She had been only on the earliest brink of the changes to womanhood. She had never even seen her menstrual flow, but the boy in the village wanted to have sex, so she agreed. He pushed his frame onto her childlike bony frame. That is what had started all the pains. Months later, at twelve years old she lay pushing in the darkness for days. Finally, after the seemingly endless labor, the family made it down the lengthy footpaths out of the bush to a distant health clinic. A clinician with minimal training cut open her belly and released the dead baby from the tiny pelvis which had become its prison. Her family’s dread turned to a bit of hope that maybe the girl would live.
And live she did. But life became much more complicated. Just after the surgery, urine and stool both leaked though the incision on her abdomen. Foul odor and discolored drainage from the urine-feces mix stained clothes day after day. She was sent back to her village, where it continued for a full year. Then, finally the wound on her belly healed, the dirty leaking through the incision stopped. Her bowel movements returned to normal. But the urine did not. Now, she began urinating constantly through the vagina. Whatever injury to the urinary tract that had been, managed to find a different method of exit. Still, it was better than the prior, at least the stool had stopped. Years went on, time continued. For seven years she stayed in the village, smelling of urine, and dripping all around.
Finally, she came to the hospital. I wish I could say that all got better, and she left with a smile. But that isn’t the way it went. Some initial blood work showed that she had HIV. Further tests and examination revealed that it wasn’t a new, mild case, but full-out AIDS. Her health was terrible. In a few moments, her world had once again worsened tremendously. She thought her world had fallen apart long ago, but now even the intact threads seemed to be shredding.
I got some initial tests for the urine problem. It was still her heaviest burden - the plague that she felt the most, and the trail of urine that others could see and judge. The HIV at least was not known as soon as she entered a room. She hoped for a cure for the chronic leak. I examined inside her pelvis, noting that its full development had been stunted by the pregnancy, now many years ago. My finger felt bones like that of a normal ten year old girl. She could barely endure the pain of the exam.
We sat down to talk, not of immediate satisfaction, but a lengthy process. First, she needed months on medications to fight the newly diagnosed virus that was ravaging her body. The chance of healing would be low if we decided to operate before her overall health was improved. However, even getting the medications was not an easy task to manage, since the closest place to obtain the necessary medications is a two day walk from her village. But determined, she agreed to make the journey monthly for the drugs. Then, we needed more imaging studies of the urinary tract to make sure we knew exactly where the defect was that was causing the urine loss. These costs were beyond her means, but thankfully the missionary who had brought her to the hospital agreed to help cover the hospital’s costs. Lastly, she had to understand that the repair would be difficult, and depending on what we found when all of the information was put together, I may need to wait for a specialist to come with more expertise than I have. She understood. Resolution to her condition wasn’t a magic tablet that could affect a quick fix, but it was a glimmer of hope.