What is VVF? (and other FAQs)

What is VVF?

VVF stands for VesicoVaginal Fistula, a term given to a hole (called a fistula in medical lingo) between the bladder and the vagina.  This hole results in perpetual, uncontrollable leakage of urine.  

VVF is the most destructive and devastating of all obstetric injuries.  Most commonly, it is caused by
prolonged, obstructed labor, meaning the baby’s head is stuck in mom’s pelvis for a prolonged period of time, being shoved against the mother’s pelvic bones with each contraction.  The baby’s head compresses the soft tissues of the mother’s pelvis against her pubic bone which results in a lack of blood flow to the structures being compressed.  This causes the cells to begin to die, and as these tissues die and fall off, a resulting hole (fistula) occurs, allowing urine to flow directly out of the bladder into the vagina.

Frequently this obstruction lasts multiple days and most cases result in the baby dying before it is ever born.  Shockingly, only 7% of VVF patients give birth to a live child.  In some cases the mother, too, will die.

The way to prevent this is to deliver the baby through c-section before tissues begin to die. But when adequate obstetric care is not readily available or accessible to the mother, VVF can occur. This is why most people in Western countries have never even heard of VVF.  Improved obstetric care and the use of c-sections in the late 19^th and early 20^th centuries essentially eliminated obstetric VVF in the United States, since mothers with problems in labor are able to receive appropriate obstetric care easily and quickly.

What is RVF?

Rectovaginal fistula (RVF) is where the tissues between the vagina and rectum are compressed by the baby’s head pushing against the sacrum, resulting in death of these cells.  This results in a hole very similar to VVF, except it involves the rectum so these women constantly leak feces.  RVF may occur on its own, but many are associated with accompanying VVF.  

How many women have obstetric fistulas?

While no exact statistics exist for how many women suffer from fistula caused by obstructed labor, it has been estimated that 2-3.5 million women currently suffer from VVF.  Huge numbers of these women continue to suffer from this heartbreaking, treatable disease because they are too poor to afford surgery to repair it at fee-for-service centers, and are unaware that any centers such as ours exist to offer treatment at no cost to the patient.

Worse still, this number continues to grow!  Each year an estimated 50,000 - 130,000 women develop obstetric fistulas.  Counting all international capabilities to treat VVF, it is estimated that worldwide just 14,000 fistulas can be repaired each year - only a small fraction of the number of new cases annually!  There is an obvious need for treating many more women.

How are fistulas treated?

Most fistulas require surgical treatment, though a small number can be treated with simply prolonged bladder catheterization. 

How successful is the treatment?

The great majority of fistulas can be cured!  Only a small number face problems and destruction so complex and complete that they cannot be fully cured. 

Are there other medical problems that VVF patients also face?

In many cases, nerve damage in the pelvis also occurs, resulting in a partial or complete paralysis of one or both legs.

What happens to VVF women within their communities?

Thankfully, education about VVF and awareness that it is treatable has improved support of this problem by
family and community members.  However in many cases, due to the stench of rotting flesh, constant wetness and stink of urine, perceived lack of value to society, and infertility, these unfortunate women are abandoned or ostracized by their families and friends.  It is not unusual for a man to leave his wife after she develops VVF, or for the woman to become an outcast in her community.  Some arrive at our treatment center owning only the clothes they are wearing, which rapidly deteriorate due to constantly being soaked in urine (a potent ammonia-based compound)

What about the patients who cannot be cured through surgery?

Certain irreparable patients who meet set requirements and undergo extensive testing and counseling are offered a procedure where the ureters (the tubes draining the kidneys into the bladder) are moved and reimplanted into a pouch made in the sigmoid colon, such that urine and feces both come through the rectum and are controlled by the anal sphincter.  Though drastic, this procedure can eliminate their urinary leakage permanently, and renews the freedom of these patients.  Currently, our hospital is one of very few places offer this procedure.  

How much does it cost for a woman with VVF to be cured?

The average VVF surgery costs around $450 (US dollars)

Why are there so many VVFs?

Less than 60% of women in developing countries give birth with any trained professional assisting (doctor or midwife).  When complications arise, as they do in 15-20% of all births anyway, no one is around to help the woman, leading to horrible complications such as fistula, or even death.

The root causes of fistula are poverty and the low status of women. The poorest women are the most likely to have obstetric complications and the least likely to deliver in a hospital.  They also are less capable to receive assistance when problems arise, less likely to get treatment should a fistula develop, and less likely to even know that treatment exists.  Additionally, in many cases men control all finances and consider pregnancy or its complications unworthy of “their” money, and may even view their wives as expendable resources.  Without addressing underlying poverty and the inequalities and abuse of women, the situation will not likely improve.

Can VVF/RVF be caused by anything else?

Yes.  A small number of cases we see are caused by traumatic rape, genital cutting, or “treatments” by traditional healers.   Over the recent years, there has also been a steady increase in surgically induced fistulas, primarily through surgeries performed by untrained or undertrained individuals in outlying areas.

How much does it cost to treat VVF?

If you stayed only one night in a hospital in the US, with no treatments being offered, you may find a bill of about $1500, however the average fistula patient can be cured with only $450. 

For only $450 US dollars, a woman can be seen and evaluated in our clinic plus receive surgery, postoperative care and physical rehabilitation.

What can I do to help?

One way is to donate to the Evangel VVF Center in Jos, Nigeria, where we are currently working. 

By mail: Make a check out to “SIM USA” and put “Project 96209” in the memo line, then send it to: SIM USA, PO BOX 7900, Charlotte, NC 28241

Online: Go to www.sim.org/giveusa and click on Support a Project, then enter our project ID number (96209) and click find.  Click give, and enter the amount in US dollars you wish to contribute, then go to checkout.  The next pages are to enter your contact and secure payment info.

If you can, send us an email letting us know about your donation and we’ll keep an eye out for it! Thank you for changing lives in Nigeria!!

All contributions are tax-deductible within the US.

Confessions of a Bad Missionary

I’ll admit it.  I’m not a great missionary.  

In fact, I might be a bad missionary.

(I don’t want to speak for my wife, who may be among the best missionaries ever, though I suspect she’d laugh at this suggestion)

When I read the stories of awe-inspiring missionaries like Hudson Taylor, William Carey, Jim Elliot, Nate Saint, and even one of the founders of SIM, Rowland Bingham, I am struck by their staunch faith, their authoritative power over the demonic, their consistent lives of evangelism, and their ceaseless intercession for those they were serving.  This is of course not to mention that they also were overcoming huge distances from home and family, disparaging loneliness, no internet or Facebook to stay connected, no electricity or water sources, perpetual threats of life and limb, and the plagues of diseases such as malaria and typhoid before treatments had been discovered.

Okay, so you may say it isn’t a fair comparison to line yourself up against the “greats,” but let me take you back to one night a couple weeks ago…

It was 3:00 in the morning.  I had been lying on the floor of the bathroom for the past hour because it seemed too painful to try to get up and back to bed.  For the prior 24 hours I had been cycling between freezing cold and blazing hot.  Between the two extremes I would just lay still yet my body shook on its own as if having a seizure.  Every bone and muscle in my body felt bruised.  Curled up in the fetal position on my tile floor that night I was hit by a sudden feeling. No, more like a compulsion.  “I just want to go home,” my mind whimpered.  I closed my eyes in defeat.

The next morning I was talking with my beautiful, strong, supportive wife about the prior night and the confession of my unconscious psyche.  “YES!” she shouted, complete with fist pump.  I was dumbfounded, and a little offended.  She continued, “It took you two and a half years, but now you finally said it too!  Look at you!  You’re human!”

I can’t say I was particularly encouraged by her enthusiastic response, but I couldn’t help but laugh.  And once again, my wife was right. (maybe I shouldn’t admit that in writing)

There is a problem in contemporary missions, and it’s twofold.  First, we in the West have created a system that places missionaries into the stratum of Christian superheroes.  Forget pastors being one step below God, we’ve all watched pastors fail publically and fail big.  They must be mere humans.  But missionaries!  Now they are people just short of godly perfection!  Partly that interpretation comes about from the same problem I have in comparing myself to books of missionary heroes.  You can’t compare a partial story, just the best and most interesting parts of their lives and ministries, to your entire story, blemishes and failures and all the unpolished pieces of your life.  And what does the average American Christian hear from missionaries?  It is the story of an entire tribe coming to Christ after seeing the Jesus video, the snapshot of a dirty young boy getting a drink from the new well someone dug in their village and the caption of “173 people heard the Gospel because of this project.”  When monthly or quarterly newsletters come out from missionaries, they rarely highlight an episode of lying on the floor through the night trying not to puke their liver out.

The second part of this misinformation about missionaries is somewhat related.  Western sending churches want Western-style reports that will pump up the investors.  They want to hear good news. They want to hear about lives being changed with specific numbers of how many were converted, but preferably in 200 words or less.  Admittedly, this perceived pressure on missionaries to meet expectations of miraculous results with every newsletter comes partially from the missionaries themselves; afraid that support will stop if reports are not rosy (unfortunately this happens).  But look through books or articles on how to write missionary newsletters and you’ll be hard pressed to find much other than how to encourage your readers and sustain their support.  Want more evidence? Read actual missionary newsletters and you’ll see it yourself.  Even when there is little of excitement to report, missionaries can find ways to word the mundane and elongate the smallest good news to create a paper pep rally for missions.

But I’m going to step out of the shadows for a moment [at the risk of losing supporters].  Being a missionary does not make you a rock star.  In fact, we’ve found that being a missionary is a surefire way to bring hurt, heartache, and challenges.  Becoming a missionary doesn’t make you automatically nearly God-like.  Rather, we see that it regularly (and sometimes painfully) points out failures, shortcomings, and areas of sin lodged in our lives.  Living as a missionary does not mean that as you walk through the market everyday people will fall at your feet in repentance, begging to know the way to salvation.  We find that getting opportunities to fully and powerfully share the Gospel take hard work and a long time – and seeing lives change at these invitations really has nothing to do with us and everything to do with God!

Now let me change directions before you call our sending agency to yank us out of Nigeria.  We are not missionary superstars.  We know that and we accept that. We are weak. We still have a sin nature and issues that God is patiently working out in us.  We get sick.  We are sometimes discouraged and feel like we should just go home.  We sometimes share the Gospel and are met with rejection or apathy.  And not every patient I treat at the hospital lives to go home.

BUT – We serve a God who uses imperfect people to work out his perfect will [consider Jonah or David].  We have a God who prefers we recognize our weakness and limitations so we depend fully on him alone.  We serve a God who hears our prayers for patients in the hospital and has, more times than we can count, worked miracles saving people who by all medical logic should have died.  We have a God who is alive and at work in Nigeria and who, for his own glory, chooses to use us as he changes hearts and lives, drawing many to Himself.

The day following my bathroom meltdown I was thinking back on my response and asked God if that was the true condition of my heart and should I really be packing up.  He said no, and reminded me of one of my favorite verses, 1 Corinthians 12:9 “My grace is sufficient for you, for my power is made perfect in weakness.”

I may never be a Hudson Taylor or a Rowland Bingham, and I may never make it as a Christian superhero.  Only God knows that.  But I thank God that he continues to work in our lives and in the lives of those around us.  I’m no Paul, but even he admitted, “Not that I have already obtained all this, or have already been made perfect, but I press on to take hold of that for which Christ Jesus took hold of me. Brothers, I do not consider myself yet to have taken hold of it. But one thing I do: Forgetting what is ahead, I press on toward the goal to win the prize for which God has called me heavenward in Christ Jesus.” (Philippians 3:12-14)

Knocking at the Door

Earlier this week, a man came knocking at the door of the nurses' office in the VVF ward. Though he is from a tribe that is historically entirely Mslm, and has been a Mslm all his life, he said he wanted to know how to become a Christian.  "I'm not happy with my religion and the things going on inside it," he told the nurse, "I want to know how to be a Christian, and I want to know the Bible." 

This man's daughter is one of our patients in the VVF ward.  She had suffered a significant trauma during her last childbirth that resulted in perpetually leaking urine ever since.  Two weeks ago she underwent surgery to repair her fistula and will likely be in our care for at least another 1.5 weeks. 

Our nurse - a young, compassionate woman, fully committed to following Christ herself - took the time to explain how Jesus died for our sins and how by asking him to take the penalty for our us, he will forgive us and give us eternal life.  Though this nurse is limited in her Hausa, one of our ward attendants is fluent in both English and Hausa, and aided with the translation and in leading this man as he repented of his sins and asked Jesus to save him.  Since that time, he has not left our ward, wanting to know more about this man Jesus and of the Bible.  

Today (Sunday) our attendant took him with her to the hospital's chapel service and to meet the pastor. After the service they arranged a time for him to meet one on one with the pastor tomorrow to talk further.  We plan to help connect him with evangelists and disciplers from his own tribe. 

Though in many instances, persons from Mslm backgrounds can face significant persecution and risk of death if they become Christians, this man says he is pretty sure his fellow villagemen will be okay with his conversion.  This perhaps may be due to a rather rapid spread of the Gospel in the past couple years among people of his tribe around Nigeria. What he wants, however, is to know as much as he can about Jesus and what the Bible teaches so that he can share it with the others back home.  Even though he cannot read in any language, he desperately wants a Bible of his own, and one for each of his children to be reading. 

How cool is that? This man LITERALLY came knocking on our door wanting to know how to become a Christ follower! Praise God for the work he has done in this man's heart and his desire to share his new-found freedom with others! 

Please pray for this man, his evangelistic efforts among his people, and for a reinvigorated desire among our VVF staff to be prepared to share the Gospel at any moment with our patients and their families.  Lives are truly being saved at our hospital, and they aren’t necessarily even the patients!

“Here I am! I stand at the door and knock.  If anyone hears my voice and opens the door, I will come in and eat with him, and he with me.”  (Revelation 3:20)

October Newsletter

Hey guys!
Just in case you are not already getting our newsletters by email, we continue as before to post them on this site under the Newsletters tab. You can find our most recent update here. If you aren't finding it immediately, it should be up and running within the next hour.
Thanks!

Finding Freedom

At first glance, Mercy* looks like a typical 12 year old girl.  She's tall and thin, with long, skinny arms and legs, obviously the product of a recent growth spurt.  She smiles when you look at her, and politely greets you, as any good Nigerian girl would do.

But tucked beneath her clothes, she hides a secret.  Everyday, all day long, feces slowly leaks uncontrollably from her vagina.  She intentionally wears her skirts and dresses a bit baggy, so as to better pad herself and to try to hide the problem. But everyone knows.  You need not get too close before you'd identify the telltale odor emanating from her young body.  In fact, everyone in her village knows that Mercy can't control her feces, a problem that places her outside the communal society in which she lives. Although she has been able to attend school, that doesn't keep her from being the odd one out, never quite able to integrate with her peers. There is no end in sight and no relief; her mother has taken her to clinic after clinic with no one able to help.

In July, Mercy and her mother made the long trip from their village two states away to come to our VVF hospital, hoping against hope that maybe this time someone could help.  After a brief exam we gave them news they've never heard before - that her problem can likely be fixed!  She was scheduled for surgery, which I performed last week.  Under anesthesia I traced the fistula, about the width of a pinky finger and a little over an inch in length, and set to work.  After a 30 minute operation, the fistulous tract and its openings were closed and repaired back to their normal state. 

This morning as I was rounding in the VVF ward, in the background I could hear a small voice quietly singing. I thought nothing of it until I came to the last bed, Mercy's.  It was the joyful song of a tiny voice who had returned to childhood.  "Any problems?" I asked. "No," came the reply.  "Are you leaking?"  The only response was a smile that stretched across the room, acknowledging her new freedom.  Freedom from leaking feces.  Freedom from smelling like an outhouse.  Freedom from always being the outsider.  Freedom to be a little girl again.

Mercy is free now.  I discharged her from the ward and scheduled her for our weekly "Freedom Ceremony" where on clinic days we recognize women (and sometimes girls) who are now free from leaking urine or feces. Her treatment came free too, as a result of external grants funding our care to these suffering females.  But she has paid a price.  She has suffered with a debilitating problem since an age before the limits of her memory.  A problem that led to ostracism and mocking and condemnation from adults and peers alike.  And all of this as a result of being raped while she was only an infant.

Please be praying for Mercy. As she completes her physical healing may God continue His spiritual and emotional healing.  As she returns to her community and school, may she be able to forgive those who wronged her, and through her graceful response, may they come to repentance.  Pray also that her experience will enable her to be a support, encouragement, and champion for women and children suffering as she has, and that through this, she may lead them to the True Healer, Jesus Christ.

"If the Son sets you free, you will be free indeed"  -Mark 8:36

*not her real name

June Update - What's KJ doing now?

Hey guys,
Our latest newsletter is out! In it see what new ministry Kari Jo has been up to - something she never thought she'd ever be doing, let alone in Africa!

You can find the newsletter in this website by clicking here or on the Newsletters tab.

March 2013 Newsletter

Our latest newsletter didn't show up in your email inbox?  Check it out on this blog!

Go to the NEWSLETTERS page to get caught up on all the news from Nigeria. :)

"I think I may have cut a ureter" and other things you don't want to hear at night.

At 4am this morning I received the following phone call:
Resident physician: “Good morning, sir. How are you? This is Dr. X. I’m in the theatre right now and I think I may have cut a ureter.”

[As the ureter is the tube that drains the kidney to the bladder, this is an integral structure to the human body, so I was a bit unhappy to hear this]

After dragging myself out of bed and down to the operating room to help him, his voice was still ringing in my head. “I think I may have cut a ureter.” Something no doctor wants to hear in the middle of the night. This got me thinking about how many times I’ve been awakened at night to strange comments on the phone.

Since by this time I’m now wide awake, I thought I should make some coffee and compile a list of some of these mid-night phone calls to share with you. I don’t know how you’ll respond, but I know I most often have responded with a low groan and an instinctive barrel-roll out of my nice warm bed.

1. You'd better come quick. I don't think your resident knows what he's doing. (Anesthetist, calling from the operating room)
2. ... Her BP is 210/140 and she's unresponsive, but I think she's okay. (Resident)
3. Good morning! I think I may need help. I'm not sure where all this blood is coming from. (Resident)
4. ... I'm not sure what it is, but it's not a head. (Resident, from labor/delivery)
5. Good morning, Dr. Shephard. I probably should have called you sooner, but ... (Resident, currently mid-surgery in the operating room)
6. ... I've never seen anything like this. And I'm pretty sure your resident hasn't either. (Anesthetist)
7. ... She needs surgery, but there's no NEPA [electricity] and there's no fuel for the generator. (Resident)
8. [after a length presentation of a fairly normal laboring patient who needed nothing] ...Also, there's a woman here with a suspected ectopic in shock that probably needs surgery. (Resident)
9. Good morning. I tried calling Dr. Y [attending/consultant on call that night] but he wasn't answering... (Resident)