The fistula program forms the foundation on which IOWD was built and anchors all other programs. The teams are comprised of female pelvic reconstruction surgeons, colorectal surgeons and urologists, all of whom possess specialized training in urogenital and rectovaginal fistula evaluation and repair. We work collaboratively with Rwandan health care providers to assess women with symptoms that are characteristic of pelvic floor disorders at Kibagabaga District Hospital. Our surgeons provide advanced surgical repair to women who are deemed to be appropriate surgical candidates. They are assisted by an integrated team consisting of Rwandan health care providers, plus the IOWD nursing and anesthesia teams. Surgery involves both abdominal and vaginal approaches, depending on the nature of injury and the needed repair. We incorporate current best practices and safe surgery principles in our surgical program. Postoperative care is a crucial component of our program and is provided for the duration of the mission by the integrated Rwandan-IOWD surgical team and then taken over by our Rwandan counterparts once the visiting specialists leave the country. Visiting specialists remain available for consultation year round. Educating Rwandan health care providers in the evaluation and treatment of women suffering from urogenital and rectovaginal fistula is central to the fistula team’s mission. Teaching is accomplished through formal didactic lectures carried out during dedicated protected time and informally within the clinics, operating rooms and postoperative wards. Unfortunately, not all patients are deemed candidates for surgery due to a variety of factors. For these patients, we provide waterproof undergarments to help patients maintain hygiene and a semblance of modesty and dignity.