By Richard A. Nisbett, Donald Lee and Jim Bankston

Each trip to Ganta Mission in rural Liberia, West Africa, is an enriching experience ripe with opportunities to serve in the Wesleyan tradition. On a recent visit, a young woman sat alone on a stark, wooden bench outside the hospital. In the wake of a spirited hymn being sung in morning chapel, she could be seen through the chapel window. She sat erect, in her most expensive lappa, dressed appropriately for an important visit.

Folded in her lap, her hands told the story of a hard life, using a machete to clear the land, planting and harvesting, gathering fire wood and water that she carried on her head for miles each morning. Likely, her parents had considered her "too valuable" to send to the mission school. Like Jesus in John 21, she was the one who came before dawn, to kindle the breakfast fire. She was dignified, strong and resilient, akin to our own pioneer grandmothers.

Silently, in quiet resignation, she sat with pride, eyes focused in resolve on the distance, yet with a steady stream of tears flowing down her cheeks. Patiently, Mary and Herbert Zigbuo, the UM Missionaries at Ganta, will inform the visitor that this young woman, Elizabeth, is afflicted with VVF. She is not unique. It is not uncommon for similar young women to approach foreign visitors requesting help with medical expenses.


VVF or obstetric fistula, is a medical condition that has affected women throughout the ages, but is now virtually non-existent in the developed world where women have access to medical care and cesarean deliveries are routinely performed. This condition afflicts about 2 million women, mostly in Africa and Asia, in areas characterized by poor access to healthcare and lack of trained birth attendants. In rural Africa, the rate is about one-in-three cases of fistula per 1,000 live births. While there are many contributing causes, fistula in rural women is primarily due to prolonged, obstructed labor, particularly in first-time mothers that are very young. In Liberia, the maternal mortality rate is 578 of 100,000 births, or about 34 times the MMR in the United States.

For those young mothers who don't die, labor can drag on for days. Under these conditions, persistent pressure on the birth canal can damage maternal tissues, rendering the woman incontinent. There is no pill or method to stop or prevent this type of incontinence, though, other than a surgical repair which is beyond the means of the average family. As the result of incontinence, the woman is usually abandoned by her family and community, and must survive using her wits on the margins of society.

Simple surgery

Fistula repair is a relatively simple surgery which, in Africa, costs the equivalent of about $150-300. While this may not seem like a great expense to those of us living in developed countries, in the resource-poor country of Liberia the average income per person has been estimated at about $125-200 per year. Obviously, surgical repair is not an option for most rural Liberian women who live a subsistence life-style. We estimate there is a backlog of between 500 to 1,500 fistula victims in the service area of Ganta alone.

Luckily for Elizabeth, The Vanderbilt University School of Medicine's Institute for Global Health (IGH) has made obstetric fistula treatment in impoverished areas such as Liberia a high priority. This summer, IGH is sending surgical and preventive-medicine teams to Ganta led by Vanderbilt faculty member Dr. Andy Norman, a global expert in fistula repair, to perform this life-restoring surgery for approximately 50 victims of VVF.

We ask readers to consider honoring the women in their families - grandmothers, mothers, aunts, wives, sisters, daughters - this spring with a gift of healing by contributing to Dr. Norman's summer mission through our Fistula Fund. This is a way to honor these most cherished of care-givers, healers, teachers in our lives by restoring the dignity and life of a woman, so that she may return to her own community.

All donations are tax-deductible and will be dedicated exclusively to the medical costs associated with fistula surgical repair. Please direct inquiries or make your contribution to: Vanderbilt University "VVF Fund," c/o Friends in Global Health, 2215 Garland Avenue, 319 Light Hall, Nashville, TN 37232 or call 615-322-9374. Thank you for your consideration.

Richard A. Nisbett & Donald Lee serve with the Vanderbilt Institute for Global Health in Nashville, Tenn. The Rev. Dr. Jim Bankston serves the St. Paul's United Methodist Church in Houston, Texas.