Tuesday, January 3, 2017



I had the talk with Ropine’s husband a week or so ago.  I told him that I didn’t know if it was going to work this next time.  If there was someone else I could refer her to I would.  I know there is a fistula hospital in the capital, but I don’t know anyone there, and it is likely to only have visiting professionals.  As it is, all of the country hospitals have been on a strike for months now.

Ropine’s husband is such a hard worker.  They come from far away so I have given him day labor jobs to help provide money for them both to be able to stay here.  Ugh….Why am I HELPING people stay here to be a pain in my side???  It’s like I am paying to have my failures stare me right in my face!

I remember the first time I saw her this past April.  I helped her to the floor in the OR consulting area since she was so weak.  I took down her cloth that was wrapped around her bottom and tried not to gasp.  She was covered in feces and urine.  (Hey, not so different than me recently, ha ha.  Seriously it’s all about the bodily fluids here in Chad)!  When the bodily fluids don’t stay where they are supposed to be because of fistulas, then….it’s a bad, bad thing.  She is one of the worst cases I have ever seen.

I knew then and there that it would be very, very difficult to restore her health and control of her bodily fluids.

She was less than a month out from her delivery and unfortunately someone had already operated on her twice in Moundou.  But here she was.  Her vagina was like cement.  Cement with leaking urine and rectal incontinence.  I would later discover with a better exam that she had basically no urethra.  She had a sliver of urethra near the opening, but over 3-4 cm of space with nothing in between the sliver of urethral opening and the bladder.


I decided to do her first surgery in July, since it worked out well with our vacations and needing to wait a while after the initial damage.

July.  Ugh.  The start of my case collections for oral boards.

The start of my case collections…take 2!  (I’m an open book in case you haven’t read the last blog).  Ya, this isn’t really a good one to go on my case list.
Okay, Ropine.  Sorry, you’ll have to come back next year when I’m done with my perfect list.  One without mistakes.  One where the surgery will actually work!

This one.  This one is impossible.

I can do a simple fistula.  I can even do a hard one.  But this one.


I’m a pretty positive person.

But not this.

First surgery in July.  Difficult.  Bilateral huge episiotomies to even see inside.  Found the bladder edges.  Brought it forward to create a new urethra with extra vaginal and labial tissue.  Could this possibly work?

Nah, that was too much to hope for.  Leaked after a while.  Like I said.  Impossible.  

Second surgery in October.  Bilateral episiotomies again to even see inside.  Wow.  Can’t believe a lot of that new urethra tissue actually took!  Fixed some small places that didn’t quite stay together.  Maybe it’s going to take after all???


I send them back home in November and pay for there trip to go.  I’m tired of seeing them around…every day.

They come back.  I have the talk with hubby.  I tell him it’s probably not going to work this time.  If he is willing to be patient with me, I will keep trying.  I tell him it’s impossible.  But with God all things are possible.

This is seriously impossible.  She had basically NO URETHRA!  All of that stuff we’ve done to repair her I’ve just read about in the books!  I am no expert!  There are many other people qualified in the world.  I even just read an article in the Green Journal about fistulas (finally something applicable to me!).  It talks about when to refer them out.  I think this one would definitely qualify as needing a reference!  I just don’t trust anyone else here!

Hubby decides to stay and wants me to keep trying.  (Of course he does!  He has a job—I’m paying him for my misery!)

Wednesday I actually had 2 vesico vaginal fistula repairs (which is odd because I only do about 10-15 per year).  I started with the ‘easy’ one.  Turns out it wasn’t so easy, but it wasn’t that complicated either.  Was so thankful!

Then Dad and I repaired a poor old lady’s foot that had been bitten almost in two by a donkey.  What can I say?  Hazards of Chad!

Next was Ropine.  Uggh….I was dreading her so much!  You know, you almost look forward to the surgery that you ‘know’ is going to work.  Where you can say with almost 100% certainty that it’s going to work God willing.  This was not that type of surgery.  This was more like, do I even dare try again?  I feel like a failure already.  Every day I walk into work I see her husband watering the flowers…Failure.

Today God made the impossible become possible.  The surgery went really well.  She had two small fistulas (½ cm) just under her urethral opening. It’s a very delicate place given that tissue is all grafted from her vagina and labia from before.

Please, please keep Ropine in your prayers.  Pray the recovery to this surgery works and that the tissue heals well and solid.  They are such a sweet couple.  And many other husbands would have left her by now here in Chad.

Update: She’s now postop day 2 and doing well.  Continued prayers coveted.  

Update-ier Update: She leaked again from two tiny holes, which have been closed again now (a big no no to do so soon after the last surgery), but I just couldn’t help myself.  So please keep praying for her.

Update-ierest Update 1/1/17: Well poo.  That lasted 3 days.  She’s leaking urine again.  Will have to wait another 6 weeks from now to do her again.  Do not know why the urine will not just all go out the foley.  The fistulas are so small but leak so much even with the foley!

On the bright side, the other fistula girl done on the same day is doing great and dry.  

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