What Happens When You Can’t Walk Away

“I didn’t choose this. I think it chose me,” says Sierra Leone’s top—and, until very recently, only—fistula repair surgeon, Dr. Alyona Lewis.

She didn’t have to be here, at the Aberdeen Women’s Center in Freetown. In Africa. After all, Alyona’s Sierra Leonean father met his Russian wife during medical school abroad and they raised their only daughter in Moscow, ensuring that she was “not short of anything.” Her mother doted on her, and her father took her on exciting business trips to Europe. When they finally did return to Sierra Leone, Alyona’s father had to prepare his wide-eyed eight-year-old daughter for a reality other children knew too intimately: “Alyona, you won’t believe me, but there are people there who don’t have food to eat.”

Still, it didn’t take long for her father’s homeland to become home, the warmth of her relatives filling her with a sense of belonging. After attending school in Sierra Leone, Alyona returned to Russia for medical training—but she “always wanted to go back” to Africa. So when she and her Sierra Leonean husband finished medical school shortly after the birth of their first son, they decided to do just that.

It was 1997. For six years, a brutal civil war had been raging in the small African nation Alyona now called home. Asked why she’d willingly relocate to an active warzone with a six-month-old baby, Alyona answers: “It was scary, but we didn’t really know the extent of the damage. We just knew we were needed there.” She laughs. “We were still young. Maybe today we wouldn’t do the same.”

Alyona doesn’t talk much about the war—the inevitable backdrop to her indisputable resilience. Eleven years of conflict in Sierra Leone left more than 50,000 people dead and countless more victims of horrific war crimes, including rape, slavery, limb amputation and the use of child soldiers. But Alyona only wants to talk about the many people she and her husband helped and how “God was on [their] side.” This must be how survivors speak.

During the war, Alyona divided her time between Freetown’s main hospital for surgery, the Princess Christian Maternity Hospital (PCMH), and its children’s hospital. It was at PCMH that Alyona began encountering many young girls who had been abducted and raped, often repeatedly. Teenage pregnancy can lead to obstructed labor, which in turn can cause fistulas—a tear between the birth canal and the bladder or rectum that makes women leak urine, feces, or both. According to the World Health Organization, of the approximately 2 million women across Asia and sub-Saharan Africa with untreated obstetric fistulas, 65% develop them as adolescents. The debilitating and stigmatized condition leaves most sufferers shunned and ostracized, and can cause skin infections, kidney disorders and even death if untreated.

International Medical Corps, which began providing emergency health care services for Sierra Leoneans in 1998, recognized fistulas as a critical and unaddressed health need, and developed a fistula repair surgery program. One day, Alyona happened to bump into an International Medical Corps volunteer doctor from Los Angeles, Dr. Beth Cowan, at PCMH. Dr. Cohen said to the young resident, “We’re here to do some surgeries on fistulas. Would you like to help?” Curious, Alyona nonchalantly replied, “Sure, why not?” She had no idea that Dr. Cowan was a trainer, or where this step would lead her.

Alyona began by screening and examining fistula patients, but soon enough became Dr. Cowan’s most trusted assistant in the operating room. Says Alyona, “International Medical Corps genuinely thought about the ability of the country they were in by training the nationals. Because the NGOs leave, and they need to leave something behind.” So on the day of her last fistula repair surgery before returning home to Los Angeles, Dr. Cowan asked Alyona, “Are you confident enough to attempt this on your own?” Alyona was, and she did.

Subsequently, International Medical Corps fought hard to get Alyona into fistula repair surgery training in Nigeria after her papers were initially rejected because she was not a specialist. For Alyona, such training was not part of her master plan. But when she returned to Sierra Leone—the only trainee to do so—and encountered the many young women who desperately needed fistula repairs, Alyona knew that if she walked away there would be no one else to help them.

Eventually, the Aberdeen Women’s Center in Freetown was built by Mercy Ship and later expanded by the Glog Foundation, realizing one of Alyona’s dreams: a freestanding center at which to provide around 300 fistula repair surgeries a year. Because fistulas often leave women as outcasts, “they need a longer stay”; the Center provides them with a private space to rehabilitate and learn about their condition, sheltered from the stigma. Now, Alyona tells women, “Don’t wait until you’re nine months pregnant—that’s too late. When you’re seven months pregnant, start walking towards the Center.” That way she and her colleagues can watch over the pregnant women, preventing problems before they arise.

Asked whether there’s a particular patient that stands out to her, Alyona laughs, “They all make an impact. I get really attached.” But there was that one. When labor strikes in Freetown prevented doctors from entering the hospital, there was the young woman who, while waiting for her own fistula repair surgery, cared for her fellow patients. After the doctors, touched by her actions, contributed money for the surgery she could not afford, the patient came into Alyona’s office and asked, “How can I repay you?” Alyona told her that she had already done enough, but the patient insisted on sticking around to help. So they took the young, unemployed woman on as volunteer. After two years, she went to nursing school and is today one of the hospital’s top nurses.

This story keeps Alyona going, as she lives in a country full of “all of these girls who have been deprived of opportunity.” She states, “A lot of [these young girls] are really brilliant, and if they had only been given opportunities, they too could have been doctors and nurses.” Facing this reality can be quite difficult, especially now that Alyona’s own sons have become teenagers. “When she looks at their young female friends—12, 13 years old…” her voice trails off. She doesn’t need to say what I’m already thinking: what will become of them?

Some things are changing, though, and Alyona says “Sensitization and education is definitely the way forward.” Before, for example, men rarely got involved, as “Delivery in Africa, especially in rural Africa, is a women’s business.” But in 2008, the United Nations Population Fund, in partnership with the Office of the First Lady, convened a forum on preventing maternal mortality that aimed to raise awareness among tribal heads, religious leaders and village chiefs, during which Alyona got the chance to discuss fistulas. This—along with awareness-raising messages, jingles, and a 555 fistula hotline—had “a very huge impact”: husbands, boyfriends, fathers, and brothers now accompany their loved ones to the hospital. Women’s health, after all, is everyone’s business.

Looking forward, Alyona hopes that more junior doctors will see fistula repair surgery as a viable specialty after medical school despite the prevailing lack of understanding that “fistula surgeons are gynecologists, obstetricians, and urologists all in one.” Acquiring her own junior doctor trainee, whom Alyona spent the last several months training, was a “very big battle.” But on January 1, Alyona will finally be “passing the baton”—going from Sierra Leone’s only obstetric fistula repair surgeon to one of two. Achieving continuity means that “half [her] goal has been accomplished.” The other half of Alyona’s goal, of course, is to eradicate fistulas altogether.

Today, the Aberdeen Women’s Center where Alyona spends her days working is situated on a beautiful beach in Sierra Leone because “God wanted the women to have the best.” But Alyona dreams of the day when she can treat Sierra Leone’s last fistula patient and watch a big hotel take over the Center. Then, the women can enjoy their lovely surroundings free of the pain and isolation they have known too well. The way Alyona paints the idyllic scene—dreamily and full of hope—I can almost see what she sees.

So maybe being Sierra Leone’s premier fistula repair surgeon wasn’t part of the plan. Maybe this life chose Alyona because she—a beautiful and brilliant half-Russian, half-Sierra Leonean doctor with a hearty laugh and unbreakable spirit—was the only one who could, and would do it. Because to the young girls and women whose lives she lights up—fighting an uphill battle in the middle of a war—Alyona is no doubt a hero. But to Alyona, she’s just a woman who couldn’t walk away.

After all, someone had to do it.

Help us save lives.