Healing Across Borders

Mark Morgan stands above Dekemhare, a town in Eritrea where he performs surgeries.

In a faraway land much different from his own, Mark Morgan, MD, FACOG, FACS, finds his place in a foreign operating room. Morgan becomes acquainted with a new hospital with the luxuries of running water and updated equipment. This is a definite improvement from years past, where plumbing and essential instruments were limited, if available at all.

Chief of gynecologic oncology at Fox Chase Cancer Center, Morgan is not preparing to operate on a cancer patient but on a young woman from a small African country who suffers from a condition seldom discussed in U.S. medical circles— obstetric fistula.

An obstetric fistula is a hole in the birth canal between the vagina and the bladder and/or rectum. It commonly results from obstructed labor, when the baby's head presses against the mother's pelvis, cutting off the blood supply to the area and killing the surrounding tissue. The fistula then causes women to leak urine and/or stool uncontrollably.

Fistulas normally occur when women undergo difficult, prolonged deliveries without medical attention. The babies are usually stillborn.

The women of Eritrea, a country bordering Sudan, Ethiopia and the Red Sea on the Horn of Africa, may not know the medical name for their condition, but they know it has cost them a child, their husbands and a normal place within the community. Women with fistula often are ostracized because of the humiliating side effects.

As part of a project begun at Stanford University in California, Morgan visits Eritrea at least twice a year to perform surgeries to repair obstetric fistula. Public service announcements alert women and the surgeries take place at a hospital approximately 30 miles outside the capital, Asmara.

Women often need to travel long distances across mountainous terrain to reach the hospital. Many make the journey with the hope of being cured so they may have more children.

Dedicated to making that happen, Morgan and his team, including another experienced surgeon or uro-gynecologist and residents or fellows, perform surgeries for eight to 10 days.

The doctors rely on translators to communicate with the women. Individuals with less serious conditions are treated by the local physician—a former nurse anesthetist who has training as a trauma surgeon and obstetrician/gynecologist.

"He does not rest," Morgan says. "He lives close to the hospital so he can check on the women at any time.

"The staff is so dedicated. It is amazing to see."

Education is a desperate need in the area, where women, if they are not afflicted with fistula, have a high risk of dying during childbirth. Maternal mortality rates are as high as one in 100.

The Eritrean government hopes to provide education about fistula to women, who often are married and pregnant at a young age. Women will be encouraged to spread what they have learned to friends and family.

Plans also call for a nurse to examine pregnant women in community health centers with the hope of detecting potential problems with childbirth and referring those women to health facilities where Cesarean section is available. This procedure is possible in Eritrea, but as it is customary for women to give birth in the home, it is often not performed in time to prevent complications.

The goal is to limit the amount of women who develop fistula and reduce the maternal mortality rate.

Until then, "I'll continue to do what I can for the Eritrean women for as long as I can," Morgan says.