Hope In Desperate Places

By Lexie Patterson
Senior at the University of Oklahoma 
Entrepreneurship and Venture Management Major

Photos by Kathi Beasley

Dr. Darius R. Maggi steps to the surgical table where his patient lies ready under medication.

"Help your fellow man."

The words his dad told him long ago are always in the back of his mind, just like the memory of his grandmother passing when his dad was only six. She, like many of these women, hemorrhaged to death during childbirth at home. For the last decade, Dr. Maggi has been changing that for the women of Sierra Leone.

“Subliminally, that’s why I ended up doing what I do because [my dad] missed his mother so much..."

maggi
Dr. Maggi explains a procedure to Dr. Susan Hardwick-Smith. Obstetric Fistula is one of the hardest gynecological surgeries to perform. Photo by Kathi Beasley. 
 Not everyone is going to be a physician. Not everybody is going to be in the healthcare field, but you can step next door and help your neighbor,” Dr. Maggi said.

Dr. Maggi, an accomplished OB/GYN who earned his doctorate from the University of Oklahoma, splits his time between the U.S. and his West Africa Fistula Foundation (WAFF) in the eighth poorest country in Africa. He spends three week intervals in Sierra Leone, four times a year.

When he took time out of his busy schedule to talk to me, he was planning his impending trip while tracking down a playhouse complete with electricity and air conditioning for his grandchildren. The deal fell through, but Dr. Maggi isn’t one to be easily dissuaded.

Dr. Maggi faces performing surgery in poor conditions on a daily basis. Risks are part of his job, after all. In 2013, his team leased an old HIV facility and, without access to certain blood tests, he and his team took their chances on contracting diseases. He spent 11 days in the hospital in 2014, recovering from an illness that couldn’t be identified. But to Dr. Maggi, there are some things more important to him than his physical well-being.

An Obstetric Fistula is almost unheard of in the U.S. It occurs in women who need a caesarean delivery but don’t have access to proper healthcare. Both the woman and baby are at risk of death; the uterus can rupture, the woman can hemorrhage to death or she can die from infection. 1 in 8 women in Sierra Leone are at risk of dying from childbirth during their lifetime. But dying, contrary to what most people might think, is not the worst thing that can happen to these women.

A woman can labor for days if an obstruction occurs. The baby’s head gets pushed against the pelvis and bladder, killing the tissue. The woman is left with a hole in her bladder that causes urine to leak uncontrollably from her body.

This leak is misunderstood in Sierra Leone. Women are thought to be unclean, to be witches or to have committed adultery. They are ostracized from their communities because of this.

“Sometimes they’re even tied up to a tree... left in a little hut to die,” Dr. Maggi said. “I’ve seen women that have had these fistulas for up to 50 years. Can you imagine being wet every day for 50 years?”

Many of these women would rather be dead than live with urine running down their legs for the rest of their lives. One woman wrapped herself with so many black, plastic sacks to try and stop the leakage that it took her 10 minutes to cut herself free.

Dr. Maggi performed over 50 surgeries his last trip. Depending on the extent of the injury, surgeries can take anywhere from 20 minutes to three hours. The conditions that he works under are not ideal. Electricity is an unreliable power source due to a generator that breaks down regularly, gets stolen or lacks diesel to run it.

Electricity is needed to use general anesthesia in order to ventilate the patient. Because of this, he does everything primarily under spinal block which acts like an epidural where the patient is numb from the waist down, still awake and breathing on their own. He wears a battery-run head lamp and stops bleeding while operating the old-fashioned, time-consuming way: with sutures. Suction is done manually via a foot pump.

Patients can be kept at the medical center for two to three months in order to ensure that they are healthy before surgery and leave in the best possible condition. Most patients arrive malnourished. Some are carried in, unable to even walk due to extensive nerve damage from being in labor for days.

They are given three meals a day, vitamins such as Zinc and Vitamin C in order to get their blood count up and treated for parasitic infections before surgery. Recovery can take about six weeks.

The facility costs $25,000 per month to run. Expenses include salaries for nurses and food, including large amounts of rice bought in Sierra Leone, for the patients. Equipment is purchased from hospital fire sales or gathered when hospitals throw out slightly damaged or expired supplies.

An example of this is boxed, surgical gloves. Although they technically have an expiration date, they don’t expire. Nurses have even washed gloves and paper gowns in order to reuse them. Equipment is kept in a locked shipping container on the premises.

Physical healing is not the only recovery that these women go through. In Sierra Leone, the value of a woman’s life is very small. They are taught from a young age that they aren’t worth much.

“There was this girl and Darius picked her up like a little child. She was only 15 years old. He picked her up, put her in the bed and gave her a hug. She had given up on her life,” Dr. Susan Hardwick-Smith, a gynecologic surgeon from Houston, Texas who has accompanied Dr. Maggi to Sierra Leone more than once, said, “[He lets them know] ‘you are valuable, somebody loves you’.”

Many of the women affected by fistulas believe they are the only ones, the outcasts. When they realize they are not alone, they bond into their own little communities. They do each others hair and nails, sing songs, make jewelry and play board games.

Several of the women Dr. Maggi has helped have become nurses and now work for him; others make bracelets and surgical caps that Dr. Maggi sells for them back in the U.S.

Every trip, women will come back and tell him how happy they are to have their life back. Although Dr. Maggi will gladly tell you how gratifying it is to hear that, he is a pro at down-playing the life-changing affect he has on these women.

He won’t tell you that he is an incredible surgeon who performs the most difficult gynecologic surgery under the worst possible conditions. He won’t tell you that he brings change and joy to a place so desperate that it overwhelms others so much that they feel helpless. But, those who know him don’t mince words.

“He’s always had a big love for medicine and for taking care of people. That’s been evident all of my life,” Deno Maggi, Dr. Maggi’s son who has been to Sierra Leone multiple times, said. “[The people of Sierra Leone] have these big ceremonies for him. In a way, he hates it because he doesn’t like the attention. When he comes in, they do these dances and songs and celebrations. They are so excited.”

Dr. Maggi has a gift for making patients and doctors alike laugh. He tickles patients or draws smiling faces on their feet. He has even put flies in the food to play a joke on the cook. It’s his ability to bring joy that helps others endure what can otherwise be a very disheartening experience.

Dr. Maggi’s goal is to open a medical hospital in Sierra Leone with a teaching facility where doctors from the states would train medical students. Sierra Leone is the prime place to learn about tropical medicine and medical students would be exposed to an extensive amount of pathology in only 2 to 3 years. Within 15 years, there would be a strong base of doctors and the medical center would be self- sustaining.

This dream seems far off sometimes. Dr. Maggi doesn’t deny that the hardships he encounters are discouraging. It’s not easy running a non-profit like WAFF; keeping people devoted to a project like this and raising funds for the foundation can be difficult.

He explains that it’s important to keep focused on why he is doing what he is doing. It goes back to the principle instilled in him by his father when he was a young boy: help your fellow man.

“He’s walked a great life. He’s such a great person, but it’s not about himself, it’s about others. He’s inspiring because he’s one of a few people that are not caught up in themselves,” Kurt Stumpff said. Stumpff met Dr. Maggi when Maggi delivered his eldest daughter. He is now a board member for WAFF.

Dr. Maggi is keeping to the path he started on. There is a sleep-over to plan for two of his grandkids tonight and a trip to Sierra Leone to prepare for in just a few short weeks. There are lives to be changed, and whether he admits it or not, he is the reason why so many women have their lives back again.

You can find out more about Dr. Maggi’s work in his newly released book, Basta! A Doctor’s Story of Giving Back, sold on Amazon or visit his website at westafricafistulafoundation.org