Article from the Daily Observer
By Tina S. Mehnpaine

This story was supported by the Pulitzer Center
 
For more than a year now, three Liberian doctors have been far from home, hunched over operating tables at the St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia, learning surgical procedures that most hospitals in their country cannot perform.
 
The doctors, Dr. Issatu S. Komara-Keita, Dr. Alexander F. Willicor, and Dr. Numeine Ernest Enders, are undergoing two years of advanced fellowship training in urogynecology and pelvic floor reconstruction, a surgical specialty that treats the bladder, reproductive system, and rectum, including pelvic floor disorders.  
 
Their studies are part of an effort by the Government of Liberia, the Economic Community of West African States (ECOWAS), and the United Nations Population Fund (UNFPA) to reduce the country’s dependence on foreign surgeons to tackle the growing number of fistula cases, one of the world’s most devastating childbirth injuries. 
 
ECOWAS provided US$245,000.   
“Based on the Minister of Health’s request to UNFPA and the ECOWAS Gender Office, both institutions agreed to sponsor the doctors. UNFPA sponsored one doctor, while the others are being supported through funds provided by the ECOWAS Gender Office in Dakar, Senegal,” Dr. Nowaih Gorpu-Dolo Dennis, Fistula Focus Person at the Ministry of Health, said in an email.
 
In Liberia, the lives of fistula survivors are marred by high costs for treatment and a lack of trained surgeons, forcing many to rely on foreign visiting doctors who provide annual treatment. The country has only three urologists—Dr. Ayun Cassell III, Dr. Lavela B. Kortimai, and Dr. Solomane Konneh—all based at the John F. Kennedy Medical Center's (JFK) urology clinic. 
 
Dr. Ayun K. Cassell III, a consultant urologist at the John F. Kennedy Medical Hospital, said these hurdles have left many women waiting months for free surgeries provided by foreign doctors or even years, worsening their condition by the time help comes.
 
“We have three urologists; we are hoping that we'll have more urologists, and we have doctors who have been sent out for studies,” said Dr. Cassell, who is also the head of the Liberia Medical and Dental Council.
 
The ongoing initiative, he said, will strengthen surgical services, improve continuity of care, and create opportunities for mentorship and knowledge transfer, helping Liberia build a permanent pool of fistula specialists capable of providing sustained treatment across the country.
 
The hidden burden of fistula in Liberia
Across the country, the Ministry of Health estimates that about 100 women develop obstetric fistula every year in Liberia, although health experts say the true number may be significantly higher than reported. The condition, which is one of the most serious childbirth-related injuries affecting women in low-resource settings, develops after a woman experiences prolonged obstructed labor, often lasting several days, without access to emergency medical intervention, such as a cesarean section. 

The Economic Community of West African States (ECOWAS) has committed US$245,000 to support surgeries and reintegration for obstetric fistula—a childbirth injury that creates a hole between a woman's vagina and or rectum.

Benedict Roberts, head of the ECOWAS National Office in Liberia, said women experiencing urine and stool leakage due to obstetric fistula will be identified, treated, and receive livelihood training such as tailoring, pastry making, cosmetology, and soap-making that prepares them for reintegration back into their communities.
“When they finish, we give them a small financial package along with the skills they learn to start as their own empowerment,” he said.

Obstetric fistula is a global health issue, with poorer countries being mostly affected. According to the United Nations, an estimated half a million women and girls are living with the condition, with thousands of new cases occurring each year. Most of these are in Asia and Sub-Saharan Africa.

Victims face severe stigma, neglect, and abandonment from their families and communities, leading to trauma and significant psychological impacts on their mental and social well-being. The constant leakage of urine or feces results in severe infections and chronic pain. The malodor associated with fistula makes it extremely difficult for these women to work or participate in social activities, further exacerbating their poverty and social isolation.

In Liberia, the leading risk factors are common, including teenage pregnancy, lack of proper obstetric care, low-skilled birth attendants, and rape. Underdevelopment, rebuilding from the 14-year conflict, and the Ebola crisis have created a critical gap in the country's healthcare system, according to the World Health Organization (WHO).

​​By David A. Yates and Simeon S Wiakanty

News provided by
Dignity:Liberia Nov 16, 2022, 08:48 ET
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Dignity:Liberia’s NGO Office Manager, Matthew Walters, delivered some bags of rice to Varney Goyah Town, the village helping with the construction of the maternity waiting home.  He told them, “On behalf of Dignity:Liberia, this is our way of giving back to the village.  They sent some money to buy a few bags of rice.  So, on behalf of Kathi and the Board…we wish you a Merry Christmas and a happy, prosperous 2022. 

In her response, the village spokesperson told him, “We are grateful that you delivered this.  We say thank you on behalf of the town chief who is not here.  Thank you very much.  God bless you.  Happy new year to them [the board] and you people on the ground.” 

Today Charlie, Erin, Becky, Nicole, and Caroline went to ELWA Hospital.  Nicole demonstrated her newborn physical assessment skills.  The rest of the team did burn and wound care and assisted with a patient in crisis.

In the morning, Anne-Marie, Kathi, and Kathy Beth met with Emma Katakpah, Clinical Assistant to the Fistula Project, Sametta D.G. George, Fistula Coordinator, and Sualaho M. Koon, UNFPA Accountant to the Liberia Fistula Project.  In the afternoon, they met with Juliette and Dr. John Mulbah who own and manage the Family Clinic in Jacobtown, Monrovia and  discussed Dignity:Liberia's future Maternity Waiting Home.

Later they visited the Dignity:Liberia in Liberia office housed on Dr. Mulbah's compound and met with Office Manager Matthew Walters.

We have posted many trip updates directly on our Facebook page.  Please be sure to visit it daily.  For more on about the team members, see last month's blog.  Thank you for your interest and support!

The palava hut at the Fistula Rehab Center is completed.  It looks wonderful!  We are looking forward to sitting in its shade and visiting with our friends.