Duke medical students Supriya Rao, left, and Rashmi Kudesia, right, with patients.

by Marty Fisher

Thanks to funding from Duke’s Hubert-Yeargan Center for Global Health and the Department of Obstetrics and Gynecology, Rashmi Kudesia, MSIII, and Supriya Rao, MSIII, were able to join Jeff Wilkinson, MD, on a recent trip to Niamey, Niger.

The third-year medical students took patient histories and assisted with surgery to repair obstetric fistula. They also completed their own project, exploring the patients’ personal histories, particularly the circumstances of their marriage, childbearing, and fistula development.

Despite the grim statistics of their lives in Niger—a lifetime average of six pregnancies and one of the highest rates of maternal mortality in the world—“these women responded with faith-based beliefs, optimism, and wit,” says Kudesia.

Indeed, after interviewing 30 patients, it became evident that, unlike in the USA, where people rely on interpersonal networks for support, the women of Niger rely on their faith and humor to cope with dire circumstances.

“They have no resources, and so their coping is very individualized. They were able to have a real belly laugh about terrible things that had happened to them. It was very powerful.”

“Even among other women in the community, these women can’t find support,” says Kudesia. “They have no resources, and so their coping is very individualized. They were able to have a real belly laugh about terrible things that had happened to them. It was very powerful.”

“There were women who had been pregnant 10 times and had been able to have a viable child, a baby, only twice,” added Rao. “When we asked, ‘Are you hopeful for the future?’ they didn’t really have a concept of that—they live day to day.”

In a culture where childbearing is the primary role of women, most of the women were desperate to have their condition repaired and return to their husbands.

“All I ask is for God to give me health and one child, as children are beautiful,” said one of the patients in her interview. Others seek only relief—to be dry—and plan to return to their families or stay on to work at the National Hospital.

Wilkinson plans to offer a four-week elective experience for Duke medical students, and one of the first to attend in May will be Nora Dennis, MSII, who helped organize the elective as well as two fundraising events for fistula surgery through IOWD.

Dennis and fellow students Marie Eve Laden, MSII, and Sarah Pradka, MSII, organized a benefit concert by Grammy-nominated African kora player Mamadou Diabate. The concert and a Karma Yoga class organized by Dennis raised $4500.