I came to understand that our responsibility, as a medical mission team, was to make the tough decisions that balanced our transience with the needs of the patients. Urinary diversion surgeries would necessitate cancer screening, something to which most of these women did not have access, while a colostomy would mean a lifelong requirement of medical supplies, which these women could not afford. Performing these operations would leave, in our absence, more women like Claudine. We were not there to satisfy our egos or fulfill a quota; we were there to heal those who were good candidates for surgery, to train local physicians on techniques of fistula repair, and to raise awareness with the goal of improving prevention in the future. Our hope was to help, but our stay was too short to responsibly help everyone.
Though we did make a difference in the lives of many, I returned home knowing there was so much more to do: as many as 3.5 million women in the world suffer from obstetric fistula, with an estimated 67,000 new cases each year in Africa, while rates of fistula repair lag far behind. The 125 women we evaluated in February 2014 were only a small representation of the population affected. Until sustainable changes are made in Rwanda, such as improving access to emergency obstetrical care and local physicians’ surgical training, achieving gender equality in education, and stabilizing the infrastructure, fistula will continue to occur and short mission trips like ours will quickly become insignificant. The days to weeks of a fistula repair trip are not nearly enough to help everyone in need, and our impermanent efforts can feel futile.
I have a new awareness of the emotional and logistical challenges of working in global health. It is easy to feel inadequate, that one’s efforts are insufficient when faced with the magnitude of the problem, and that there are limits to what one can do. But this sense of frustration is my motivation as I begin the process of growing into the global health community. I will never forget Claudine’s story or those of the other women who silently suffer with her.