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As a urologist in practice for 20 years in Lewiston, I have had a significant interest in treating conditions that cause incontinence. In the United States, most incontinence is related to the aging process, and can be successfully treated in nearly all cases.
Earlier this year, I went to a medical meeting where I learned of the West Africa Fistula Foundation clinic in Africa, under the direction of Dr. Darius Maggi, a retired ob-gyn from Texas.
The foundation called for volunteers to help in treating one of the most tragic causes for incontinence, called vesico-vaginal fistula, which results when a connection develops between the bladder and the birth canal.
I decided to visit the clinic in Bo, Sierra Leone, and help out for the month of June.
Sierra Leone is the second poorest country in the world, with one the highest childhood mortality rates and lowest life-expectancy. Childhood deaths happen in childbirth, by infections (particularly typhoid and malaria), and by injuries. Sierra Leone lacks a health care system in any sense of the word. Despite the crushing poverty, patients were happy and overwhelmingly grateful for our medical care.
In Bo, VVF cases were common, and were all caused by prolonged, obstructed birth, something that has been effectively prevented in America once proper C-section was developed in the 1850s.
Bo is a city of 175,000 in a province of 850,000 people, where there are very few doctors, and no C-sections. The typical VVF patient is a young woman of age 19 having her first baby. All cases result with the baby stillborn after suffering labor that may last up to two weeks.
http://www.sunjournal.com/news/columns-analysis/2011/10/30/medical-mission-sierra-leone/1104702
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