Healing the wounds of childbirth

By Myron S. Cohen

Imagine being in labor for several days but the labor is not progressing because the baby isn’t positioned properly.  In the end, not only does your baby die, but the loss of circulation during this long and agonizing struggle creates a hole between the rectum or bladder and the vagina which leaves you chronically incontinent.  Because of this, you are cast out by your family and community.

Dr. Jeff Wilkinson (center) with happy patients and staff

This condition, called obstetric fistula, rarely occurs in the United States and other wealthy nations, and when it does, is quickly and easily repaired.  Sadly, however, it is all-too-common in the developing world.  An estimated 2 million women in Africa live with obstetric fistula.

In Malawi, where UNC has been working since 1989, the maternal and infant mortality rates are very high, largely because there aren’t enough trained birth attendants. Obstetricians are even rarer.  In the district hospital in the capital of Lilongwe, there are more than 13,000 deliveries per year and no trained obstetricians.

That is, until now.

The UNC Department of Obstetrics and Gynecology at UNC is partnering with UNC Project and the Institute for Global Health & Infectious Diseases to expand women’s health research and care in Malawi and has recently recruited Dr. Jeff Wilkinson, an obstetrician who specializes in maternal health in developing countries, to join the faculty.

This woman suffered with a fistula for ten years before coming in for repair. She was sent home completely dry for the first time in a decade.

Earlier this fall, Jeff moved to Lilongwe to help launch several new programs at UNC Project-Malawi, including obstetric fistula repair services and emergency obstetrics.  He is also exploring the formation of a new residency training program in ObGyn.  He will soon be joined by his wife, Dr. Sumera Hayat, a family physician who is also focused on women’s health.

Jeff is passionate about saving women and their babies in Southern Africa.  Before joining the our faculty Jeff lived in Tanzania working as part of the Duke/Kilimanjaro Christian Medical Center women’s health project (His work in this capacity was featured in a 2009 New York Times article).

Jeff’s work in Malawi is supported by UNC, the U.S. Centers for Disease Control and the Freedom From Fistula Foundation.  He has been in Malawi for just about two months, and he’s already transforming the lives of dozens of women.

In short order, Jeff organized a fistula referral clinic and ward. He reports that in the first six weeks,  he saw 33 women in the fistula unit and completed 22 surgeries.  There are now two hospital rooms dedicated to the fistula patients, and they are overflowing. The women are doubled-up in the beds and many more sleep on mattresses on the floor (Renovations are underway to increase the space for fistula patients).  But the women are going home healthy, happy, and with “dry hands,” some for the first time in many years.

We feel extremely fortunate to have Jeff (and soon Sumera) at UNC Project.  They will improve the lives of many women and babies in Malawi.



Each month, Dr. Cohen writes a “Global Health Update” column for the UNC Global Newsletter.  We reprint the item here.

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