Sunday, April 22, 2012

Transition and Change in "B Ward" - VVF

I have done so much but haven't updated you all one iota! (iota... is that a word or just redneck talk...?)
Well I'm going to do separate entries for a few of the main events as of late!

The biggest news in the last 2 weeks is that "B Ward" formerly knows as the "plastics" world, has taken a major transformation and turned into a world of "ladies only" patients.  VVF (Vesico Vaginal Fistula) repair surgeries started a week and a half ago with some women starting to go home "dry" already! Yay for that!!

"Plastics Dinner"
With all the "B Ward" Plastics Nurses. 
Many of these nurses have left in the last 2 weeks : (
I wish you could see them better cause they're all pretty special!

VVF (Vaginal Vesicular Fistula) is basically a hole between the bladder and vagina that causes a woman to constantly leak urine and at times even feces, due to problems with labour and delivery usually resulting in a dead baby too : ( This surgery is fairly simple, but requires about 2 weeks of catheter care in hosp. It is however completely life altering for these women. "A Walk to Beautiful" is a documentary put out by the Fistula Hospital in Ethiopia, who are leaders in the whole are of VVF.  Check out their link, the documentary is worth the watch if you're interested.

Our surgeon Dr. L. Romanzi also has a blog page: (her blog) (general info)

I've mentioned a bit about VVF before but I'm am definitely getting more closely acquainted with it's reality now that I'm with the patients on the wards.  I really wish I could accompany some of them home and see what life really entails, cause sometimes here on the ship I feel like we have no idea.

I can tell you though that leaking urine or even feces, IS as bad as it sounds. Especially if you live in poverty where you don't have access to sanitary pads or diapers etc.  They are very happy to get to use the pads once here in hosp.  That's only pre-operatively tho, as post operative "no diapers allowed!" only 'blue pads' so that we see if and how much they are leaking. Pre-operatively the ward carried quite an odour despite the showers and use of diapers, so this is no easy life for these women.  They are often abandoned by their husbands and even ex-communicated from community social life.

VVF is most common in the women from the North, or at least those are the ones we are offering surgeries to this time around.  A few reasons for this:
- the 2010 screening I believe was done in the North, and all the women we are operating on have been waiting since that screening for their surgeries... 2 years my friends... 2 years!! yoy...
- less accessibility to c-sections the more remote you are

I wish all my L&D girls could have been at the in-service Dr. Romanzi did last week.  She is here from the States doing 2 months of surgeries.  It is crazy how preventable these fistulas are, given you have medical care that is.  It brought me to tears when I realize all these women needed was a timely c-section.  I think I will be much happier now every time I have to run to the OR for "failure to progress" when I think about my VVF patients who would have given anything they had for a timely trip to the OR. I'm trying to get a hold of the surgeon's lecture notes cause these comparison stats between here and North America were fascinating... coming soon!

I want to tell you all everything about it but some of you may not appreciate it, so you can skip this part if you're not interested in the fine details!! : )

Amber with Julienne
Julienne is awaiting surgery at the Hope Centre.
I can't wait to see her again on the ward very soon.
Try to notice her height.. I'm actually bending down, 
so she's not very tall! Common for VVF patients.

Imagine though being in labour sometimes for over a week.... I can't imagine it.  The women I see at home are in agony if they've had even two days of early labour, never mind a week of full blown active labour.  I want to spend more time hearing these ladies stories, but communication is pretty difficult on the ward so I resort to reading charts.  Tchokossi, Kabye, Adja and Peul are the tribal languages our women are speaking. We do have translators in the wards, but most of them are fluent in "Ewe" (pronounced A-way) and French of course.

As I mentioned most of the women we are seeing are quite tiny. Short stature equals tiny pelvis.  African race also equals higher percentage of 'android' pelvis', which are narrow and difficult to deliver babies through!  A common reason for them not getting very tall/having a small pelvis is malnutrition and bearing heavy loads at a young age.

VVF occurs from the head rubbing against the vaginal tissue for too long, so that the tissue basically becomes necrotic from lack of oxygen/circulation.  The rubbing of the presenting part also contributes to the breakdown of the tissue.  It's simple how it occurs really, and is sometimes simple to repair; however, it seems a lot of the women that weren't able to be seen the last time the ship was here were the more complicated cases involving ureters and rectums aswell... So we're having fun with catheters and drains and hourly in/outs!  I will try to track down the surgeons power point and add in some more interesting facts.  

Stay tuned for more VVF stories! : )