there have been some deep revisiting of lessons in just this one project!) I hustle to get the needed supplies and then find out the decision has been to postpone the repair for tomorrow. Here is another lesson for me! I want to lash out, I want to push and resist because I do not understand why! I do not do this; which is my normal behavior. But what hits me harder than you can imagine is going over to Rose, our future survivor, to comfort her and let her know what is happening as I am ending my day. I am looking at her, the bed is wet, she is sitting on a yellow plastic bag to try and create a dry barrier. You can see the discomfort and then her eyes start to water as I am telling her what is happening. In that instant my heart is broken and I feel helpless. I ask the nurse to come over to talk to her because with some of our language barriers I am not sure all that is happening or what is completely understood between the two of us. The nurse lets me know she was mentally ready for her repair today and now with this news she is struggling psychologically with the shift in plans. I just want to SCREAM and cry with her! I hold her and try to comfort her but I know this is not possible; this holding will not be enough. I leave the hospital defeated and disheartened.


I get home and start to process my day and try to find some peace. My lessons stand out to me and I accept the wisdom. I also need to focus on the fact that she is safe, on her journey to repair and the universe has a much bigger plan than my expectations. This process may not have been perfect but the good is that she is being repaired tomorrow and at the end of the day this is a true gift to help her rebirth, I may even say it is better than good. J


What is always getting in your way? Is there a pattern? How do you handle it and/or the people involved? My emotions are my strength and also my weakness. I am forever working on managing them, I am getting better; far from perfect J but I also accept this side of me too because it is who I am.

Kisumu County Hospital is open for fistula repair and we are part of the change we want to see in this world; touching the lives of women silently suffering from obstetric fistula! Aho!


Asante sana to the teams at KCH and the Fistula Foundation who have worked tirelessly to get fistula treatment up and running. A beautiful set of blessings for the Thanksgiving holiday! May you look around your dinner table and see the unseen blessings before you!

Fistula foundation team


fistula KCH team with lindsey in a meeting


In munay-