VVF is an abbreiation for vesiculovaginal fistula.... essentially an opening between body parts that means the woman leaks urine continually. Besides the physical consequences of the condition, these women suffer social repercussions as they are ostracized and are cast out from their homes and families for being "unclean". Madagascar has a huge population of women suffering from this condition, with over 50,000 known women on a wait list for surgery and repair.
You may wonder, how do so many women in Madagascar suffer from this condition and we rarely, if ever, see it in the States? Actually, VVF used to be common in the US as well, until C-sections became common practice that is. This allowed for quick rescue of both baby and mother from the dangers of obstructed labor. Typically what happens is that a woman is in obstructed labor for a prolonged period of time (sometimes DAYS), and the pressure against her bladder/vaginal tissue causes it to lose blood supply and creates a hole. Many Malagasy women are very small in stature and have difficulties with child birth. Without an emergency C-section, the woman usually loses her baby and is then left with a fistula that means she leaks urine continually. At times the emotional struggles of this complication can be much harsher than the physical. They come from all around the country, some of them having suffered for years of their lives, looking for hope and healing... however unreachable it may seem.
A couple of weeks ago I attended our first dress ceremony for five women who were "graduating" from the program. It is a special time of celebration for women who are now considered "dry" after successful VVF repair, and are ready to begin their journeys home. Each lady is gifted a new dress and hat, and is pampered by having her hair and makeup done (all of this comes with the approval of the local Malagasy chaplains that we team with in the hospital to make sure it is culturally appropriate). Then we all gather together, share in some music and worship, and then host a "graduation" ceremony. Each woman is invited to the front to collect their graduation gift (typically practical supplies that they can use, but that also have a symbolic meaning) and share a few words with the other patients and crew members.
These stories touched my heart deeply and reflect the individuality of each woman's journey. One woman had her fistula for only months, but was so withdrawn you could see how alone she felt in her suffering. Although she had heard rumors that maybe the ship would kidnap her and take her away, she felt the risk was worth it for the chance that she might be healed. I can't imagine how desperate you must feel to voluntarily travel across the country by yourself, to a big white ship that may either offer you hope and renewal, or may take you away from your loved ones forever. Despite that initial fear, she laughed when she told us her story. Another beautiful woman shared that she had been leaking for over 30 YEARS, had been abandoned by her family and husband, and had been completely alone in her suffering for that time. That is just a little longer than I have been alive on this earth. Finally, she is dry and can return home to her loved ones. It was a joyful celebration!
In the midst of these individual stories, is a feeling of sisterhood among the ladies. For the first time, they are together with other women like them. They realize that they are not alone in this situation. Although they are generally quiet when they first arrive on the ship, we soon see them gathered together in the wards, giggling over something our day crew has said or holding knitting circles. We see them walking down the halls, singing at the top of their lungs. We see them laughing at the "vazas" (us, foreigners) who do silly things just to make them smile. And while at 5'4" I tower over these petite ladies, their presence fills the hospital. While there are many emotional struggles to work through, and while surgery is not always successful after the large amounts of damage their bodies have suffered, there is so much more work being done in these women. Here, they come back to themselves, discover hope, and build community. Although challenging at times, it has been such a blessing to work with these women... here are some of their beautiful faces.
Walking out of the dress ceremony in a dance line!
Group photo.
Hanging out with the ladies on B ward.
Me, Joceline (recovering after surgery) and Deborah.
Joceline, at her dress ceremony! So beautiful!
Our VVF team leader Steph, shared Isaiah 61 as her hope for these women, and I'd like to share a piece of it here with you:
He has sent me to bind up the brokenhearted,
to proclaim freedom for the captives
and release from darkness for the prisoners...
to comfort all who mourn,
and provide for those who grieve in Zion-
to bestow on them a crown of beauty instead of ashes,
the oil of joy instead of mourning,
and a garment of praise instead of a spirit of despair.
They will be called oaks of righteousness,
a planting of the Lord for the display of his splendor.
If you are interested in learning more about VVF, I recommend watching "A Walk to Beautiful". It's a short, touching documentary about the lives of these special ladies.
I'll be posting again, hopefully next week, to give you some updates on our long term patients... and lots of photos!
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