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Meet August's Women of the Month: Tikkun Olam in Medicine

Jewish physician and nurses work as volunteers providing lifesaving treatment for women and children in the developing world.

Dr. Deane Marchbein with local women on the road to Masisi in the Democratic Republic of Congo. Photo by Doctors without Borders/MSF

By Rahel Musleah

Source: The Jewish Woman Magazine's article Tikkun Olam through Medicine

In the West African country of Niger, pregnant women can labor for days without medical intervention. The prolonged pressure from the baby’s head often causes a hole in the wall between the vagina and bladder or rectum, and the women become incontinent, ostracized and abandoned by their families and villages.

“The women are filled with shame,” says Suzy Arencibia, a 46-year-old nurse from Herndon, Va., who volunteers to help repair obstetric fistulas through the International Organization for Women and Development (IOWD). “Hundreds of women camp out in the courtyard of the National Hospital in Niger and wait for IOWD to arrive three times a year. They live there for months.”

Arencibia has been on the two-week missions to Niger twice; her last mission was to Rwanda, where IOWD is initiating a similar program. “To see these women is heartbreaking. I’m so fortunate to have an education and a healthy family. I felt I owed something back to the world.” Arencibia recalls one girl of about 14 who had given birth to a stillborn baby. “She was trying to learn English and was so proud when she learned to say, ‘Hello, how are you? I am fine.’ She didn’t have a chance to have a real childhood, yet she was still so grateful and positive.” The women, says Arencibia, “just want you to come and sit by them. They can’t control their urine or feces. No one else wants to be near them.” The overseas work is so compelling that Arencibia gave up her job of 15 years as a labor and delivery nurse and joined an orthopedic outpatient surgery practice to sharpen her surgical skills.

Like Arencibia, many Jewish physicians and nurses volunteer their medical expertise in developing countries. Their devotion to sharing their skills with those who are less fortunate has motivated many to reconfigure their own careers. Their Jewish values stoke their desires to make the world a better place through acts of loving-kindness and compassion. “An essential part of Jewish life is a commitment to charity, community and good work,” says Deane Marchbein, a Boston anesthesiologist who has participated in six Doctors Without Borders/Médecins Sans Frontières (MSF) missions since 2005 and recently assumed the vice presidency of its U.S. board of directors.

The arrival of schoolbooks and medical equipment for clinics in Bura, Kenya, is a cause for celebration for internist Sue Abkowitz Crawford and the women from the Mseto orphans group. Photo courtsey of Sue Abkowitz Crawford
Marchbein’s passion for helping children is also fueled by personal tragedy. Her only son, Caleb, died in 1993 at age 6 of Fanconi anemia, a genetic disease found in the Ashkenazic community that causes bone marrow failure and cancer in children. Through MSF, she reaches people in forgotten rural areas or places of civil unrest.

In developing countries, Marchbein notes, women risk their lives to have children; they labor at home and seek medical care only as a last resort. She recounts the story of a mother of five discharged home to the bush to die after a medical mistake at a non-MSF hospital caused an obstetric fistula. “She found her way back to the hospital four hours from the main city. She couldn’t walk; she could barely sit up; she suffered from dehydration, fever and infection.” After a month in intensive care, it became apparent that surgery was her only chance for survival. “We operated for eight hours without the right equipment. We had no ventilator to help her breathe, no special IV for nutrition.” Miraculously, she breathed on her own after the surgery.

“People ask, ‘How can you go to such a place?’” says Marchbein. “I think, ‘How can you not go when you have skills that are so useful?’” Fear caused another young woman in the Democratic Republic of the Congo to lie about her medical condition. “We treated her for a miscarriage, but it turns out she had a botched illegal abortion and didn’t tell us. Her whole body was infected by the dead baby. We were terrified she would die on the operating table but, amazingly, she survived.” Rape is commonly used as a method of terror in the war-torn Congo; an MSF project for victims of sexual violence addresses the physical and emotional needs of women and girls as young as 4 years old.

Marchbein set up a pediatric burn unit in a hospital in the Ivory Coast and has taught local nurses to administer anesthesia. She was part of the first volunteer medical team to arrive in Haiti after the earthquake. “We saw exactly what you saw on CNN. Dead bodies on the street and total destruction. The volume of surgical injuries was unlike anything I’d ever seen.” MSF’s trauma hospital in Haiti had collapsed, forcing the group to rig up operating rooms from plywood scaffolding walled off by bed sheets, and to improvise another from a metal shipping container.

Photo by Operation Smile, Vicki Cronis
Pediatric anesthesiologist Judith Brill takes a child back to surgery at Preah Bhat Norodom Sihanouk Hospital in Phnom Penh, Cambodia.

“I go wherever I am needed. I never specify where,” says Marchbein, who left the private practice she ran for 20 years to join the staff at Massachusetts General Hospital (she is “on loan” to the Cambridge Health Alliance) so she could have the flexibility to volunteer every winter. Because surgeons and anesthesiologists can work day and night seven days a week, they generally volunteer for two months, less than the six-to-12-month commitment for nurses and other medical staff. Her husband, who owns a music store, supports her work, she says.

“Some things are very, very hard to see,” Marchbein admits. “But I place such a value on being useful that I go back for more.” When she returns home, she feels grateful for a “real flush toilet,” the abundance in the grocery store, and the sterile medical equipment. “My experience puts in context how lucky I am, how lucky my patients are. The team spirit from MSF carries over when I come home. I am much less annoyed with the trivial things that go on day to day.” She adds, “The mission is so clear, I don’t feel conflicted about it. I’ve learned that I’m tough, committed and more resilient than I would have imagined.” Arencibia has experienced a similar impact. “I’m a lot braver and self-reliant than I thought I was. I can create solutions to problems, and I’ve become more confident.”

Obstetric fistula is practically unheard of in the United States because cesarean sections are routinely performed when a woman is in prolonged labor. According to the World Health Organization, an estimated 2 million young women in Asia and sub-Saharan Africa live with untreated obstetric fistulas, a major cause of maternal mortality. IOWD, founded in 2003 by Long Island resident Barbara Margolies, brings American surgeons and nurses to Niger and Rwanda to operate (more than 1,000 surgeries have been performed) and to train local doctors (Niger’s population of 14 million is served by only 485 doctors; only a handful can repair obstetric fistulas). An educator, author, lecturer and photographer, Margolies first visited Africa in 1984 to research her children’s book, Rehema’s Journey: A Visit in Tanzania.

Photo courtsey of Suzy Arencibia
Nurse Suzy Arencibia in Niger with a fistula patient‘s baby.

“In so many countries, women have no options for their own well-being or for family planning,” says Judith Brill, a professor of pediatrics and anesthesiology at Mattel Children’s Hospital at the University of California in Los Angeles. “They have many children to look after with minimal resources. The children are poorly nourished and the mothers equally so. It’s much harder to heal and stay healthy.”

Brill has volunteered on more than 30 missions with Operation Smile, which provides free surgeries to repair cleft lip, palate and other facial deformities for children around the world. Her first mission took her to Gaza in 1999, right before the second intifada. “It was relatively calm, but still pretty tense,” she recalls. “My family was anxious. I thought it was an opportunity for me as a Jewish American woman to be seen in a positive light, even if just by one person.” She experienced some anti-Israel bias from the international medical team but, she says, the bottom line is that “the children were just children. The mothers were grateful and gracious. And I was hooked.” On a mission to Jordan where she operated on children transported from Iraq by the U.S. military, she again worried about how she would be received. She found that “in a one-on-one relationship with a child and mother or grandmother, it doesn’t matter if you are American, Iraqi, Jewish or Muslim. The child is the common denominator.”

Her travels have taken her to Latin America, Asia, Ethiopia, Jordan and Russia (13 times, including one mission to Chechnya). Most missions last about 10 days. Modeling Jewish values for her three sons, ages 16, 19 and 20, also ranks high on her reasons for volunteering.

Photo Courtesy Suzy Arencibia
Patients at the National Hospital in Niamey, Niger, where nurse Suzy Arencibia helped repair obstetric fistulas.

Internist Sue Abkowitz Crawford, 52, has brought her three children along on many missions for Health Volunteers Overseas (HVO), in which she and husband Glen, an orthopedist, have participated for 20 years. Their children’s ages didn’t deter them: They traveled to Indonesia in 1991 with a 3-year-old and a 1-year-old. Emily, now 22, Neil, 19, and Matthew, 12, have attended school and learned about other cultures and religions in countries from Bhutan to Vietnam and have gained an intimate understanding of tikkun olam. Matthew, who is becoming a bar mitzvah in October, organized the first sports program in Bura, Kenya, a village without running water. After he observed children playing soccer with balls of trash, he began collecting soccer balls for them. The program has grown to include 300 children from 10 schools, and this past February, Matthew presided over the final competition.

Crawford’s own sense of adventure has been well satisfied: She has hiked the Himalayas and eaten yak tongue and intestine and still-beating cobra hearts. In Bhutan, a primarily Buddhist country, she celebrated Passover with the matzoh, gefilte fish and Haggadah she brought with her, but substituted hot chili peppers for bitter herbs.

Her desire to help those in need overseas began in her last year of medical school, when she and Glen crafted a four-month program for themselves at Kilimanjaro Christian Medical Centre in Tanzania. Crawford worked for 12 years in a primary-care outpatient group practice. Six years ago, she took her current position at the Anna Jaques Hospital in Newburyport, Mass., which allows her the flexibility to continue to volunteer with HVO for two months every other year, providing care and training and educating local doctors and medical staff in developing countries. “There is so much paperwork and politics in medicine here in the USA. I’d rather just take care of sick people,” she explains. “That’s why I went into medicine.” She also makes two or three shorter trips each year as director of Africa projects for the International Medical Collaborative (IMEC), which collects and rehabilitates medical equipment and sends it to facilities in developing countries.

Back in the United States, she helped set up the sister-city group, the Greater Newburyport Bura Alliance. In addition to caring for orphans in their own village, some of the women of Bura play a critical educational role in raising awareness of HIV and prevention strategies. Women bear the brunt of the HIV epidemic because their husbands contract AIDS and bring it home, Crawford says. The rate among the general population in some parts of Africa is about 30 percent; in hospitals it rises to 50 to 60 percent, and in TB wards it spirals to 75 percent. “Anyone can get it,” Crawford says. It’s no longer a death sentence, she adds, but prevention remains key.

“We see unusual diseases like cerebral malaria, tuberculous meningitis and typhoid. People don’t come in with trivial medical problems like a sore throat. They present late in course,” Crawford explains. She can still see the face of a Masai girl in Tanzania who was bitten by a tsetse fly carrying sleeping sickness. The parasitic infection, easily cured with antibiotics, was left untreated except with tribal medicine. The girl went into a coma and died, but could have been saved with earlier medical intervention. In Transkei, one of the former black homelands in South Africa, Crawford worked part-time in a 300-bed hospital with patients who suffered from tuberculosis of the brain, abdomen and bone, and part-time in a clinic operated out of a container truck in a trash dump that 4,000 people called home.

“I always think I could have helped,” Crawford says, “but people die because they have no access to care...I’ve learned humility and a grand appreciation for the nurses and doctors—many women among them—who work in other places. The work touches us all the time.”

Agent of Change

Diana Wolfe with Nana Traore, a village birth assistant in Karangasso, Mali.  Because many of the women Wolfe encountered in Mali were always either pregnant or breastfeeding, they thought that women only got their period once or twice in a lifetime.
Obstetrician Diana Wolfe, 40, contends that the educational aspect of health care is paramount and is dedicating her career to fostering the understanding of individual and group perceptions of health issues necessary to effect change. Currently a perinatology fellow at UCLA, she already had a master’s in public health and had been a Peace Corps volunteer in Mali (1998–2000) before entering the Medical School for International Health (MSIH), an innovative joint program of Ben Gurion University in Israel and Columbia University.

MSIH offers a cadre of students from all over the world the chance to focus their studies on global health issues like infectious diseases, nutrition, disease prevention, humanitarian emergencies, cross-cultural competencies and community health. Students spend three years at the BGU campus in Beersheva, Israel, study the last year at Columbia and complete a two-month internship abroad.

“The women [in Mali] thought they only got their periods once or twice in their lifetimes,” Wolfe says. “I realized this was because they were either pregnant or breastfeeding all the time.” Wolfe gathered data when she returned to Mali between her first and second years of medical school. She interviewed women from seven villages, modeling the project on an MSIH assessment in the Bedouin community. Female mutilation (still widely practiced, though illegal for medical professionals to perform) is a ritual that might only be stopped if the underlying perception is addressed, she says. In remote areas, the lack of aid, education and interventions present a stark reality, but, as Wolfe notes, women in rural regions and among immigrant populations in the United States also face challenges in maternal health care.

A Pittsburgh native, Wolfe grew up with early exposure to other cultures through her mother, an anthropologist, and her father, an astrophysicist who took his family to England and Moscow when he was doing fellowships overseas. “I’m very accepting and respectful of differences,” says Wolfe. “We’re all human beings regardless of our faith.”  She shared Jewish customs and participated in local Muslim observances in Mali. But she has dispensed with her one-time goal to travel to Yemen or Saudi Arabia. “I realize there is a limit. It would be tough for a Jewish woman because of safety factors.”

Still, she holds on to her idealism. “It’s our responsibility to help those who don’t have access to the skills and care we have. It’s an ethical goal.” —Rahel Musleah

 


 

Source: The Jewish Woman Magazine's article Tikkun Olam through Medicine

Rahel Musleah is an award-winning journalist, author and apeaker. Visit her Web site, www.rahelsjewishindia.com