Vesico-Vaginal Fistula

Documentary, Mercy Ships, Photojournalism

VVF (vesico-vaginal fistula) is a problem common in countries where there is a lack of obstetric care. It occurs when a woman is in labour for long periods of time without going to a hospital. The pressure of the baby causes a hole (fistula) to form between the bladder and the vagina. The result is an uncontrolled flow of urine. They are often dubbed ‘the modern-day leper’. Though I object partially to this statement, as I’m still very much trying to continue to document the very much ongoing problem of leprosy in the world, there’s no denying that these women are very much pushed out of society because of their smell.

This month from the start of June to the end, we have two VVF surgeons on board, and with no maxillofacial surgeons, almost all the patients are VVF ladies. This was taken a few weeks ago in the VVF screening tent on the dock next to the ship. The ladies in white are ones that are going through to the hospital to have a final screening, to see if they are definitely eligible for surgery. Unfortunately, the Mercy Ships are limited by the amount of surgeries that the surgeons can perform in a day, and some patients are beyond repair, and others given priority. It is a sad fact of the field service that we cannot help everyone.

VVF patients wait at the hospitality centre to be called forward for surgery.

This VVF lady gingerly approaches the second screening room, almost certainly fearful that she may be denied the surgery she urgently requires.

However, a huge amount that come through do get surgery and almost all the operations are successful. It culminates in a large dress ceremony, where a few days after surgery the patients receive confirmation from the doctor that they are ‘dry’ and no longer leek any more. They dress up and put on make-up and perfume.

VVF ladies in the waiting room before the ceremony that marks the end of in some cases many year of torment and rejection.

Like I mentioned before, African celebrations are similar everywhere – singing, dancing and praising are a given.

This is Cicile Ahamogbe, one of the VVF ladies that Claire has been following. Aged 44, she has been leaking for a year and a half. It started when she was in labour for three days with her daughter before finally receiving a caesarean section. Her daughter Destino is lucky to be alive.

Cicile stands up to say how the operation has changed her life. During the day she is constantly going to the toilet, but come the night time it becomes a problem. “I would wake up in the night with the children sleeping in my bed, and we would all be wet. The blanket, my clothes, their clothes: everything.”

Given her condition, it had become very difficult for Cicile to provide for her children. Sometimes her husband sends money, but for the most part Cicile had little to no money to feed or clothe her kids. The urine problem kept her in her house away from people.

Before coming to Mercy Ships she knew no one in her village that had the same problem as she did. Once she arrived to the ship, however, she met several women like her. She will return home to Kpalime with a support system that will be invaluable.

This woman is too overcome with emotions to say anything, and having stood up, can only utter a thank you to the doctors and nurses through her tears before sitting down.

When the ceremony is over, the ladies go to get a group photo with (in this case) Dr. Arrowsmith, the VVF surgeon that operated on them.

Not that I like ending on a sombre note, but once again recalling that these are modern-day lepers, I can’t help but notice that the analogy doesn’t go all the way. Where these ladies will no longer be judged and people will realise that there is no longer anything with them, those in the world with leprosy will never be able to regain lost feeling in their nerves or grow back lost digits, limbs or noses. It has made me even more determined to continue documenting this disease. If you think you can help in any way, financially or through contacts with those that work with leprosy I’d really love to hear from you


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