. · • Limekilns Parish Church - Mercy Ships • · .

Aberdeen Clinic and Fistula Center

Barry and Marcia McDougall Barry and Marcia

Freetown, Sierra Leone

Barry and Marcia McDougall moved to Charlestown in December 2005 from Stirling. Marcia works in Anaesthetics and Intensive Care at The Victoria Hospital and Barry runs a local computer support business called CompuDocs. They spent the month of January 2006 in Sierra Leone, working with Mercy Ships.

This is an account of the work of the Fistula Centre in Freetown where they worked.

Aminata's World

Aminata is fifteen years old. She lives in a small village of eight mud and thatched huts in the eastern province of Sierra Leone, West Africa, near the Liberian border.

Map of Africa Sierra Leone

Her parents have three other children. Four others died in infancy from typhoid and malaria. Aminata's father makes a barely adequate living harvesting palm oil and palm wine in the neighbouring plantations. Water is obtained from a creek close to the village; the nearest clean water can be carried from a larger village six miles away which has a pump and well installed by a relief organisation.

One man in the village has a bicycle but otherwise the only transport to the nearest town, two hours away on a dirt track by car, are the infrequent, overcrowded and unreliable minibus taxis. The roads, poor at the best of times, are often impassable during the rainy season.

Stranded van in Sierra Leone

Aminata's mother spends the day washing clothes, pounding cassava, gathering firewood and fishing in the streams nearby. The children help her, carrying bundles of sticks and containers of water back to the village. There is a school in the next village but Aminata's parents cannot afford to send any of their children there. At the age of ten Aminata was circumcised in a ritual undergone by 90% of young girls in the country; they will not be accepted for marriage without it. She was married at the age of fourteen to an older man in the village and has just delivered her first child, who was stillborn. The labour took place in her parents' hut, and Aminata was attended by a birth attendant who had no formal training but who collects a fee when the baby is delivered. After three days in labour there was no progress due to lack of space in Aminata's narrow pelvis, and the family could not afford to send their daughter to the hospital in the town. Eventually the dead baby was delivered, leaving a trail of destruction in its wake - the prolonged pressure in on Aminata's tissues had destroyed her bladder wall and she now experiences a continuous leak of urine: she has a vesico-vaginal fistula (VVF). Women may also suffer constant leakage of bowel contents due to damage to the rectal wall.

Aminata's husband left her after the delivery and she is again dependent on her parents, with no prospect of marrying again or of having any more children, the only hope for economic security in these remote villages. She will be unlikely to find work outside the village as her condition makes her smell. She will spend her life in hard manual labour and will die probably by the age of fifty. This scenario is repeated in countless women's lives across Africa due to early marriage, a lack of maternity care, poor transport networks and poverty. In 2006 in Sierra Leone the maternal mortality rate is high (Aminata was lucky to survive) and 20% of children die before they reach the age of five.

VVF is virtually unknown in the developed world and few surgeons are trained to deal with the problem; the last fistula hospital in the USA closed in 1930. However there is now hope in Africa for women like Aminata. The first African fistula hospital was set up 40 years ago in Addis Ababa, Ethiopia by two Australian gynaecologists and has trained many surgeons to repair fistulas, including two Americans working with Mercy Ships in Freetown, Sierra Leone.

Mercyship the africa mercy The Africa Mercy

Mercy Ships is a Christian organisation which operates a hospital ship, the Africa Mercy, which has just replaced the ageing Anastasis and has taken over the work in West Africa. On board many different types of life-changing surgery are performed including maxillo-facial, plastics, eye surgery and VVF surgery, and this ministry has been expanded to include the Aberdeen Clinic and Fistula Centre, a purpose-built hospital in a suburb of Freetown. So far the clinic has operated on more than 1,000 fistula patients. The women come from all over the country and are found by extensive advertising campaigns, which involve a Mercy Ships nurse visiting far-flung hospitals and clinics by 4WD vehicle and asking medical officers to inform villagers by word of mouth that a screening team will be in their area on a particular day to see women with a fistula. On the last such screening trip, the team identified 24 new patients, all of whom will be brought to Freetown at a future date for surgery.

Barry and I visited the Fistula Centre for a month in January 2006, following contact I had made with one of the surgeons when I worked on the Anastasis in Benin last year.

Doctors at the fistula clinic

An Ethiopian surgeon from the Addis Ababa hospital was visiting during January to attempt some particularly difficult cases and I was asked to provide anaesthetic expertise for these cases. Normally three local anaesthetic nurses do spinal anaesthetics for the operations, but the difficult cases required a combined spinal-epidural technique which lasted longer, as some cases took over four hours. I also did some teaching for the anaesthetic and ward nurses, as well as sorting out a few equipment problems. Barry provided computer support for the doctors and administrators at the clinic, improving the Internet connection and helping with software problems. Before we left for Africa we organised a fund-raising concert with ten musical anaesthetists from Fife and Edinburgh taking part. Overall £3000 was raised which will pay for a new operating light badly needed for the second operating table (two operations take place simultaneously when both surgeons are available). Ultimately the centre hopes to be obsolete in terms of fistula surgery and may then diversify into other types of healthcare. Work is underway by the government to improve maternity services in the country but until this happens eradication of VVF is a far-off dream.

Aminata was fortunate; she heard about the Mercy Ships clinic, travelled to Freetown and underwent a two hour operation to repair the hole in her bladder. After a two week stay at the clinic, she was no longer leaking urine and was able to return home with a somewhat brighter future ahead.

New dress ceremony

At the end of her stay she was given a new dress and there was a joyous celebration, with all patients and staff singing and dancing around the clinic. Unfortunately not all of the women can be cured; sometimes the damage is too severe and only major reconstructive surgery, impossible in Sierra Leone, could suffice. Around 20% of the complex cases treated when we were there were unsuccessful. Those women did leave the clinic knowing that they are loved and valued, having been told of the love of Jesus.

Any visit to Africa leaves a lasting impression. Aminata's is a different world, with conditions similar to those that existed in this country two hundred years ago. I am thankful that I have grown up in a society where I can be educated, contribute to society through my work and enjoy a comfortable lifestyle. However, what we are given ultimately belongs to God; the challenge is to live in such a way as to honour him and share his concern for those less fortunate than ourselves, being wise stewards of our abilities, money, possessions and influence. Poverty has no easy solutions: economic investment, political will and popular demand are all required before there can be improvement in conditions in the developing world. However, poverty is not something that we can ignore. God has a profound concern for the poor and throughout the Bible God's people are called to action.

"This is how we know what love is: Jesus Christ laid down his life for us. And we ought to lay down our lives for our brothers. If anyone has material possessions and sees his brother in need but has no pity on him, how can the love of God be in him? Dear children, let us not love with words or tongue but with actions and in truth."
1 John 3: 16-18

During the recent outreach in Ghana, the Mercy Ship team provided...

- 39 general, reconstructive and gynecological surgeries
- 1,364 eye surgeries
- 10,211 dental procedures
- a maternity ward at a local women's clinic
- a youth health center in the region's largest slum
- six additional classrooms for a Christian school
- 24 new water wells in outlying villages

Similar statistics are repeated on every Outreach they do in Africa, and with The Africa Mercy, launched in March 2007, they will have access to six operating theaters on board which will allow them to perform more operations.

Barry and Marcia McDougall