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Fistula Center Opens in Niger, Africa

For Lewis Wall, MD, a Dream Has Come True

For almost 20 years, Lewis Wall, MD, worked doggedly to build a hospital in one of the world’s poorest countries to treat women with a devastating childbirth injury. His dream became reality in February 2012, when a 42-bed hospital opened in Niger, Africa. The facility is dedicated to repairing fistulas, wounds inflicted by prolonged labor, which leave women—and often girls—steadily leaking urine and sometimes feces.

“It was wonderful to be there that day,” says Wall, a Washington University obstetrician and gynecologist at Barnes-Jewish Hospital. “This hospital may seem small by American standards, but it will make a large difference in the lives of so many African women who have suffered needlessly for too long.”

For most of his career, Wall’s passion has been to end the scourge of fistulas in Africa. He first saw the miserable lives of women with this injury when he worked as an anthropologist in West Africa in his mid 20s. Medical care to repair fistulas is widely available in developed countries. But in Africa, many women don’t have access to medical care during childbirth or afterward, should injuries occur.

Lewis Wall, MD (center), addresses the crowd at the grand opening of the Danja Fistula Center in Niger, Africa.

Fistulas occur in women of all ages but are more common among those who marry young and whose narrow pelvis makes them susceptible to childbirth trauma. Many women with a fistula are divorced by their husbands, cast out by their families and must eke out a meager living with no marketable skills. Often, they live humiliating, desolate lives on the edge of their village, with only rags to catch their waste.

“When these girls get a fistula, life is basically over for them,” says Wall, who enrolled in medical school at age 27 because he decided the world needed more doctors than anthropologists. “They become social pariahs. With an inexpensive surgical repair, we are able to give them back their life and dignity. It’s astonishing.”

In 1995, after visiting a large fistula hospital in Ethiopia, Wall envisioned opening a similar hospital in West Africa, where fistulas are prevalent. He founded the nonprofit Worldwide Fistula Fund to raise money to construct hospitals to repair fistulas. The fund has helped support and build a number of fistula centers in Africa. It also has provided money to train local doctors to perform the surgical procedure and to help raise awareness of the problem.

In Africa, girls often marry as young as age 12. Many cannot deliver babies safely because their birth canal is not fully developed. These young women may labor for five or six days only to deliver a stillborn baby. The treatment for obstructed labor is a cesarean section, but this care is not available in many parts of Africa. As a result, women often develop a fistula.

In Niger, among the scattered grasslands on the edge of the Saharan desert, people grow millet and raise sheep, cattle and goats. The majority of people live on less than $1 a day. There are very few personal or private resources for medical clinics or hospitals.

Getting the Danja Fistula Center built in Niger was much harder than Wall anticipated. “I thought I was fairly realistic because I had lived in West Africa for two years,” he says. “But we had to contend with unexpected obstacles—bureaucratic hassles, insects, a lack of communication and supplies, and people who thought their own interests would be threatened.” He also had to raise about $1 million.

Large contributions from the Trio Foundation of St. Louis, South African musician Dave Matthews and an executive at Merrill Lynch helped the Worldwide Fistula Fund reach its goal. The fund also received many small personal donations, including $35 from a potluck hosted by a group of elderly women in New York.

“This was not my individual achievement; it was from the efforts of thousands of people,” Wall says.

An operating room inside the new Danja Fistula Center

Mark Manary, MD, a Washington University pediatrician at Barnes- Jewish Hospital, understands some of the obstacles Wall faced in getting the hospital built. Manary has spent more than 15 years treating malnourished children in Africa. He started a nonprofit organization, Project Peanut Butter, that each year produces between 1,000 to 1,250 tons of a peanut-butter mixture used in Africa to treat children with malnutrition. “Wall’s work removes a huge burden, a permanent scar, from the lives of thousands of African women,” Manary says. “I admire his commitment and persistence.”

Each year, about 1,000 women will have fistula surgery in the hospital, which is affiliated with an existing leprosy hospital run by a Christian missionary organization. Some will travel hundreds of miles in trucks and buses to get there. Aside from repairing fistulas, the hospital will oversee outreach efforts to promote maternal health and reduce childbirth deaths. It also will educate women about microfinance, business and empowerment.

The new hospital is part of a grand vision to eradicate fistulas worldwide by building fistula centers that would serve as focal points for maternity care and public-health outreach in the world’s poorest countries.

“For starters, we hope this hospital will help countless women and alleviate human suffering,” Wall says. “We also hope it will advance women’s rights and gender equality. But for now, I’m just going to enjoy this accomplishment. There still is a lot of work to do.”

To read more about the work being done to help heal women with fistulas, visit the following sites: fistulafoundation.org and worldwidefistulafund.org/.

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