Fistula Care in Sierra Leone

The following post was contributed by the Fistula Care Project and is a part of their Stories from the Field series that documents the experiences of women suffering from obstetric fistula and the people who work on the issue.

Dr. Alyona Lewis is the only national fistula surgeon providing routine obstetric fistula repairs in all of Sierra Leone. Based at the Aberdeen Women’s Centre in Freetown, Dr. Lewis and her team transform the lives of hundreds of women each year. Managed by the Gloag Foundation, the Aberdeen Women’s Centre is the fulfillment of Dr. Lewis’s dream to see a freestanding fistula center where women with fistula are welcomed without discrimination.

Dr. Lewis first encountered the problem of fistula in 2002. This was just after the war in Sierra Leone, during which rebels frequently abducted and sexually assaulted women. Some women began to leak urine following the trauma; others became pregnant and subsequently experienced obstructed labor. In either case, many women ended up leaking urine uncontrollably, ashamed and stigmatized. At the time of the war, Dr. Lewis worked in a maternity ward. She remembers not having equipment, banked blood, and the freedom to transport patients-sometimes the only thing she could do was to hold a woman’s hand as she died.

International relief workers came to Sierra Leone in the war’s terrible wake. One visiting doctor from the International Medical Corps (IMC) saw the young and inquisitive Dr. Lewis on the wards and asked if she would be interested in learning how to screen fistula patients. Dr. Lewis began to assist. Although IMC wanted to train Dr. Lewis in fistula repair surgery, she was initially rejected because she was a resident obstetrician-gynecologist rather than a specialist. With time, however, IMC reconsidered, and Dr. Lewis promised that she would not let them down. She trained first in Nigeria and later under expatriate fistula surgeons who visited Sierra Leone. Most recently, EngenderHealth’s U.S. Agency for International Development-funded Fistula Care project supported Dr. Lewis to hone her skills and learn how to train others to repair fistula onboard Mercy Ships’ floating hospital. Dr. Lewis has been fortunate to work alongside many great fistula surgeons, who passed on not only their technical expertise but also their passion for the job.

One of the many women whose lives have been transformed through Dr. Lewis’s commitment to fistula surgery is Jojo. Jojo was waiting for fistula repair at a public hospital at a time when all of that hospital’s cleaners and support staff went on strike. To draw attention to their cause, the workers turned off the water supply. Seeing the need, Jojo organized all of the waiting patients to clean the wards and to fetch water. Dr. Lewis and her colleagues all contributed money and their time to be able to repair Jojo’s fistula. It was a challenging case, but the surgical team tried their best and said a prayer. Dry at last, Jojo regretted that she had no way to pay. She committed to serve however she could and became one of the hospital’s best nurse aides, full of empathy and kindness toward patients. Today, Jojo is finishing nursing school, with plans to learn midwifery. As a midwife, Jojo will be able to keep other Sierra Leonean women from developing the obstetric fistula that she did. Dr. Lewis smiles to think of how Jojo’s life has been transformed: It is stories like these that keep her going.