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I met eighteen-year-old Fanjakely late last year as I was photographing potential patients at a screening day in Toamasina, Madagascar. I knew immediately that she was one of the first Obstetric Fistula patients that had come in. How did I know? The state of her clothes, the look of despair and rejection on her face, the smell. If body language was any key, because I couldn’t speak her language, she told me with her eyes “don’t look at me, don’t ask me questions, I came here reluctantly but I have my appointment card and now I just want to get out of here.”

Photo Credit Justine Forrest

Photo Credit Justine Forrest

It had always been her dream to be a mother. When she was fifteen, her captivating features and grace caught the eye of a handsome farmer, and they were wed. Not a day went by without him telling her that she was beautiful.

She discovered that she was going to have a child. As the miracle inside her grew, she had no idea that her months of excitement were, in fact, a prelude to sorrow and suffering.

Her suffering began when her labor became four days of excruciating pain. On the third day, the midwife tried to help, but all her knowledge and experience brought no relief. To find help, they would have to leave the village. At 7 a.m. on the fourth morning, Fanjakely, her husband, brother and mother-in-law set out in a pirogue (a small boat much like a canoe) for a four-hour ride on the river to another village. Then they crammed into a packed taxi-brousse (Malagasy bus). Fanjakely passed out two hours before they finally reached the hospital at 7 p.m. There she finally delivered a baby boy named Antonio.

Her heartache was just beginning. She described what happened the next day:  “After I stood up to go to the toilet, the urine flowed out. It was flowing plenty, it would not stop.” With absolutely no idea of what was happening, or why, she was terrified, confused, unhappy and angry, “I didn’t know who to be angry with,” she said.

Sadly, Fanjakely had just become another victim of inadequate healthcare systems in developing countries. Her problems could have been easily prevented by having a caesarean section. Every day, 10 women in Madagascar die from complications related to pregnancy and childbirth. Many more survive but, like Fanjakely, suffer from a debilitating injury called obstetric fistula that is caused by obstructed labor that creates an opening between the bladder and the birth canal.

The doctor explained that the fistula could be surgically repaired, but Fanjakely knew that she would never be able to afford it.  She said, “I was so sad, because I thought I would never get health, because I have no money for surgery.”

Life became very difficult. In spite of her efforts to stay dry, the smell of the constant flow of urine caused people to reject her. Her young heart was broken.

In the midst of all the horror, Fanjakely was grateful for two miracles. Often women who suffer an obstetric fistula give birth to a stillborn child and in most cases their husbands abandon them. But Fanjakely was blessed with her beautiful, healthy baby boy and her husband never stopped loving her. He was the epitome of unconditional love. Everyday her that she was beautiful and would encourage her by saying, “Maybe one day you will get surgery.”

Little did they know how prophetic his words were. A radio announced Fanjakely’s third miracle: a hospital ship that treated obstetric fistula for free was coming to Madagascar! With what little money they had, Fanjakely bought adult diapers and made the four-hour journey to Toamasina.

Franjakely arrived at the ship scared and alone – soon she would meet many other women with stories just like hers and realise that she was in fact not alone!

Currently it is estimated that there are 2 million other women world wide and another 500,000 cases are added to that list each year!  Unfortunately they are just the ones that the World Health Organisation knows about. Most of these women live in remote villages and suffer silently.

80% of obstetric fistulas can be fixed quite easily with a 30 minute surgery and cost around $200-$400. During our field service in Madagascar during 2015-2016 100 women had surgeries here on the ship. This year we have established an Obstetric Fistula clinic which is now up and running with a team of Mercy Ships nurses and 17 local Malagasy nurses who will be trained and mentored by Mercy Ships nurses to continue to the work with the help of Freedom From Fistula when we leave. Already 34 women have had surgeries in the last three weeks and our wards continue to fill with women each week. These 34 women are either recovering or have already gone home with renewed spirits, hope and restored bodies. It is exciting to celebrate with them at their “dress ceremonies” before we send them home. That’s where I have been today 🙂

It is exciting work and I feel incredibly privileged to see these transformations and be part of sharing their stories.

Photo Credit Justine Forrest, Women wait at the Women's Health and VVF Screening

Photo Credit Justine Forrest, Women wait at the Women’s Health and VVF Screening

Photo Credit Katie Keegan - Fankajely (MGB12827) on the ward

Photo Credit Katie Keegan – Fankajely (MGB12827) on the ward

Photo Credit Katie Keegan - OBF Dress Ceremony Portraits

Photo Credit Katie Keegan – OBF Dress Ceremony Portraits

Photo Credit Katie Keegan

Photo Credit Katie Keegan

Photo Credit Justine Forrest, MGB16254 Honorine ready for her VVF Dress Ceremony

Photo Credit Justine Forrest, MGB16254 Honorine ready for her VVF Dress Ceremony

Photo Credit Justine Forrest, MGB12800 Marie at the final VVF Dress Ceremony

Photo Credit Justine Forrest, MGB12800 Marie at the final VVF Dress Ceremony

Photo Credit Justine Forrest, VVF Dress Ceremony, MGB16328 Vavo, MGB16340 Baondalana, MGB16329 Zabitika, MGB16335 Celine and MGB16341 Georgina

Photo Credit Justine Forrest, VVF Dress Ceremony, MGB16328 Vavo, MGB16340 Baondalana, MGB16329 Zabitika, MGB16335 Celine and MGB16341 Georgina



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21 Responses to Blog: Fanjakely

  1. Caroll says:

    A few years ago I watched a PBS documentary, A Walk to Beautiful, on the subject of obstetric fistula, so I knew exactly what the medical term meant. What awesome work you all are doing! Your story and pictures were inspiring!

  2. mindys7 says:

    Well, definitely some tears here. Having worked in OB for years the statistics you give just break my heart! So awesome what you guys are doing to help these women! So amazing to see the transformations! Thanks so much for sharing!

  3. Terry Vachowski says:

    Thank you, Justine, for all you do, most of all spreading awareness.

  4. Jan says:

    Your blog made me cry and smile, Juzzi! I can’t imagine how difficult the past years have been for beautiful young Fanjakely. Thank you for your part in putting the smile back on her face.

  5. Lisa Moore says:

    What a wonderful & inspiring mission. Thanks so much for sharing this beautiful story. These women are beautiful & I love seeing their smiles and laughter. It has probably been a long time since they have felt joy like this. Thanks for what you and the others are doing to make a difference in these lives & so far beyond. You will never know how far the ripple effect goes in each case.

  6. Linda DeLaughter says:

    It is stories like this one that bring us closer to the true meaning of why it is called “Mercy Ship”! Thanks to you and your family, Juzzie, for helping to bring normalcy to the lives of these women and for sharing their stories!

  7. Lindie says:

    I can’t add anything new to the comments. I am so proud of Mercy ships and of you and your family. Your blogs are so special and really help us see things differently. Love to all.

  8. Katie K. says:

    Justinie – thanks for sharing the story of the amazing women who have persevered through so many challenges – more than most of us can comprehend. I just received the most recent Mercy Ships newsletter that had this story of Fanjakely and I appreciate reading your post that included more details. I’ve saved the newsletter as I intend to share it with my friends/family. Like many, I was unaware of this type of fistula as a complication of childbirth. We here in North America and other similar locales who are blessed with basically immediate and instant access to all healthcare options need reminding about how we can help. Thanks to your family, entire Mercy Ships crew, support staff, as well as all other organizations that tirelessly work for the heath and dignity for all.

  9. Cindy Rold says:

    What a beautiful story. And the photos showing the transformation are powerful. It’s easy to take so much for granted. Then I read about a 30 minute operation that costs only $200-$400 and ask, why aren’t all women able to get such a surgery? You have inspired me to make a donation to make more operations possible.

    • Justine says:

      The main reason is that they just can’t afford the surgery Cindy! In Madagascar alone, two thirds of the population live on less than $1 a day and the medical facilities and the few surgeons that can perform the surgeries are in the big cities which can often be 3-10 days travel away, and extra cost again. Mercy Ships provides free surgeries to people in the countries that we are in and we can do that because everyone that works on the ship, from the surgeons to the housekeepers, are all volunteers. It is a pretty unique place 🙂

      • Cindy Rold says:

        Yes, of course that’s why they can’t get the surgeries. It was meant as a rhetorical question and a prod to me to remember that what doesn’t seem like much money to me can seem like a fortune to someone in a developing country. The services provided by Mercy Ships are so valuable. I would be tempted to volunteer at some point, except for the fact that I get seasick :(. I’ll stick to donating here and volunteering elsewhere.

        • Justine says:

          Hahaha on all accounts Cindy! We spend the whole field service in port with no sailing required – that’s normally a 10 month stint with little or no movement!!

  10. Liz Propst says:

    Thank you Justine and all those who volunteer for this great ministry!

  11. Deanna Emmert says:

    In a world where most all I hear about these days is of violence, greed, and stomping on others to gain power and control, this story shines like a beacon of hope and encouragement. How blessed you are to see this hope and encouragement “up close and personal,” Justine. Thank you so much for these real life stories. I am so glad you heeded His voice and are where you are!!

  12. Kaye Rhodes says:

    Thank you so much for sharing this interesting story and helping so many with your work. The smiles on their faces at the Dress Ceremony speak volumes!

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