Dr. Christopher Payne Visits Niger

(written as Dr. Payne)

I have just returned from a two week trip to Niger for the Danja Fistula Center; this is the primary project of the Worldwide Fistula Fund. I am the Vice-President of the Board of Directors of WFF. Danja is about 400 miles east of the capital, Niamey. The trip was harder than usual this year as the nearby airport in Maradi was closed for renovation. We had to land about 1½ hours away on a rural landing strip in Tohla. It was great to finally make it to DFC; the Guest House is simple but clean and nice. Our surgeon, Dr. Itengre, had patients ready to be evaluated and we got right to work. He is already an accomplished fistula surgeon (the only FIGO certified surgeon in the country). Our purpose was to focus on the problem of residual urinary incontinence after “successful” fistula repair and on treatment of pelvic organ prolapse. We also had discussions on starting to perform some of the complex reconstructive procedures for women whose injuries are too severe to repair. These techniques are well established in the West but have not been employed frequently in Africa for a variety of reasons—lack of resources for perioperative care, complex needs for long-term postoperative follow-up, and difficulties in proper informed consent. There is a great need but it will take considerable planning to bring these new treatments to DFC.

Arrival in Tohla

DFC Guest House

Operating with Dr. Itengre

I am proud of the high quality of patient care at DFC. The staff treats the patients with kindness and respect; I have worked in places in Africa where this is not the case. The director has doubled the budget for patient food in the past year; many patients arrive malnourished and I believe this could improve surgical outcomes. The patient ward is always kept clean. The operating area is better than any of the African public university centers in which I’ve worked. But the primary asset is “the Village”, an area adjacent to DFC with simple shelters for the patients to stay in when they are being prepared for surgery or where they can stay when they are well enough to be discharged after surgery. It is very helpful to have a place for patients who require prolonged follow-up. While many of the patients are anxious to return to husbands, friends and family, others require assistance in “reintegration”. DFC has a program to teach such patients skills that they can use to support themselves after discharge—literacy skills, agriculture, sewing/knitting, jewelry making. Although the housing structures are totally Spartan the women are fed, they have toilets and showers, and most importantly, a sense of community. It was clear that they enjoy being there. During our tour one patient was asked if she was comfortable said “yes, I am happy to be with my sisters”.

Central area of the Village

One of the living quarters

Water for the patients

Skills training area for sewing

Before dinner gathering

Pregnant women waiting care

Me with Dr. Itengre at departure

So, all in all it was an excellent trip. We have negotiated a minefield of problems and are looking forward to greater success in 2016. As one of our Board members reminded us at the meeting,

"There is always room for improvement, you know—it’s the biggest room in the house.” - Helen Heath Leber

I would also like to take a moment to mention the June trip we took to Ethiopia. WFF has been working with Dr. Lewis Wall and colleagues at Washington University in St. Louis to start a new residency program in Mekelle in the Tigray region of northern Ethiopia. The leader of the Mekelle GYN program has been discussing starting a Urogynecology training program together with two major centers in Addis Ababa. I was invited to join a group of experts from the US, Europe and Africa for a week in Mekelle where we gave an introductory symposium on Urogynecology. However, the greatest value in the week was not the lectures or demonstrations but simply the opportunity for these three great Ethiopian surgeons to be together and talk with colleagues who had directed training programs. The most valuable faculty member was Dr. Lassey who has recently started the first Urogynecology training program in Ghana. Another highlight of the week was visiting the factory of Dignity Period (http://dignityperiod.org/) where an Ethiopian woman, educated in the United States, has formed a company that makes washable, discrete menstrual products. There is research showing that inability to attend school during menses causes many girls to drop out. These products are affordable because they can be washed and reused. Some of the large NGOs (Non-government organizations) are buying them in bulk and distributing them for free. I think it is a great success story.

Lecturing in Mekelle

Visiting Dignity Period factory

Course faculty visits Hamlin