The Continuation of Hope

My last column noted the amazing work performed by Medecins sans Frontieres (MSF, Doctors without Borders), detailing the Jahun, Nigeria Project. The picture was a sweeping one, the 30,000 foot view of that project. You might ask – you should ask – if there are real examples of the work done by MSF there; specifics, not generalities.

I have, for you, just such an example, and just in time for the holidays. Here is a Christmas/Hanukkah/Kwanzaa/Boxing Day true story of hope fulfilled; this is what we do when we are at our best.

A Fistula Patient’s Story

Asabe is an 18 year old woman from the village of Hantsu in Jigawa State, Nigeria. As a complication of female “circumcision”, performed by a traditional healer, Asabe developed a vesiculo-vaginal fistula (VVF) 7 days after birth. This means that the healer accidently cut into Asabe’s bladder when performing the procedure we would term “female genital mutilation”. Thus, from a few days after birth, Asabe had no control of her urine; it drained from her vagina.

At 10 years of age her parents brought her to the MSF hospital in Jahun; she was examined by our surgeon and counselled to return with her first menstrual cycle; she would have to put up with this leak until that time.

When Asabe was 13 years old, the family returned to the MSF hospital. Her first VVF repair was performed that year; a week after the surgery she began to leak urine again. Asabe was discharged 4 weeks after her initial surgery and asked to return in 3 months for repeat surgery. Between 2010 and 2014 she had eight fistula repair procedures, performed by three different surgeons; she continued to leak urine. There is a small percentage of these patients who can never be repaired; it appeared that Asabe was one of these. It couldn’t have been easy for this young girl to deal with the burden of always leaking urine. Indeed, she nearly fell into social neglect as the family grew tired of staying in hospital with her, of dealing with her problem. A significant percentage – not all – of these women are shunned by their families. Was Asabe going to be one of these ?

Our MSF counsellor, Ms. Bilkisu Aliyu, was with Asabe for counselling and reassurance, and in the operating room for each and every surgical procedure.

Despite the challenges this young woman faced, she was was brave, courageous, and always had a smile. From 2014 to 2015, Asabe was lost to follow-up, having gone to the mega-city (population 12 million)  of Kano to live with her grandmother. Ms. Bilkisu kept in touch, providing counselling and support and, in 2015, Asabe returned for surgical review by Doctor Geert Morren, an internationally known fistula surgeon. After his consultation and a ninth surgical procedure, she was dry.

Asabe was discharged in December 2016. She had spent so much time in the MSF facility that she came to know, and fell in love with, one of our Security guards. The two of them married and now have a child, a baby boy named Umar. Notwithstanding the difficulties with her family, Asabe is now reconnected to all of them. She is Ms. Bilkisu’s next-door neighbour in Jahun, a happily married and proud mother.

Asabe’s case is just one of many among the patients we have in the MSF-Jahun VVF Centre.

During the final discharge ceremony interview with the event planner in 2016, Asabe commented as follows (These are her exact words):

“I grew up in urine and had no idea what happens to me. I once lived a difficult life full of challenges as a fistula patient. I am happy to being dry and getting married this day. I wish to be an advocate of girl child education and hope all harmful traditional practices should be stopped!

To MSF, I appreciate everyone for my care, restoring my dignity and putting smiles on my face.

Thank you all.”

Given the present day misery in our country and world, there is much about which we could be despondent. Yet this is a story of the triumph of hope. Asabe’s family didn’t shun her; although her fistula repair was difficult because of the anatomy involved – some fistulae are more complex to repair than are others – it was ultimately repairable. Finally, this story does, or should, remind us that there is beauty even in the most ugly situation, joy even in the midst of horror.

There is hope, my friends ! I wish you a Merry Christmas and/or Happy Holidays.

17 December, 2017

[Donations to MSF can be made on-line at:]

Ms.  Bilkisu Aliyu, MSF-Jahun contributed to this column.

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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