One of the various, non-religious, definitions of “hope” found in the Oxford English Dictionary is “grounds for believing that something good might happen”. Perhaps the Biblical definition (Hebrews 11:1) is more interesting, “…the assurance of things hoped for, the conviction of things not seen…”. To believe in either (or both) of these demands a certain faith that is, sometimes, lacking; hope itself often seems in short supply.

And indeed, why should it not be? We have ongoing “generational” wars – some of you who read this were not even born when they were begun – with no end in sight; climate change that threatens the future of our world; and of course, the threat of nuclear war, now more present than in decades.

Yes, hope may be in short supply at times; but not always. I’ve just finished 6 weeks in Jahun, Nigeria, where I was deployed with MSF (Médecins sans Frontières, Doctors without Borders) to a maternity hospital. MSF, arguably the most respected medical NGO in the world, goes into places others won’t, providing help where it is needed, to whomever needs it.

The Project is 9 years old – well established – and encompasses a portion of the Nigerian Ministry of Health Hospital in Jahun. Initially organized to surgically repair damage women suffered from traumatic birth or rape, it rapidly became the place women with complicated pregnancies came to give birth. Thus, the project has morphed from one providing only urgent surgical reparative care to one providing, as well, needed peripartum women’s and newborn health care.

This project was desperately needed. The women – ranging in age between 14 and 40 – are profoundly anemic – due to the pregnancy and a diet poor in iron; infested with parasites – due to poverty and lack of clean water and sanitation; suffering from pregnancy-related complications such as pre-eclampsia (hypertension and kidney damage) and eclampsia (those of pre-eclampsia plus seizures). Without the MSF project, these women, and their families, would have little except village healers to rely upon.

The MSF-Jahun Project Staff is an eclectic mix: French – this particular project is run out of the Paris Office of MSF – German, Italian, American, Japanese, Belgian, Iraqi, Liberian, Ivory Coast, and Nigerian, with the local Nigerian staff making up the largest fraction. The international aid workers of our group live and work together in conditions that are a bit better than rustic. All is not perfect, there are sometimes arguments, but the overall tenor is one of friendship and collaboration while working on something bigger than any of us.

This is where I see hope. Each of the international aid workers could be elsewhere, pursuing advanced degrees, advancing their careers in their home countries. But they are not; they are here, side-by-side working to make the lives of these women and children better. They are here, not making pronouncements, simply doing what needs be done for our brothers and sisters who are, in this case, Nigerian. Those needing help could be any of us: Puerto Ricans, Texans, Somalis, Afghans, any of us.

This hospital provides care for birth trauma termed vesiculo-vaginal or colo-vaginal fistulae; these are trauma-induced connections between the urinary bladder or the colon and the vagina. One need only use one’s imagination to think of how terrible this kind of trauma is, and what the consequences might be: the women are shunned, sometimes left completely alone, because of this medical problem. There are some families who refuse to take part in the shunning, who recognize their family member as sick; this is, of course, to be applauded. However they are treated by friends and family, these women’s lives are made worse by this fistula disorder. Surgical repair, while not always successful, may be life-altering. MSF-Jahun Hospital has several expert international surgeons who work with the Nigerian surgical staff to correct these problems. The idea is that the local staff, working and training with the international experts will, over time, be able to perform even the most complex surgery.

The surgery is not enough, of course. The women, presenting here malnourished, parasitized, and often quite anemic – presentation with a hemoglobin of 3 to 4 gm/100 mL blood is not unusual; normal is about 14 to 15 gm/100 mL – so we feed them, provide iron and other vitamins, and treat the parasites. It is only when the women are strong enough to tolerate the surgery that we go ahead. And in the right hands, with the properly-timed surgery, the results are quite good; about 90% of the repairs are successful and the women no longer leak urine or feces.

The good done here, however, is not all surgical. About 1,000 women are admitted monthly, most of whom do not have fistulae. Rather, these are pregnant women nearing delivery who come to us for assistance; delivery at home, in our country often thought of as a good thing, is fraught in Nigeria. So they come, malnourished, anemic and parasitized. We treat these conditions and help with the deliveries and the aftercare. When families decide they want no further pregnancies, tubal ligations are also performed.

If this does not meet the criteria for “hope fulfilled”, I can’t imagine what would. In a place far from their homes, MSF international aid workers and local staff, working in resource constrained and somewhat risky conditions, return these women to their families; return, to these women, their lives.

3 December, 2017
[Donations to support MSF projects throughout the world may be made via the internet at  www.doctorswithoutborders.org/donate]

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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