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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.

What a privilege to be invited to the IOWD mission. I knew going into it that there would be no way to predict what the experience would be like, but it exceeded my expectations on all levels. From that first greeting in the courtyard, I realized that these missions were having a significant impact. The patients' smiles were the largest, most sincere expression of appreciation that I can fathom. The patients inspired me. I had expected to be moved, but I did not anticipate having volunteers with fluency in the local languages, which allowed a degree of communication that I had not imagined. This enabled us to know the women, not just their medical complaints. The atmosphere of the medical trip allowed everyone to be included, most importantly the local health care providers. It was an absolute privilege to be part of a team delivering such high quality care and one that is respectful. Medically, the exchange of ideas and dialogue regarding patient care was wonderful. There was so much mutual respect. To see the senior physicians collaborate with junior members during the initial examinations and then again in surgery enabled the patients to receive the most appropriate care. I was deeply grateful for senior members of the team and their knowledge because the injuries we saw are complex and hard to imagine let alone correct.

Renee Ward MD
Urogynecologist, USA

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