Vancouver doctors helping women near & far

Pair work to improve lives of women in Ethiopia and Nepal with nutrition, education and surgery

By Marissa Harshman, Columbian Health Reporter



At their office in Vancouver, Drs. Leslie Struxness and Lynn Osmundsen provide gynecological services to women. Earlier this year, they took their expertise overseas to help women in Nepal and Ethiopia.

Struxness and Osmundsen each took a break from their work at Aethena Gynecology Associates in east Vancouver to volunteer in other countries, but the work they performed during the trips differed greatly.

Struxness focused on nutrition education and birth defect prevention in Nepal. Osmundsen performed surgical procedures for women in Ethiopia whose lives have been devastated by uterine prolapse.

Both said their trips were rewarding.

“It was a life-changing experience and so rewarding to watch the entire community open themselves to the help we could provide and to commit to better health,” Struxness said.

Surgeries in Ethiopia

Osmundsen and a team of medical providers that included two other surgeons, two residents, two anesthesiologists and four nurses spent two weeks providing life-changing surgical procedures in Gimbie Town, a rural area in western Ethiopia. They performed about 60 surgeries in 11 days — all funded by financial and medical supply donations.

In rural Ethiopia, many women suffer from uterine prolapse, which occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

In Ethiopia, women often begin hard, manual labor as young as 12 years old. Then, by the time they’re 14 or 15, they begin having children. Ethiopian women often have multiple vaginal deliveries and often experience obstructed labor.

“All that put together, plus poor nutrition, leads to prolapse,” Osmundsen said.

Doctors there don’t have the education or training to provide corrective surgeries or hysterectomies, so the women are left to live with the condition for years, Osmundsen said. Some of the women operated on during Osmundsen’s trip had been living with prolapse for decades, she said.

Women with prolapse can’t work or contribute to their communities. Their husbands often leave them, and they become ostracized from their community, she said.

“When people go to the hospital in Ethiopia, they think they’re going to die,” Osmundsen said. “But they decided it’s not worth living the way they were, so they took the risk of surgery.”

A health care worker in Ethiopia spent about a year traveling to communities to find women living with prolapse and arranged for 60 women to receive corrective surgery from the visiting medical team.

“You had to try to be very efficient to get to all the cases,” Osmundsen said.

Many of the women traveled two to three days to get to the hospital. The team was able to provide surgeries for all of the women who came to the hospital. And all of the women did well, Osmundsen said, with most returning home two days after the procedure.

The youngest surgical patient was about 22 years old; the oldest was likely in her 60s, Osmundsen said. The women don’t keep track of their ages, but they do know how many times they’ve been pregnant, how many of their children lived and how many died, she said.

Most of the women had eight to 16 births, Osmundsen said.

“It’s an amazing experience to be able to go and actually help women get back into society,” she said. “The people were very grateful.”

Education in Nepal

Struxness and eight other volunteers traveled with Global Nutrition Empowerment, an Albany Ore.-based nonprofit, to provide nutrition education and distribute multivitamins in rural Nepali villages. The team helped more than 1,200 women.

In the past, Struxness has participated in surgical medical mission trips. This trip enticed her because it focused on prevention rather than correction.

Of particular focus was neural tube defect prevention.

In the first 12 weeks of fetal development, if the neural tube doesn’t fully form into the brain and spinal cord, it leads to birth defects. One of the most common forms of neural tube defect is spina bifida, which can include paralyzed legs.

Children can also die from neural tube defects, Struxness said. Those who survive are often abandoned.

Distributing folic acid and vitamin B to all women of child-bearing age — not just those who are pregnant or trying to conceive — can help to prevent the birth defects, Struxness said.

In the U.S., women typically get enough folic acid in their diet and eat fortified foods. In remote areas of Nepal, the diet consists largely of rice, potatoes and other root-based foods. They don’t have access to fortified foods either, Struxness said. That’s why the multivitamins are so important.

On the three-week trip, Struxness and the rest of the team stayed at area tea houses or family homes and then hiked to villages where they held clinics in school classrooms or women’s centers. At the clinics, women received exams, blood work, education about the need for certain vitamins and minerals, and then they would be given vitamins.

The team also educated community nurses and area doctors about the importance of folic acid for healthy pregnancies and babies. That way, the work will continue long after the volunteers have left, she said.

“You just know it’s going to be sustainable,” Struxness said. “The incentive is there, and that’s really gratifying.”

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