Obstetrics & Gynecology

Eritrean Women's Health Project

What is the Eritrean Women’s Health Project?

Dr. Mary Lake Polan, chair of the Stanford University Department of Obstetrics & Gynecology is the founder of the Eritrean Women's Health Project, a health initiative for fistula repair.

Eritrea has one of the highest maternal mortality rates in the world with approximately 1,000 deaths/100,000 births. A main contributor to this elevated mortality rate is the high incidence of obstructed labor. The rural nature of Eritrea, with poor communication and transportation infrastructure in the outlying areas, results in 80% of deliveries occurring without a physician or trained midwife. As such, many women labor for days, resulting in high maternal and fetal mortality as well as a high incidence of birth trauma such as vesicovaginal fistulas.

In September 2002, four gynecologists from Stanford University School of Medicine, and one gyn-oncologist from Johns Hopkins University, spent two weeks at the Mikane Hiwot Hospital in Asmara operating on 37 women with vesicovaginal and rectovaginal fistulas. We performed a variety of procedures and began to teach the surgeons in Eritrea these surgical techniques to repair large vesicovaginal fistulas. Preliminary outcome data from the project suggests that two-thirds of the women were successfully repaired and remain dry. We plan to return to Eritrea in early 2004 to continue the surgical education of the Eritrean physicians and to operate on more women with fistulas. News articles about the project:

Who are the health care professionals involved?

In September 2002 the team included four gynecologists from the Stanford University School of Medicine Department of Obstetrics and Gynecology: Dr. Mary Lake Polan, MD, PhD, MPH, Eritrean Women's Health Project Leader and Founder and Professor and Chair of the Stanford Department of Obstetrics and Gynecology (pictured in center); Dr. Amreen Husain, MD, Assistant Professor of Stanford Gynecologic Oncology (pictured second from left); Dr. Joelle Osias, MD (pictured third from right); Dr. Carol Glowacki, MD (pictured second from right) and one gyn-oncologist from Johns Hopkins University, Dr. Clifford R. Wheeless Jr.,MD (pictured at far right).

Fistula Repair Surgical Team
2002 Fistula Repair Team

In February of 2004, the team returned to Eritrea to continue their work training the physicians in Eritrea to do fistula repair, this time in the city of Massawa. The team consisted of Dr. Mary Lake Polan, Dr. Amreen Husain, Dr. Bertha Chen and Dr. Chad Hamilton from the Stanford University Department of Obstetrics and Gynecology and Dr. Mark Morgan, a gynecologic oncologist from the University of Pennsylvania Medical Center. Assistance was provided by Maureen Snider, R.N. and Lindsay McGuire. The team operated on approximately 60 patients and is already anticipating returning to perform more surgeries in the future. Documentary filmmakers Melba Williams and Carla Gutierrez filmed patients and the medical team for their upcoming film about this humanitarian effort.

Exam Room Team Exam room team, including Lindsay McGuire and surgeon Dr. Amreen Husain.
Film makers Melba Williams and Carla R. Documenary filmmakers Melba Williams and Carla Gutierrez.
Dr. Chad Hamilton and Dr. Mark Morgan
Dr. Chad Hamilton and Dr. Mark Morgan in the operating room.
Dr. Mary Lake Polan and administrators Dr. Mary Lake Polan and administrators opening day of the Eritrea School of Medicine in February 2004.

Waitng Area
Families at Massawa Clinical Hospital Waiting Area

Dr. Chad Hamilton and Dr. Bertha Chen Dr. Chad Hamilton and Dr. Bertha Chen

Dr. Bertha Chen on Eco-friendly vehicle

Maureen Snider R.N. and friends

What is a fistula and how is it repaired?

Vesicovaginal fistulas form a large opening between the bladder and vagina, resulting in constant leakage of urine. It is caused by prolonged, obstructed labor while a woman is giving birth without the easy availability of cesarean section. It is estimated to occur at a rate of 350 fistulas/100,000 deliveries in the developing world. The occurrence of fistulas with leakage of urine and occasionally stool from rectovaginal fistulas is a major medical and social problem for women, resulting in divorce, ostracism from the family, and poverty. For more information check out the National Library of Medicine's Medline site. Many fistulas can be repaired surgically.

How is this Project Funded?

Funding for this project comes from donations by individuals and private funding agencies. The physicians and nurses donate their time; funding is utilized for airfare, freight and transportation charges for donated surgical equipment, antibiotics, sutures, and catheters.

To find out about making a donation to the project, send an email to: Dr. Mary Lake Polan, Project Leader and Chair of the Stanford University Department of Obstetrics and Gynecology.


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