Queensland gynaecologist Judith Goh was recently appointed an officer of the Order of Australia in the recent Queen’s Birthday Honours list. She talks to DAVID ADAMS about her work with international Christian medical charity Mercy Ships helping some of the estimated two million women who suffer from obstetric fistulas…
Queensland gynaecologist Judith Goh was recently appointed an Officer of the Order of Australia in the recent Queen’s Birthday Honours list in recognition of her service to gynaecological medicine, in particular the field of fistula medicine, and the promotion of the rights of women and children in developing countries. She speaks about her work with international Christian medical charity Mercy Ships in helping some of the estimated two million women who suffer from obstetric fistulas around the world…
First of all, congratulations on being appointed an Officer of the Order of Australia. What does it mean to you?
“Very humbled. I hope it means that more people are aware of the terrible state of women’s health in developing countries. Hopefully by creating awareness, more can be done to assist these women. I also hope that as more people are aware, it will assist in fund-raising for the treatment of women with childbirth injuries.”
Judith Goh with one of her patients. PICTURE: Mercy Ships International/I Joshua Fletcher
“I believe that my skills as a doctor/gynaecologist and surgical skills are gifts from God, and as such I have to be accountable for what I have been given. For me, this means to use them to their potential and to be mindful of what I have been blessed with. From my perspective, this means using my skills to assist women in developing countries.”
– Judith Goh
How long have you been working with groups like Mercy Ships and how did you initially become involved?
“I have been doing volunteer work, in particular fistula surgery, since 1995.
I initially got involved with overseas work when I was a medical student . At some stage during the medical curriculum, there is an elective term that one can do overseas – most choose to go to Europe etcetera. A woman at church (ex-missionary in India) suggested I go to India. In 1985, I spent three months in rural India as a medical student and had a great time and it stimulated me to do my specialty training in obstetrics and gynaecology so that I could go back overseas at some stage as a volunteer.
“Towards the end of my specialty training in obstetrics and gynaecology, there was another opportunity to work overseas. So in 1995, I took the opportunity to go to Ethiopia for six months. I worked several months in rural Ethiopia and then went to the Addis Ababa Hospital and did some training in fistula surgery. That started my career as a fistula surgeon. I was asked to return to the Fistula Hospital in 1997 for six months as there was a staff shortage.
“From then on I have been contacted by various people/groups to assist women with fistulas. I have served on the Mercy Ships – since 2004 and plan to return early 2013.”
What does your work with Mercy Ships typically involve?
“When I go on the Mercy Ship, it (is) in the capacity as a fistula surgeon. I have been on the ship several times and also assisted in the land-based fistula unit in Freetown, Sierra Leone. Post-operatively, the women usually stay on the ward for at least two weeks to recover. This means that the beds fill up really quickly without many discharges to make more space for beds. So my time on the ship is usually for about two weeks. Seeing patients and operating. Depending on the degree of difficulty of the case, about four to five women are operated each day.”
How many countries have you now worked in with them and how often do you go?
“Ethiopia, Tanzania, Bangladesh, Uganda, DR Congo, Sierra Leone, Liberia. I go over a few times a year – usually between two to four times, depending on the need there. I’m going back to Uganda in July, then back on Mercy Ships in January. I usually go over in September also but there are things at home I need to attend to.”
What is the cause of obstetric fistula in women and why is it a problem?
“Obstetric fistula is the most common fistula world wide. It is usually due to prolonged obstructed and neglected labour. The problem is lack or no ready access to emergency obstetric services. In Australia, for example, if a mother is having difficulties in labour, depending on the situation, a caesarean section or an instrumental delivery may be performed without any significant delay. In many areas of developing countries, a mother has no access to these services and on average, a woman with an obstetric fistula would have labored for four days and unfortunately, the baby does not tolerate this prolonged labour and over 90 per cent of babies will be stillborn.
“As the baby’s head is lodged in the maternal pelvis for such a long time, the blood supply to the tissue (vagina, bladder and rectum) between the baby’s head and mother’s bony pelvis is severely compromised. This tissue dies off and and a hole or fistula occurs between the vagina and bladder and/or vagina and rectum. Thus the woman is now totally incontinent…The woman, usually young, is extremely embarrassed by the incontinence and offensive odour. Her family and friends often shun her.”
How widespread is it as a problem and where is it most prevalent? Is it preventable and if so, what measures are being taken in this regard?
“Obstetric fistula occurs anywhere that has a lack of emergency obstetric service, especially in developing countries in Africa and Asia. There are several million women with untreated obstetric fistula. It generally thought that there would be several hundred thousand new cases each year…
“It is prevented by good obstetric care and the availability of services to deliver a baby without delay. We often forget that the first fistula hospital was established less than 200 years ago in New York. As obstetric services improved in the USA, there was no longer a need for a fistula hospital.
“Poverty, lack of education and infrastructure and the subordinate of women in some cultures are common barriers for prevention. Most families in rural developing countries earn only a few dollars a day and this is barely sufficient for food let alone education and health care. The cost of a trip to the hospital plus treatment expenses are usually well beyond the means of the family. The lack of infrastructure such as roads and hospitals compounds the problem. Unfortunately, many women are also unaware that obstetric fistula is preventable.”
How are you able to balance your work life in Australia with your volunteer work overseas?
“I work in Brisbane and the Gold Coast. I am currently in private practice, which means that I can generally take time off as I require. My volunteer work has priority in my practice. When asked to assist and volunteer overseas, I block off those weeks and it is not negotiable. The staff in my practice is aware of this. I believe that if I do not give it my priority, it is quite easy to be distracted.”
How important is your faith in driving your volunteer work?
“I believe that my skills as a doctor/gynaecologist and surgical skills are gifts from God, and as such I have to be accountable for what I have been given. For me, this means to use them to their potential and to be mindful of what I have been blessed with. From my perspective, this means using my skills to assist women in developing countries.
“I really do not believe that God has given me these gifts so that I can just stay at home. Although there are financial and time constraints as a self-funded volunteer, it’s also very rewarding. I learn to appreciate things more at home, even basic things like electricity and water. I have witnessed how these very poor people who have had their lives torn apart from war, death, disease and injuries still praise God and are strong in their faith. I has certainly helped me in my walk with God.”
What can people who are reading this do to help support your work and that of Mercy Ships?
“Please pray for the women I treat. They have gone through a horrific ordeal with a prolonged labour, delivering a stillborn and now incontinent…Many are now outcasts. In many war-torn communities, they have lost loved ones and often mistreated (for example physical injury, rape). Please pray that they will be healed, not just physically, but spiritually and emotionally.
“Pray that more people will volunteer. There is a wide-range of skills required on the Mercy Ships. Pray that financial support will continue. All volunteers are self-funded. However, monies are required as all surgeries on the ship are done without any cost to the patients.”
ABRA’S STORY
Abra quietly remembers the journey of her life. For 24 years, she has known suffering and great emotional pain. One day and one event changed the course of her life for over two decades.
On that day, Abra went into labour. It was her fifth child, and after struggling with the pain and pressure, she was taken to the hospital for a caesarian section. “There was no hope,” Abra remembers sadly. “Even the doctor lost hope.” The baby died, and Abra remained in a coma for five days.
When she awoke, she learned that her husband had decided to leave her. Then, a few days later, she realized she was incontinent, as a result of obstetric fistula. The injury is caused by obstructed labor. Unfortunately, it is a condition that is much too common in developing countries, where women have little access to medical care.
The condition exacts a terrible emotional toll, as well. Abra was ostracised by her family, friends, and community. “Everybody in our area knows about my sickness,” Abra says quietly with downcast eyes. “All of them know.”
Over the years, people often mistreated Abra. They made signs and yelled insults at her. When she stood up, they often checked her clothes to see if they were wet. For a few years, she was able to stay with some relatives. However, when they died, she was on her own in the bush, secluded from the world. She was isolated from every kind of help and support – physical, mental, and emotional.
“In those times of challenges and pain, I did weep most of the time. I didn’t have anybody to come to my rescue. I spent most of my time in my hidden place, where I wept.” She struggled with depression that made it difficult for her to eat, and she longed for the day her suffering would come to an end. “This was all I could tell myself before the ship came,” she says sadly.
Then, in 2010, Mercy Ships sailed into the port of Lomé, Togo. The arrival of the hospital ship brought hope for Abra – something she had not felt for a long time. Soon she was received a free successful surgery. After spending a few weeks in the ship’s hospital, Abra was able to go home.
She felt like a new woman, but her joy was short-lived. Tragically, a few weeks later, Abra was the victim of a brutal rape that ruined the surgical repair. She was back in the same nightmare she had experienced for two decades. “When my sickness came back, I was confused and lost,” Abra explains. Sadly, the ship had already left, and she had nowhere to turn.
Abra took refuge with her brother, who required her to be the housekeeper for the entire family. The work was very difficult for her. When she was unable to complete all the tasks, she was driven out of the home. She was only allowed to re-enter the house at certain hours to sleep. She had to wake early every morning to leave the house, and wait until late in the evening to return. She was not allowed to use the kitchen or even take a cup to drink from. She could not share in any of the food. Her brother’s family wanted to make sure she suffered because they were uncomfortable with her sickness.
Abra struggles to hold back tears as she recalls those days. “My brother did not agree with me. According to him, I’m telling a lie – I am not sick because I didn’t lose weight.” She quietly says a prayer and pauses before continuing, “My brother mistreated me. He mistreated me to the point that I got seriously sick.” The pain of her brother’s rebukes and abuse almost destroyed Abra’s spirit.
Finally, she found reprieve with her aunt. “She told me I smelled like a dead corpse before joining her. But the hands of God are upon me. Today I am here. I am still alive today,” she says.
A year later Abra’s daughter contacted her, telling her the wonderful news that Mercy Ships had returned. “For me, Mercy Ships has been sent from God to me, and I know that the ship is here to heal, I was hopeful. I didn’t know other people, too, have this sickness, I thought I was alone. But now, I know that I’m not the only one. I’m confident, and God is with me.”
Now, Abra has healed from her second surgery with Mercy Ships. She is living with her daughter and has been accepted back into the family. “I feel better now. No, rather, great. And I thank the Lord for the life of the medical team. May the Lord bless them, strengthen them, and give them long life. They will be blessed. God will reward them for ever and ever.”
Abra’s face radiates with happiness as she adds simply, “I have joy in me.”
