Aira Hospital

Aira Hospital has a long tradition of repairing obstetric fistulas dating back some 30 years or more. We used to have a regular flow of fistulas, but the later years it has decreased. Either because there are fewer fistulas around – which I doubt – or rather because there are several so-called women’s or fistula projects run by individual NGOs which collect women with obstetric fistulas and bring them all the way to Addis Abeba for repair bypassing Aira Hospital. Passing the river to fetch water so to say.

That is done for three different reasons:

1)      Lack of awareness

2)      Arrogance

3)      Greed

1) Lack of awareness that repair of obstetric fistulas is done at Aira Hospital. It is widespread and very firm believed that fistula repair can only be done at the famous Fistula Hospital in Addis Abeba

2) Many missionaries and other laymen think they know best and consider the treatment in Addis Abeba superior to everything else. The argument that the women are treated with dignity at the Fistula Hospital is used often. I do not have the slightest doubt about that, but although we do not teach our patients the alphabet or some handicrafts, and although we do not provide the repaired women with a new dress when discharged it doesn’t mean that we do not treat our fistula patients with the same dignity as we treat all our other patients.

3) Many individuals take the opportunity to make money from the different “fistula projects” by shuffling fistula patients long distances by road to Addis Abeba and cash generous daily allowances and mileage for that.

At the same time the Addis Abeba Fistula Hospital which is overburdened with patients tries their best to have fistula repairs done in the countryside at satellite centers.

Look at this map. Fistula patients are collected from places as far as Begi and taken by car all the way to Addis Abeba – 20 hours on the road.

The catholic sisters around Dembi Dollo came to know about our service only lately. Last week they referred 10 fistula patients for repair. 5 of the women were from Lalo Kile, 40 km south of Aira. They had originally been brought to Dembi Dollo to be transported to Addis Abeba later.

They arrived in Aira Wednesday and were all 10 repaired successfully by Friday as we have no waiting list. They will be discharged hopefully no later than after 14 days if no complications show up.

It is our sincere hope that this could be the beginning of the end to the fistula circus in our area.

As you have read in previous blogs, I have the privilege to follow the work of the esteemed fistula surgeon Dr Kees Walldijk here in Nigeria. For an amateur golf player it would be the same as being mentored and learning all the professional skills of Tiger Woods.

Just as organized, meticulous and perfect in his work Dr Kees is neglecting his own comfort and private life. Visiting around 9 hospitals in Nigeria and 3 in the neighboring country Niger he is constantly on the road like a nomad, driving long distances to do surgery in the 12 hospitals he supervise, staying in low budget  - ***(minus three star) hotels without any comfort and eating whatever is available of local food.

In his living area in Katsina there is no electricity, no air-condition or other modern facilities. The only luxury he allows himself is a functioning fridge. When indoor temperature reaches 40° it makes a lot of difference if you can have something cold to drink in between.

Postoperative ward in Kano before starting surgery

After some sessions the ward starts to fill up.

Dr Kees is not the only traveler. One of yesterday’s patients – a young girl – had travelled all the way from Niger where she is living close to the border of Chad!

I am already doing my second week here in Nigeria learning fistula surgery from the esteemed fistula surgeon dr Kees Waaldijk. What I highly appreciate is his straight forward no-nonsense approach with the focus exclusively on making leaking (incontinent) women dry (continent) and his willingness to teach and share his enormous experience.

Very complicated cases are done with a remarkable efficiency and speed, achieved not by rushing but by performing only minimal surgery – only the very necessary steps in a rational way. Every suture is placed accurately and meticulously. Not one unnecessary movement as when the barber is cutting three times in the air and one in the hair.

As a first time visitor to Nigeria I am puzzled that in a country where the oil is flowing free, people often have to line for fuel and that power supply is as erratic as in most other parts of the African continent.

One light source which is always available is the sunlight, and that is what Dr Kees is mostly relaying on. Even when there is gasoil (diesel) and the generator is working he doesn’t bother to lighten the operating theater lamp.

When you are accustomed to more than 40°C the operating theater surroundings makes you freeze – the temperature measures “only” 25°C.

When”googling” on the name Kees Waaldijk two different persons show in the result. One is a lawyer who has devoted his life to fight for gay rights. The other is a surgeon who has devoted his life to cure poor women in Africa suffering from obstetric fistulas. 

There is a cause for everyone.

I am at present visiting the Dr Kees Waaldijk, a highly esteemed fistula surgeon in the northern part of Nigeria to learn more about advanced fistula surgery. For more than 25 years Dr Kees has operated and cured innumerable fistula patients with a minimum of resources and under extremely primitive conditions. His experience is extraordinary and his documentation unsurpassed. He claims to be a “documentation freak” who has registered every surgical procedure in detail from his very first operation performed more than 25 years ago until his last yesterday.  What this surgeon doesn’t know about obstetric fistulas is not worth to know.

After only a few days of observing his daily work in the operating theatre I have already been introduced to a wide variety of fistulas. Complex and very difficult cases which other experienced fistula surgeons would have deemed inoperable or would have struggled with for ours in the operating theater are dealt with efficiently and with a remarkable speed and elegancy.

The key points I have picked up until now are:

1)      Minimal surgery  (minimal additional trauma)

2)      Anatomical /physiological reconstruction

3)      Adaption of the tissues with big  bites of the needle (“the surgeon adapts the tissue – Allah heals”)

4)      Forced fluid intake to maximize urine flow

5)      Early mobilization