by Barbara Miller

Dr. Lewis Wall is dedicating his life to repairing obstetric fistulas of women in Africa. Nicholas Kristof, who has been writing about fistulas since 2002, lauds him for his work, as we all should.

Dr.  Wall is an ob-gyn at Washington University. When not in St. Louis, he has done many fistula repairs for women in Africa: “You take a human being who has been in the abyss of despair and –boom! — you have a transformed woman. She has her life back.”

A fistula is a hole. An obstetric fistula is a hole due to the birthing process either between the vagina and the rectum or between the between the vagina and the bladder. Because of the fistula, the woman becomes incontinent, with either urine or faeces coming out of her vagina. She is typically abandoned by her husband and becomes a social outcast.

Obstetric fistulas are common throughout much of the developing world for a variety of reasons: childbirth of very young and/or malnourished women, poverty, female genital cutting and infibulation, lack of access to prenatal and delivery care and to emergency obstetric services. Related to many of these factors is a culture of patriarchy which devalues and disempowers women and girls, offering them little say in when and how to bear a child and whether or not they can access medical care when a problem arises.

Kristof has been writing about fistulas and the heroic efforts of many to repair them, including Dr. Catherine Simpson. He is delighted that Dr. Wall will also be opening a fistula hospital soon in Niger.

Kristof tells us that Dr. Wall started out as an anthropologist working in West Africa where he learned to speak Hausa. “But he concluded that the world needed doctors more than it needed anthropologists.” So he went to medical school at age 27.

Sorry, but the world doesn’t need just “more doctors.” Starting with the great tradition launched by anthropologist/psychiatrist Arthur Kleinman, medical anthropologists have for long pointed out the limitations of western biomedicine including what its scope allows it to treat and the related narrow training of doctors. In treatment and training, technology rules. Medical students are systematically sleep deprived and distanced from their patients. Melvin Konner’s book Becoming a Doctor convincingly recounts these processes. Konner is a biocultural anthropologist with field experience among foragers of the Kalahari desert.  He decided to attend medical school, and then wrote about it as a dehumanizing rite of passage. He does not practice medicine but continues to teach anthropology and comment in the public media from time to time about how to reform medical school in the U.S.

If Dr. Wall had gone straight to medical school, chances are slim to nonexistent that he would have  repaired a single obstetric fistula in Africa.  Instead, being first an anthropologist first afforded Dr. Wall the contextual awareness and humanitarian spirit that medical school training totally bypasses.

The anthro-doc combo has become an increasingly valued option by many young people in the U.S. (if my students are a good sample, and I believe they are), popularized especially by Paul Farmer. Farmer is the only anthropologist I know who has inspired a documentary book while still living: Tracy Kidder’s Mountain beyond Mountain. Many of my students have read this book and want to become some version of Paul Farmer, combining anthropology with a profession that helps people who are resource-poor and ill. Our classes in medical anthropology and global health are always oversubscribed. I call it the “Farmer effect.”

So Dr. Wall was only partially correct. The world doesn’t need more doctors. The world needs more anthro-doctors. As well as people who combine anthropology with other healing/health-related professions such as public health, nursing, midwifery, and more. As Dr. Wall might admit:  you do need to know something about “the people.”