Leaving Their Mark

In 2005, the U.S. Congress appropriated $70 million for fistula care programs throughout the world, including Africa. Engender Health was one of several partners contracted by USAID to execute this program. Engender Health funds all fistula care and training onboard the Africa Mercy. Two fistula surgeons have undergone training under the guidance and mentorship of Dr. Steve Arrowsmith, a long-time Mercy Ships volunteer and consultant to Engender Health. With more than six years experience working in Africa as a fistula surgeon, Dr. Arrowsmith recently gave up his practice back home in the USA to pursue fistula care full-time. During his time in Africa, he has founded fistula centers in both Nigeria and Ethiopia.

One doctor to be trained under the guidance of Dr. Arrowsmith is Dr. Iloegben Sunday-Adeoye. An experienced surgeon, Dr. Sunday-Adeoye has surgically repaired thousands of obstetric fistulas and directs the South East Fistula Centre in the Ebonyi state of Nigeria. Obstetric fistulas occur as a result of prolonged obstructed labor. This happens when the head of the baby cannot pass safely through the mother's birth canal. Very often, the baby dies, and the mother is left with an abnormal hole between the vagina and the bladder, referred to as Vesico-vaginal fistula (VVF). Chronic incontinence is the primary symptom.

The challenges facing pregnant African women are immense. A culture of male dominance means that women must have their husbands' consent to seek medical attention. Access to hospitals is often limited by long distances, cost, conflict, and even weather. The lack of capable surgeons means that, even if a woman does manage to get to a hospital, the necessary care may not be available. It is estimated that there is a worldwide capacity for only 6,000 fistula surgeries a year. But figures show that more than 130,000 women develop fistulas each year. That is why the training of VVF surgeons in Africa is so important. Mercy Ships, in partnership with Engender Health, is managing to achieve this vital goal. While onboard the Africa Mercy, surgeons perform surgeries, as well as learning to train and educate potential students of their own. They also learn how to address the cultural issues of ignorance and superstition surrounding cesarean sections.

A woman in labour in a first world country has a 1 in 47,000 chance of dying. A woman in West Africa has a 1 in 12 chance of death. The need is in Africa, and therefore the focus is on training African surgeons. With the Mercy Ships/ Engender Health program, African surgeons are given complete preference in the selection process. In the last month onboard the Africa Mercy, the combined efforts of Dr. Arrowsmith, Dr. Sunday-Adeoye, and other VVF trainees have resulted in nearly 50 women being successfully healed of VVF. With the knowledge gained, surgeons like Dr. Sunday-Adeoye can confidently train others to increase the number and success of obstetric fistula surgeries within West Africa.

Mercy Ships surgeon Bruce Steffes removes goiters and repairs hernias, healing the patients physically and showing Christ's love to his patients. Dr. Steffes also shares his surgical skills as CEO of the Pan-African Academy of Christian Surgeons (PAACS). PAACS is a rural-based educational program using African mission hospitals to train national physicians. Founded in 1997, PAACS currently has eight programs that are "training and discipling African surgeons in Africa, for Africa, for a lifetime of service to God and countrymen." From the beginning of April to the end of June, Faya Yaradouno, fourth-year PAACS surgical resident at a hospital in rural Gabon, will be training onboard the Africa Mercy under the mentorship of Dr. Steffes in general surgery. Dr. Yaradouno will also be trained by the Mercy Ships orthopedic, plastic, and maxillo-facial surgeons. Dr. Yaradouno will be using the skills and ethics of surgery that he learns through PAACS and Mercy Ships to serve all types of patients for many years to come.

With over 300 million people in Africa without access to surgical care, PAACS is addressing critical needs at a critical time. "In Africa, being a general surgeon means skin and its contents," Dr. Steffes said. "You are going to be the neurosurgeon. You are going to be the orthopedic surgeon. You are going to be the maxillo-facial surgeon. The more tools we put in their toolkit here on the Mercy Ship, the better off they are going to be." Last year, 57 specialty surgeons from abroad financed their own way to the PAACS training hospitals to work with national surgeons in Kenya, Ethiopia, Gabon, and Cameroon. Generally, there is only one surgeon for every 250,000 people in Africa - and in some places, the ratio is much more dramatic. The shortage is compounded by the fact that many African physicians move to Europe or North America.

Surgery is a difficult career path. Often, students choose the better-paid specialization in infectious disease or jobs with non-governmental organizations. Working conditions for surgery are very poor, with sub-standard equipment and unreliable electricity and water. The increased risk of HIV exposure and the prospect of being overworked for a lifetime discourage medical students from pursuing surgery as a career. To overcome these obstacles, PAACS emphasizes discipleship - the idea of service to God and the people of Africa - so surgeons will remain in rural areas. In addition, Dr. Steffes hopes PAACS programs will help build a network of ethical, honest surgeons across Africa. PAACS partners with Loma Linda University in California and the Christian Medical and Dental Associations (CMDA). They have future plans for Zimbabwe, Egypt, Niger, Angola, and Togo. Currently, their most pressing need is to begin training board-certified surgeons to serve in those areas as Program Directors.