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April 17, 2006   Today was a screening day. I want to tell you about my day, but this will not be for children or the squeamish.... So often I mention VVF and many of you may have no idea what I am talking about, so I am going to tell you about my day and what we do. VVF stands for vesico-vaginal fistula- essentially it is a hole between the vagina and the bladder or urethra or somewhere along the way-that means that urine just pours through the vagina without any control.  Some of the women also have an RVF-recto-vaginal fistula, that is just what it sounds like, a hole to the rectum and yes feces (or Poo as they call it here) comes through. You would not believe the extent of the problem here in Africa, it is something we do not have in the first world. It just does not happen. And here, once word gets out that you treat this problem the women start coming. This is going to be a long blog--so get a cup of tea. Oprah made this issue famous with her special on the problem. so word is getting out.

My day started so early, I have been preparing for this day for a little while.  We have already had 2 sessions of surgeons for this time in Liberia. Our time has been very successful.  So I was up at 5am, prayed for while, got ready in a dark quiet cabin and headed to the dock. Met with a group of about 10 of us working on the details for the day and we prayed together and continued to prepare our plan of attack. We thought we might be expecting about 70 women to fill 28 slots on the ship and for our visiting doctor to travel to the interior-away from the big city of Monrovia.  He will spend time teaching an African doctor more about doing the surgery. Still working out details, but hoping to travel upcountry with them to visit the hospital and train local nurses.

Right away we started with a group of women who had spent the day on the ward because they came from Gbanga-far away. One of them was beyond our repair. That is always so hard to tell someone. The last screening we had this beautiful young woman come in dressed in her finest lace dress. She was horribly scarred leaking urine and feces. It was like every thing was just one hole and when we told her we could not help her. she said that so many have told her that, then she dropped to my feet and began to beg us to help her die. To please kill her. that she could not leave again, and she just wanted to die. that she would jump under the ship.  I remember looking at the surgeon that day as we both got tears in our eyes, and just did not know what to see. Our hearts broke and we had to take a moment to regroup. I called my friend Clementine-a Ghanaian prayer warrior that I work with. she came and took the woman and prayed with her, and became her friend and to this day she visits her weekly. She prayed to accept the Lord and is going to a local church now with people who love her again.

We continued on throughout the day. We were running 2 exam rooms and like mice on a treadmill back and forth, one after another. At times the stench was horrible. Some would pull down their cloths and the urine would just run over the floor. They do not have our modern luxuries like Depends.  They creatively rig up something around their waist and make a sling through their legs and put about 2 yards (a lapa) of fabric between their legs to soak up the urine.  their skin is broken down and looks like it hurts from being wet with urine all of them time. Many of them are rejected from their families and have no living children.  The problem is most often caused by prolonged labor. they labor until the baby finally dies, and give birth to it or eventually have a c-section for a dead baby. The baby's head presses against the pelvic bone causing the area to be deprived of blood supply and leaves a hole.

Some of the women have been tortured or beaten. During the war, horrible things happened in this country.  I am not convinced these things are not still happening. An older woman lays on the table and tells us how a rebel plunged a knife through her vagina. You can see the faces of everyone in the room drop as we begin to understand what she is saying. Liberian is this funny version of English, essentially we speak the same language, but not always so much the same. The translators grin and laugh when I speak and tell me that my liberian-english is getting good. So then we also have another woman tell how a man put his hand inside her (in her vagina) and just grabbed and pulled it outside her body.  We are so unprofessional and cant help but gasp as she describes how he did this 3 times.

We see them one after another. Some have traveled days to get here. Most of them tell of a dead child or many dead children. one woman tells how she delivered the feet and body but the rest of the baby does not come. She is in labor for days, travels to a hospital, where they tell her they cannot help her-I try to picture this baby hanging out of her, and she says that is exactly they way it is. she goes to another hospital and finally they take her. they cannot get the baby out, so they "open her belly" and still cant get the baby out. the baby is dead already, so finally they just cut the babies head off and remove it.  A friend and I look at each other and I say "what"?

My day is long-well in my terms anyway. It is hot, the AC does not work well on the ship these days and the room we were working in was about 86 degrees, and the sweat would just run down my face. I should have gotten a shower before I typed this!!!! I process with Mark for a while and dread my hot night of sleep.  Often after a day like this or even as I drive down the road I ask myself...how did I get so blessed to NOT be born here. I have never been so glad to be an American. We are so blessed. I am so glad my girls are Americans and will never have to suffer like this.  We saw so many women today with a British and African surgeon. the British guy was so sweet, he would get so excited to tell these women he would try to help them, that he would "work on them", one of them shouted out.. praise the Lord.

Other highlights of the day: 2 of my translators were late this morning because the taxi drivers were burning the market place. Some riots over traffic congestion and some drop in fee by 5LD (liberia dollars-that is about 10 cents US). That means that poor Mark was extra busy.  He had to play Mr Mom because it was a school holiday today and then got busy with all of the riots. The kids wanted to fish on the dock but it was SO hot. Riots in Monrovia have become part of life. Someone stole Marks cell phone out the car window in traffic over the weekend. They just reached in the window and took it.

I heard this Todd Agnew song My Jesus. Click on the title and see the lyrics, and thought hmmmm-would we at home in America let these women in our church. Would we let them in our homes? Jesus would have hung out with these women. He loves them as much as any of the rest of us. Would we be so concerned about their urine on the pew and in the carpet to no be able to love them.

It was a long hot day, and it was great. This is my favorite surgery that we do. It is neat to see our medical people around and how different our passions are. some of the nurses and docs love plastic surgery, I just endure plastics to get to VVF. And some cringe at the thought of working with my smelly wet ladies. But I will enjoy the next few weeks as I get to watch these ladies transform.  They will go from sad non-engaging people to excited loving happy people and I get to be a part of their lives. What a privilege. I feel so honored to be here.