Written by Jodi Grahl

Final Day

Image of Tiquipaya's snow-capped hills the morning of the final day of the mission

It is late on our final day of mission, and Carrie and Janet and I are spending the night in Santa Cruz to catch an early flight home tomorrow. The past few days are a blur. As predicted, good things happened and disappointing things happened, and we are still trying to figure out which are which. As also predicted, none of us will be quite the same after the intense and emotional experience of accompanying a diverse group of Bolivian women from Tiquipaya and Cochabamba as they undergo life-changing treatments. 

In my previous post, I talked about the Novasure procedure introduced in Tiquipaya by Dr. Carrie Giordano. The final three days of this Gyne Mission were primarily dedicated to the introduction by Dr. Janet Tomezsko of another technique that was entirely new to Tiquipaya: the Tension-Free Vaginal Tape or TVT procedure to treat stress incontinence. 

With the patient's permission, I am sharing the story of Tania, one of the women whose life has been changed for the better thanks to this procedure.

Image of Tania the morning after her surgery

Tania is an always-smiling, 53-year-old widow and mother of three bright young women. Two of her daughters are in medical school and the third recently graduated as a biologist. Tania and her husband were a humble but hard-working couple who made daily sacrifices to make sure each of their daughters could study and earn a degree. When her husband, an electrician, died suddenly last year from a stroke, Tania took on the solo task of getting her daughters through college. Her eyesight is very poor, but she proudly holds down a demanding, low-wage job in her local parish, where she is responsible for programming events and ceremonies. She walks the two kilometers between her home and the parish office four times a day, and it was during those walks, especially when she coughed or sneezed from the dust along the way, that she suffered most acutely from her embarrassing condition.

Image of TVT procedure patient, Tania, telling Jodi about her life, job, and three daughters in the O.R.

Tania was the sixth of seven incontinence patients surgically treated during this mission. The first five procedures were headed by Dr. Janet Tomezsko, who has performed thousands of TVT procedures in her 16 years of private practice in the greater Chicago area. While performing the first five TVTs in Tiquipaya, Janet explained them step-by-step for the hospital staff and interns. Tania's TVT procedure was then performed by the Hospital Director, Dr. Sandro Zambrana, under Janet's close eye and guidance.

Most of our TVT patients returned home the same day as their procedures. Because her implant was at the end of the day, Tania was kept overnight for observation. She is now home with her daughters, and she will be back at work in a few days.

We are grateful that we were able to offer the gift of a vastly improved quality of life for a total of nine women from Tiquipaya and Cochabamba. Two of these women had both the Novasure and TVT procedures. Dr. Carrie also assisted Dr. Zambrana in a complex hysterectomy, and a number of other pelvic repair procedures were performed. Several more women benefited from consultations. In addition, a Conference was hosted on Tuesday evening by the Gynecological Society of Cochabamba, at which presentations were made by Carrie and Janet on the Novasure and TVT procedures, respectively.

Image of Dr. Janet Tomezsko reassuring Tania’s daughters that the surgery went well (with Jodi translating)

As I mentioned, there were "disappointing" things that happened during this mission as well. One phenomenon that we encountered was that many women who came for consultations and who indeed desperately needed our help, in the end could not go through with or voluntarily declined their procedures. In some cases, women were forced to back out due to other health issues, such as Chagas-related heart conditions. A few women reported they could not get time off from their jobs. Our social workers also noted various cultural beliefs that may have played a role to keep others from reporting for surgery. Finally, our own Dr. Janet pointed out that even in the U.S., women often have a hard time recognizing and prioritizing their own needs amid their busy lives caring for others.

It is our hope that many of these untreated women and others will be coming in the next days and weeks to the Tiquipaya Hospital, where Dr. Zambrana and his staff are now better prepared to serve them on their own, with ongoing support through our permanent Gynecology Program managed by our local staff in Cochabamba.

Carrie, Janet, and I will keep reflecting on the progress made and lessons learned during this mission trip, as we continue to shape and drive Solidarity Bridge’s gyne program.

It's almost midnight and I have to be up in a few hours, but I couldn't sleep without updating you! Thank you, on behalf of the women of Bolivia, for reading their stories and sharing this week with us.

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