© St. Louis Post-DispatchUS Ambassador Bisa Williams (a St. Louis native) cutting the ribbon at the opening ceremony of the Danja Fistula Center, Danja, Niger, February 11, 2012.
And like so many whose bodies aren't ready, the 12- or 13-year-old girl had a terrifying and painful labor that lasted for days. The trauma left her with a stillborn baby and damaged tissue between her bladder and vagina. She constantly leaked urine. She smelled foul.
The girl's husband and family rejected her. She was forced to live alone, feeling cursed, begging for food on the edge of her village.
The damage the girl suffered - an obstetric fistula - can also occur between the rectum and vagina, leaving victims unable to hold their wastes. The injury can be easily fixed. In the United States, fistulas are almost nonexistent because of access to C-sections.
But in parts of Africa, a fistula means a heartbreaking life of isolation and shame.
"Many women who have these injuries are little more than girls themselves," said Wall, professor of obstetrics and gynecology at Washington University School of Medicine. "And when they get these injuries, their lives are basically over."
It is estimated that more than 3 million of the most impoverished women in the world needlessly suffer in fear because of obstetric fistulas. And thousands of new cases occur each year.
Wall's goal is to help every single one.
© Erik M. LunsfordDr. L. Lewis Wall, Professor of Obstetrics and Gynecology at the Washington University School of Medicine, talks to Dr. Morgan Wolfe, a first year resident, on Monday, Aug. 19, 2013, at the Barnes-Jewish Hospital Center for Outpatient Health in St. Louis.
Last year, that dream finally became a reality with the opening of the Danja Fistula Center, a 42-bed hospital that has already restored dignity and hope to more than 300 girls and women.
But Wall isn't stopping there.
Fistulas, he said, are a symptom of a pervasive human rights violation that shakes him: the oppression of girls and women.
"They are victims in a very real sense, because of their biology and their social environment where they live. And in my mind, that's not right," Wall says. "It's a social justice issue on top of a medical issue that makes the medical issue so much worse."
The greatest health disparities between rich and poor countries, he said, are in the areas that affect women. The gaps are in maternal death, childbirth injuries and infant mortality.
ROAD TO M.D.
© St. Louis Post-DispatchDr. Lewis Wall and his wife, Helen, at the opening of the Danja Fistula Center in Niger, February 11, 2012.
Wall became an anthropologist instead.
He grew up in the Kansas City suburbs and graduated from the University of Kansas. He then earned a doctorate in social anthropology as a Rhodes Scholar at Oxford University with dreams of studying ancient Egyptians.
But Wall grew bored with academic quarrels over Amazonian myths. His interests wandered into how different societies and cultures can affect health. He traveled alone to northern Nigeria on a Fulbright Scholarship to study how the area's Hausa population views sickness and injury. For two years, he lived in a mud hut with no electricity or running water, sleeping on a bed of corn stalks.
"I realized these people really needed a doctor more than they needed an anthropologist," Wall said.
Despite all their problems, the villagers were welcoming. "I'm still astonished to this day, how they opened their home and community to this white guy from somewhere they had never heard of," he said. "I ended up with far more respect for the villagers that live there than some colleagues I've worked with over the years, because of their honesty, integrity, compassion and openness."
He returned to the United States and completed his doctoral dissertation in anthropology. And at the age of 27, he enrolled in medical school. After the rotations in different specialties, he discovered he wanted to be an obstetrician, just like his father. "To my horror," he joked.
The plight of the Hausa people never left him, he said. "That experience was not to far beneath the surface, even going through medical school."
COMBINING INTERESTS
© Worldwide Fistula FundDanja Fistula Center in Danja, Niger, looking at the entrance to the inpatient ward.
He found it with Dr. Thomas Elkins, then the head of obstetrics at Louisiana State University, who recruited Wall to work at the university. Elkins traveled often to Ghana to provide fistula repair surgeries and train doctors. Wall went along in 1994.
Wall recalls caring for a woman, 67, who had suffered a fistula during her third pregnancy at the age of 32. The fistula was so small it took just 20 minutes to repair. "She had been in misery for 35 years because of something that could be fixed with a tiny operation," he said. "It makes you weep."
In 1995, he founded what became known as the Worldwide Fistula Fund. His goal: Build a fistula hospital to help the Hausa women in northern Nigeria and southern Niger.
Niger is one of the poorest countries in the world. About 85 percent of women there can't read or write. Most give birth at home without a trained health provider. One in seven women will die from childbirth. Tens of thousands suffer with fistulas.
Wall needed to raise at least $1 million. For several years, he gave talks at churches and held small fundraisers. He set up a website to take on-line donations, most of which came from family and friends. In 2002, he joined the Washington University faculty and continued to make trips to West Africa to provide fistula surgeries and train African doctors.
"While the faculty and staff at Washington University know Dr. Wall from hospital rounds or from lecture halls, I know him from cramped bush taxis and smelly hospital wards in some of the world's poorest places," American urologist Steven Arrowsmith, also active in fistula repair initiatives, told a Washington University publication in 2006.
© Erik M. LunsfordDr. L. Lewis Wall, Professor of Obstetrics and Gynecology at the Washington University School of Medicine (right) walks to an exam room with Dr. Morgan Wolfe, a first year resident, on Monday, Aug. 19, 2013, at the Barnes-Jewish Hospital Center for Outpatient Health in St. Louis.
A turning point came in 2009, when Pulitzer Prize-winning journalist and New York Times columnist Nicholas Kristof wrote about Wall's fundraising effort. Niger officials had just approved Wall's plan to build the hospital on land donated by a Christian missionary organization. Kristof described those suffering from fistulas as "the most stigmatized, suffering people on the planet."
Donations poured in - ranging from $125,000 by rock star Dave Matthews, to $80 collected after a potluck. Other major donations came from Merrill Lynch and the Trio Foundation of St. Louis. To date, the fund has raised about $3 million.
"We raised half a million dollars within two to three months, and we were buried in letters and emails," Wall said. "It gave us the critical mass to get things up and running."
MOVING FORWARD
© Erik M. Lunsford
The little hospital will care for as many as 1,000 women a year. Next door is a hostel, where 24 women can live and receive services to help them after they leave. The hospital also serves as a research and training facility, where nearly 30 surgeons are expected to be trained in fistula repair by 2017.
Wall knows it will be a challenge to continue his campaign and keep the hospital and hostel running. But he wants to build more hospitals. Train more surgeons. Educate communities on how to prevent fistulas. And do more to help patients re-integrate into society.
In January, Wall will travel to Ethiopia for seven months to help develop a new residency program in obstetrics at Mekelle University. He hopes to develop a partnership whereby Washington University medical fellows, residents and students can travel to Mekelle to teach and help with patient care.
"Ending fistulas requires developing the medical infrastructure to the point where every women gets obstetric care, and every emergency is treated in a timely fashion," Wall said.
It's a tall order. It requires things such as good roads, better telecommunication, adequate health providers, well-supplied hospitals and transportation.
Most importantly, it requires a change in the culture, Wall said. "You have to value women."
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