Fistula Camp - Day Four and Five

Eight patients remained and it was obviously wearing on the entire team. It was probably like when a marathon runner sees the finish line and all you can think about is finishing. The ward round again went well with all the patients doing well without complications and finally dry. I had to laugh at my post-op notes because the attending physicians back home would definitely be upset with their brevity. They looked something like this:

Post-op Day One
Pt doing well
Dry
No concerns
Plan: continue present management

It's not exactly the thorough note I would usually write but when you're seeing 40 patients before operating on 8 more - brevity is your friend.
As I was heading to the operating theatre - the OB/GYN from Kisii reminded me that sometime around hour 10 the previous day I had agreed to talk to "some OB/GYN people" in Kisii about "Women's health in Canada". Since there were only 2 obstetricians in Canada I didn't see this as a huge deal - maybe a cup of tea and a little chat.
I got to the LECTURE THEATRE and 150-200 people started pouring in to hear me talk about "Maternal and Child Health in Canada". Huh...I was not prepared for that. Well what can you do when caught in this situation where you're essentially doing Grand Rounds on a massively huge topic to a huge audience without preparation? Wing it. I talked for a little bit about how we manage labour and our wards and some basic population information that I had researched for an upcoming grand rounds that I am actually PREPARING for and then I took questions. And the questions were extremely intelligent and thoughtful about how we keep our maternal and child mortality rates down and mostly I was embarassed to live in Canada. Not embarrased of my country because I am an extremely proud Canadian but embarrased of the vast wealth of knowledge and resources and free health care that I found myself using the word "luxury" over and over again. I imagined how they cared for their patients as much as I did and they would have so much less to offer them in terms of resources and would watch complication after complication that would be easily fixed with textbook medicine that they just did not possess. There was such an eagerness to learn too I thought of how sparsely some of our rounds are attended in Winnipeg, even by excellent presenters and it further magnified the inequity - even the knowledge sharing wasn't equal. I'm hoping with some of the information that we shared that day we can incorporate educational topics in our Nairobi-Winnipeg partnership. After the meeting was finished and they laid out their additional education plans based on the Millenium Development Goals (if only we did that in Canada) they gave me an extra special thank you. There are lots of different types of clapping in Kenya and it's also well-known for its flower farms so they mimed picking me "flowers from Naivasha" and then gave me a big boisterous clap - it was wonderful.
When I finally got to the operating theatre at around 10am they were on their 2nd case and we were well under way. That day we operated on a seventeen year old girl who had twin stillbirths that would have been the same age as Cian. There was also a 73 year old woman who had been leaking for 40 years with the easiest fistula to repair of the entire group - finally dry after all this time. By the end of the night we had done seven cases with only one remaining for the following day. Then the nursing staff came to the theatre to tell me that our last patient had been crying all day because she was convinced we were going to leave and she wouldn't get her surgery because why would the doctors stay around for just one patient and after all, all she had seen in her life was disappointment. Everyone else on the ward was happy and smiling and she thought that she would be left behind - still plagued with her problem. She broke my heart and the nurses asked me to come talk to her. Dr. Khisa was exhausted but such a softie that he probably would have done her that night but we had time the next morning before we left and it's always better to do surgery when you aren't totally exhausted. Plus I had been pushing him so hard to finish because I missed my boys so terribly.
When I got to the ward she'd obviously been crying but I promised her that we would operate on her "kecho" (tomorrow) and that we would not leave without her getting her operation. She seemed to finally believe this - content to rest before her big day and our final one.
We went back to the guesthouse for supper and with our final two bottles bought by the woman from Human Rights Watch. That day we toasted "To the patients" - to the brave women who survive.
The final patient got her operation the next morning without complication and with a big post-op smile on her face. All the patients in Kisii were dry at the end of the week and doing well. We returned home exhausted but fulfilled by their smiling faces and how they had touched our hearts.