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Jewish Journal editor’s note: This is the Jewish Journal's final installment of a four-part series about North Shore (Massachusetts) doctors who volunteer their time and expertise in impoverished regions of the world.

Many diseases that are virtually eradicated in the Western World still ravage poor people in underdeveloped nations.

Women who suffer from prolonged, obstructed labor can develop vesico vaginal fistulas, a painful and embarrassing condition that is virtually unheard of in the United States, but affects one out of every 200 women in the poorest parts of Africa.

According to Dr. Michael Reich, an obstetrician and gynecologist at Salem Hospital, fistulas are holes that develop between the bladder and vagina, and/or the rectum and vagina of pregnant women whose labor does not progress normally.

Most of the women who develop them are young, poor and giving birth in rural areas without trained medical personnel present.

With no access to drugs that might advance their labor, and no doctors available to perform medically necessary Cesarean sections, the girls can remain in limbo for days with a prolonged second stage of labor.

In 95 percent of the cases their babies are born dead, and the women wind up with an unpleasant and chronic condition in which they leak urine or feces.

“It is catastrophic for these women,” Reich said. “They are incontinent and they smell. They are often rejected by their husbands and become social outcasts. And they have no money or resources to fix the problem.”

As a volunteer, Reich makes regular journeys to Africa to help these women. “Much of what I do when I am in Africa is surgically repair fistulas,” he said.

Reich, 57, has made a total of 13 trips to Kenya, Cameroon and Nigeria over the past two decades. On May 24, 2008, the Danvers doctor will depart on what will be his 14th visit to Africa.

There he will work closely with Dr. Jonathan Karshima, a Nigerian gynecologist and friend. Together the two will travel to rural clinics and primarily treat women with fistulas.

In the 1990s, Reich participated in several organized medical missions to Nigeria coordinated by World Health Vision in Pittsburgh. On those trips, he went with a group of doctors with different specialties.

Reich’s interest in Africa began in the1980s when he was employed at Kaiser Permanente in Portland, Oregon.

“The hospital allowed physicians to take regular sabbaticals as long as they were medically-related. In 1987, I went to Kenya and worked for three months with the Kikuyu tribe in a mission-run hospital north of Nairobi,” Reich said.

Reich, who is a member of Temple Beth Shalom in Peabody, Mass., finds it interesting that many hospitals in under-developed nations are run by missionaries.

“Our Christian brothers and sisters open hospitals and schools, and also place a heavy emphasis on devotion to Jesus and Christian teaching,” he said.

The doctor believes that in many Third World countries, politics often gets in the way of providing good healthcare to its citizens.

Although Nigeria is an oil-rich nation, the government is very bureaucratic and establishing birthing centers in rural areas and staffing them with knowledgeable professionals is not a priority.

Instead of traditional birth attendants with little or no medical experience monitoring deliveries in rural areas of Nigeria, Reich would like to see trained professionals who can take appropriate action when medically necessary.

Part of the problem is that many of the local doctors leave Africa to practice elsewhere. But politics also plays a big role.

“This problem affects poor, disenfranchised women who have minimal influence and minimal, if any, financial resources,” Reich said. “Vaginal fistulas which arise from obstructed labor are a marker of poverty, and an indication of a society that can’t provide basic obstetric services to its women. The solution to the problem is to prevent it,” he said.

Unfortunately, he believes that Africa is 20-50 years away from a solution.

Although it’s difficult to get accurate figures, Reich estimates that 100,000-200,000 new fistula cases arise in Africa each year.

In comparison, he said perhaps five women in the U.S., out of an estimated four million who give birth each year, develop fistulas.

“They were more common 150 years ago, but now they are extremely rare because labor in America is carefully monitored,” he said.

The lack of proper OB/GYN care for poor women in Africa is also responsible for a high maternal mortality rate.

According to Reich, one out of every 100 women in the poorest parts of Africa die in childbirth, compared to one in more than 10,000 births here.

“If a woman in labor at Salem Hospital starts bleeding, we can give her medicine and we have a blood bank right down the hall.

The pregnant women in rural Africa don’t have that. In addition, many of them have poor nutrition, are dehydrated and anemic, and have worms or other parasitic infections. Once again, it all comes back to poverty,” he said.

Reich is deeply committed to his medical missions in Africa. “We have to help our brothers and sisters in the poorest parts of the world. It’s a profoundly different setting than my work life is here, but I view it as medicine for my soul,” he said.

Source: JewishJournal.org [2]

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