Fighting Fistula – Jeffrey Wilkinson ’89, INDS

Published: Jun 21, 2009

In a developing world awash with suffering, Jeffrey Wilkinson ’89, interdisciplinary studies, has used his medical skills to focus on a very specific problem for African women: a hugely debilitating condition known as obstetric fistula.

Obstetric fistula occurs in women who undergo a difficult childbirth or are victims of sexual violence. The fistula is a hole that appears between the rectum and vagina or between the bladder and the vagina. It often develops after prolonged labor, and the condition causes incontinence and infections, as patients cannot hold in their urine or fecal matter.

The United Nations Population Fund estimates that two million women remain untreated for obstetric fistula in developing countries – and at least 50,000 to 100,000 new cases occur each year. Treatment requires a relatively simple and low-cost form of reconstructive surgery, but most fistula patients can’t afford the $300 that pays for the surgery and post-surgical care.

That is where Wilkinson – a physician with the Duke University Center for Minimally Invasive Gynecologic Surgery – enters the picture. He moved to Tanzania in 2008 to perform fistula surgeries at the Kilimanjaro Christian Medical Centre (KCMC), a Duke partner facility, in the town of Moshi, near Mount Kilimanjaro.

Wilkinson received his medical degree from the Johns Hopkins University School of Medicine. As a urogynecologist (a subspecialty of obstetrics and gynecology that deals with incontinence), he has helped many patients that he says are “the most underrepresented and vulnerable group of patients you can possibly think of…without power, money or voice.”

The surgeries at KCMC are covered by the center’s own budget, government grants, the African Medical and Research Foundation, and other donations. Wilkinson and the OB-GYN team at the center are also teaching Tanzanian health workers how to do emergency obstetrics as a preventative measure to avoid maternal mortality and fistulas.

Wilkinson’s colleagues say he has made a big difference in the countries where he has worked. His efforts featured prominently in a recent article in the New York Times, which highlighted the work done by Wilkinson and his Tanzanian colleague Gileard Masenga at KCMC.

“The work he is doing on behalf of women in the developing world and as a representative of our Duke faculty set him apart from the average physician,” said Haywood Brown, chair of the department of obstetrics and gynecology at Duke University Medical Center.

Masenga, a senior obstetrician and gynecologist and one of Tanzania’s leading experts on fistula surgery, agrees. “The KCMC obstetric and gynecology department has improved and benefited from his presence in term of improved patient care, teaching and clinical oriented research,” he says.

Wilkinson took several short trips to Niger between 2004 and 2008 where he treated fistula patients and grew increasingly interested in working full-time in Africa. When he moved to Tanzania last year, he traveled with his wife, a family physician, and their two young children.

Wilkinson says the most common reason for maternal mortality and prevalence of fistulas in a country like Tanzania are delays in seeking and receiving obstetric care during childbirth.

“There are insurmountable odds against women,” he says. “It’s fortunate that most labors can occur without major problems on their own, or else this would be a much more widespread problem.” Looking back on his days at UMBC, Wilkinson says that his interdisciplinary studies have helped him manage the different issues and fields he grapples with in his current job.

“Our work isn’t just doing a surgical fix to a patient’s problem. We also address the psychological and social aspects of condition, as well as the financial and economic issues, the science behind it, the statistics, and the epidemiology,” he said. “The [interdisciplinary program]… has helped me a lot in understanding the problem of obstetric fistula and maternal mortality.”

— Eliza Barclay

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