[Lisa Ling] Coming up, on Life on the Line: [speaking in native language] [female voice] Having a vesicovaginal fistula completely changes a woman's life.

A vesicovaginal fistula is a hole that develops between your bladder and your vagina so that urine just leaks out.

[speaking in native language] Imagine just being wet all the time.

Oftentimes, the husbands leave them.

Oftentimes, it was the result of a difficult delivery, so that baby died.

Their family members get tired of taking care of them, 'cause they can't get a job, 'cause nobody wants to be around somebody that smells like that.

[speaking in native language] [dramatic music] [dramatic music] [shallow breathing] [dramatic music] [dramatic music] [voices, gunfire] [dramatic music] [music swells] [music swells] [machine beeping slowly] [Lisa Ling] Life on the Line An inspiring look into personal journeys of hope and determination.

[female voice] [speaking in native language] [Danae] A vesicovaginal fistula is a hole that develops between your bladder and your vagina, and most often in developing countries it's from a difficult obstetric complication.

Let's say the baby's head is trying to deliver, and it gets blocked and it can't deliver, so it stays for hours, even days, not delivering, and then the tissue between the vagina and the bladder dies.

It forms a hole in between so that urine just leaks out.

[speaking in native language] [Lisa Ling] For two years, Famalta lived with a fistula.

Ostracized by her family, she had no money and no way to fix her problem.

[speaking in native language] [Danae] Imagine just being wet all the time.

People don't even have money for regular clothes, let alone if they're wet all the time and they have to wash them.

So then, they go around smelling like urine.

Oftentimes, the husbands leave them.

Oftentimes, it was a result of a difficult delivery, so that baby died.

Their family members get tired of taking care of them because they smell, and they can't get a job, they can't go to the market, because nobody wants to be around somebody that smells like that.

[musical chime] [Lisa Ling] Two years ago, Famalta heard Bere Adventist Hospital was having a fistula week: a week when they're doing fistula surgeries for free.

She sold all of her clothes to pay for a motorcycle to take her and her son to the hospital with the hopes of starting a new life.

She never went back home.

[Danae] So, I went through four years of obstetrics and gynecology training and never saw one fistula in America because most people deliver in the hospital and get good care.

So, when I came to Africa, I didn't know how to repair them.

I wasn't trained to do them.

But, slowly started doing some of the easier ones, through reading the books and talking to different people who had done them.

And then, I invited an expert to come and help me, and we did 28 in one week, and it was an amazing week because I learned a lot from him.

Famalta was one of the early patients to go to Bere for surgery.

She first came to me a couple of years ago and, Famalta's fistula was actually not a very difficult one to repair.

[speaking in native language] [speaking in native language] [Lisa Ling] Dr. Nederberg continued doing fistula weeks, sending out announcements over the radio.

[male voice on radio speaking in native language] [Lisa Ling] It's the only way women like Rebecca might hear about the potential for help.

Before hearing the radio announcement, she didn't know if there could be a solution for her problem.

[speaking in native language] [Lisa Ling] Rebecca has lived with her fistula for 20 years, not knowing it could be fixed.

Because of the way she's treated, she rarely leaves home.

[speaking in native language] There is a way to diagnose a woman here with a vesicovaginal fistula even without doing an exam, and that's usually when I get really close to them, 'cause you, I can now smell their urine.

Um, oftentimes women put on perfume and they mask the urine running down their leg.

But when I go down to do the exam they have layers and layers of cloth that they tie up, and they put a string around their waist and they tie it in between their legs, and it is wet constantly.

But at least it's not running down their legs so they're not, people aren't noticing that they're dripping.

Um, but it's very--as you can imagine--it's very embarrassing for them, um, so they try to do everything possible to cover that up.

[melancholy piano chords] [speaking in native language] [piano chords cont.]

[Lisa Ling] Even though Rebecca only lives 10 miles from the hospital, it takes an entire day for her and her husband to travel there by bicycle.

Unlike most women with a fistula, Rebecca's husband has not left her.

[melancholy piano cont.]

[Danae] Patients walk a long ways; patients bike a long ways; patients take donkeys, patients ride on an oxcart.

They come in all different forms, and they come from very far away.

And, if you can imagine, those same patients are the ones that couldn't get here in an emergency for a, a delivery.

So these same patients come from all over the place to try and make it to obstetric care.

So, it's all about access to good health care.

Rebecca arrives at the hospital and is evaluated.

Dr. Nederberg will do her surgery in the morning.

[upbeat music] [Danae] A typical day would involve us waking up around 6:15, 6:30.

[male voice] Or whenever the kids start making too much racket.

The Nederbergs stay busy, splitting their time between the hospital and their four children: Lyle, Zane, Addison, and Juniper.

Their journey together started in medical school.

Bye, bye.

Bye, I love you.

[Olen] I met Danae at Loma Linda at the medical school retreat that they have every year.

I always wanted a guy that would live in a hut in Africa, and my roommate was in his class.

And one day, she came home and she was like, "I think I found a guy that would live in a hut in Africa."

And I was like, "Yeah, right.

He's a poser."

I went up and talked to her, with all the courage I could muster.

And she humored me.

And then, the rest is history.

This month, we've been in Chad nine years.

I had always wanted to come back to Africa, after I spent a year in Zambia doing humanitarian work.

Olen had spent some time in Africa, traveling around for about six months.

He was inspired because of his time in Africa.

[Lisa Ling] An emergency room physician, Olen spends his morning doing administrative work and helping where he's needed.

This morning, he's doing rounds on Pediatrics.

[Olen] So I had a hemoglobin of 3.

I had one yesterday with a hemoglobin of 2: anemia that you never see in America.

This is the Africa that we imagined.

This is where we always saw ourselves serving.

We read the statistics on Chad, and we thought, you know, maternal care is atrocious in Chad.

Danae is a OB-GYN.

This is where we can really make an impact.

So, we ended up in Bere, Chad.

[Lisa Ling] As Olen heads back from the hospital to homeschool the kids, Danae's day is just getting started as she heads to the operating room to begin preparing for Rebecca's surgery.

Bye, I love you.

[music] [Lisa Ling] Famalta is on her way to the hospital, too.

She works there, helping prepare formula for malnourished children and educating new mothers.

[speaking in native language] [Lisa Ling] During fistula week, she also meets with women who will be having surgery to fix their fistulas; telling them her story and letting them know that they're not alone and that life can get better.

On this morning, she talks with three women who have surgery scheduled for later in the day, including Rebecca.

[speaking in native language] [speaking in native language] [tense music] [speaking in native language] [hopeful music] [hopeful music] Women suffer with this sickness and you can see here, this is urine, it just drips down her leg and it, it's dusty here, so it's really difficult.

People, there's no pavement or anything, so, it gets in their shoes, and I imagine that walking in a dusty land, it's, it's, it gets so you're walking in mud, basically, urine-mud.

Um, so these are her shoes and urine, and today we're gonna fix that.

[hopeful guitar anthem] [machine beeping] [Danae] It got complicated.

Her ureters ended up being right on the incision line.

Fistula surgeries are sometimes easy, and they're sometimes hard.

And sometimes in the beginning you think they're easy, and they become hard, and sometimes they're hard and you think they're easy.

So, you just sometimes can't tell before the surgery.

[Lisa Ling] For Rebecca, it'll be four weeks before her Foley catheter is removed and we know for sure her surgery was a success.

[Danae] Rebecca will stay at the hospital during her whole time.

There is risk after the surgery of an infection, and if the Foley catheter gets blocked, the nurses know to emergently call me so I can come and either remove a blood clot or change the catheter.

The biggest risk is obviously the first couple of days.

Sometimes I come in the night and make sure the nurses are doing their job because it's such a hard surgery, and you go through a lot of stress.

I kinda look; I'’m on my knees; my clothes are wet with urine; my shoes are wet with urine.

It is a lot of, a lot of stress just waiting, but, makes it all better in the end.

[Lisa Ling] As Rebecca begins her recovery and post-op, another patient, Isabel, is brought into the operating room.

She's been in labor all night, and she just arrived at the hospital.

She's not only at high risk of developing a fistula, but at this point, her health and her baby's health is at risk, too.

[Danae] She's been in labor all night, and the baby's not coming down.

Um, the head is hitting the pubic bone so hard, um, so imagine if the head was hitting that, that so long and the baby couldn't come out, if they're at home in the village, then that's how a fistula is formed.

It makes that tissue die in between the bladder and the vagina, and then, um, a fistula forms.

[machine beeping] [Lisa Ling] Dr. Nederberg begins a C-section surgery, the safest way for Isabel to delivery her baby and to prevent complications like a fistula.

But when the baby comes out, there's a problem.

[indiscernible] Very sad story.

[tense music] [machine beeping rapidly] [speaking in native language] [Danae] Come on, baby.

[beeping slows down] Come on, baby.

[sound of baby crying] Yay!

Oh, Lord.

[baby crying] [music] The baby was sicker than I thought.

We don't have um, fetal monitoring here, so I actually didn't think the baby would live.

So I'm very happy that the baby finally cried and they were able to resuscitate the baby.

[baby crying] [machine beeping] She could have easily had a fistula because she was in labor for so long.

If she would have delivered at home, she would have hemorrhaged and died.

And the baby would have died, too, because as you see, we barely saved that baby here.

But the baby would have died and the mom would have died.

[machine beeping] [Lisa Ling] For women with fistulas, the idea of having surgery and spending four weeks at a hospital to recover can be financially impossible.

These patients are some of the poorer patients.

They don't come here because they know at the hospital it's gonna cost money.

So, all surgical costs are free; hospitalization is free; all medicines are free.

And, now, even in the last couple of years, I'm like, "Well, I'll pay for your food, too.

Please, just come."

For this fistula week, Dr. Nederberg has even hired Famalta to cook for the patients.

Now, they have no excuse not to come.

And even if their husband or other family member says, "Well, I have to go to the fields.

Or, I have to go to work, I can't take care of them," We're like, "Oh, we don't need you anyways 'cause now we have Famalta, so we don't need anybody else to take care of them."

[speaking in native language] As night falls, Dr. Nederberg checks on Rebecca before going home.

[speaking in native language] Rebecca looks great.

She's having a little bit of pain, but she looks fine.

Everything looks good with her Foley and her stents, so, we're happy.

[speaking in native language] All right, I'm going home.

Call me if you need.

[door creaking] [car engine] [Danae] I have noticed that women often come in rags, and their clothes are soaked in urine, and they smell bad.

Even when you wash them with soap, they smell really bad.

So, we're going to the market to buy some fabric.

Uh, my fistula ladies are ready for their dresses, and we're gonna go buy some material so we can make new dresses for them.

It's very exciting and one of my most favorite times of the fistula week.

[speaking in native language] I found this awesome fabric, and I'm so excited, 'cause it's the perfect fabric and they had it here in Bere, so I'm very excited about it.

We have talked to Jonathan.

who is a nurse that works in the hospital and one of my good friends.

And, he has always done my fistula dresses, and he knows the, he only has a few days to do them and usually and, um, I have given him all the fabrics and he's gonna make dresses for them.

So, it's exciting.

[whir of sewing machine] [speaking in native language] So, Rebecca is doing fantastic.

She's up, walking around.

She's several days out from her surgery, and she's dry, and she's drinking plenty of water, and she's meeting all of her milestones after her surgery.

[speaking in native language] Women who recover, they have been through such a long, rough, difficult life.

I don't think they can ever be the same anymore.

Even though, yes, you healed them and they can have a new life, and they can have a new dream, it's still difficult for them because, you know, everything they had hoped for before, like having children and a happy marriage and good life and all that is, it's just not the same.

[speaking in native language] [Danae] Today we're here to celebrate getting new dresses for all of our fistula women.

So, they've suffered for their sickness for a long time, and now they're here to get a new dress, and they no longer have to smell like urine.

So, we're very excited to give them a new dress.

They're sisters together, and they will always be united with this healing together.

[sound of singing; clapping; a flute; drumming] [sound of singing; clapping; a flute; drumming] [clapping, singing and drumming cont.]

This program was made possible by the Ralph and Carolyn Thompson Charitable Foundation; the Foundation for Adventist Education; and the Kendrick Foundation.