Many of our patients aren’t exactly certain of how old they are. Rasoa (not her real name) is 14, maybe 15 years old. She works planting rice with her farming family in a village in the Befandriana district, 70 miles from Mandritsara, and enjoys cooking. The chapter of Rasoa’s story that brought her here to the hospital began 9 months ago when she became pregnant.

During her pregnancy she did not seem to have any problems and all had been reassuring when she saw the village midwife. However, when her labour eventually began, things were not so straightforward.

Although initially it seemed like perhaps just a long, difficult, first childbirth, it soon became clear that the baby was ‘stuck’ and both Rasoa and her baby’s lives were in danger. She and her mother and uncle set out to seek help, travelling by ox-cart. Rasoa’s uncle explained that they stopped at every town and village along the road asking if someone – anyone – was able to help, but no one had the skill and facilities needed to deliver the baby and save Rasoa’s life. All along the way, everyone said that the family needed to get to Mandritsara – to the Good News Hospital, where there are maternity facilities and the only surgical provision for a 125 mile radius. So, they continued on their journey of desperate hope, travelling for 2 full days and through the night. Rasoa’s uncle says that the 8 people travelling together on the cart did not cease to pray for her, and he considers it the grace of Jesus that helped Rasoa to come here to the hospital.

When she arrived at the hospital, Rasoa’s baby was already dead and she was close to death herself. She does not recall anything of the first 3 days that she was here because she was so extremely unwell. For the surgical team, we had the challenges of a baby that was dead but still stuck and a mother in grave danger. Delivering the baby was the first very difficult step, then Rasoa went to our Intensive Care ward. She remained here for many days, teetering on the edge of life and death. The prolonged time of obstructed labour had caused extensive internal damage as tissues were deprived of their blood supply through the pressure of the baby’s head pushed against them.

The consequence of this damage was soon confirmed – Rasoa has extensive fistula trauma. This means that both urine and stool pass constantly and uncontrollably through the vagina. Obstetric fistulae – to the bladder and/or rectum - are the consequence of lack of access to timely intervention for obstructed labour through assisted delivery or Caesarean section. Here in Mandritsara we regularly see women with obstetric fistulae, and their stories have the common themes of poverty, young pregnancy, long traumatic deliveries, long journeys to find help, and almost always a dead baby. Sadly, these ladies are often rejected by their spouse and by their community as a result of the unpleasant leakage of urine and stool.

For Rasoa, her story is not yet over. It will hopefully be possible, eventually, for her to have specialist reconstructive fistula surgery. This is very difficult surgery that is only available in a few centres in Madagascar, one of which is the Good News Hospital where it is done free of charge. This stage will come with time, when her tissues have scarred and settled.

For now, we have formed a colostomy so that her stool passes into a stoma bag on her abdomen, rather than uncontrollably through her vagina. This will also keep stool away from her surgical site as it heals when she eventually comes to her fistula surgery.

Alongside the medical care that Rasoa has received here at the hospital, she has regularly heard the truths of the Gospel shared on the ward. Rasoa says that she knows Jesus and in what she has heard here at the hospital, the Resurrection has particularly stood out to her. Our Saviour Jesus was born into our broken world, died to bring us forgiveness and rose again to bring us Life in all fullness.

When asked what she would ask people to pray for her, Rasoa’s response was to ask for the Holy Spirit to work in her so that she can better understand. Rasoa’s faith in the face of brokenness is an inspiration to us all. As we pray for her and those alongside her continuing journey of healing, we are reminded that in journeying with Jesus we can know forgiveness, brokenness restored, life in fullness and Resurrection hope.

‘Now I know in part, but then I will know fully, just as I am known.  Now these remain: faith [abiding trust in God and His promises], hope [confident expectation of eternal salvation], love [unselfish love for others growing out of God’s love for me], and the greatest of these is Love.’ – 1 Corinthians 13:12-13 (AMP version)

1. Pray for “Rasoa” that as she hears more of the love of the Lord Jesus, she may know the peace of God in her heart and trust Him for her future.

2. Pray for the surgeons and staff at the Good News Hospital that they may be given all the skill and compassion that they need as they care for “Rasoa” and similar patients who arrive.

3. And pray that the Good News of the Gospel may continue to spread to the remotest villages around Mandritsara.