In college psychology, I recall studying the phenomenon called “learned helplessness,” which was studied in animals and applies equally to human behavior. In the learned helplessness experiment, an animal is repeatedly hurt by an adverse stimulus which it cannot escape. Eventually, the animal will stop trying to avoid the pain as it has learned that it is helpless to change the situation. Finally, when opportunities to escape are presented, the animal doesn’t escape. It simply passively puts up with the discomfort.

When we are counseling patients or friends in our country who feel helpless or depressed it is quite easy to encourage them to imagine a light at the end of the tunnel, that things are not really that bad or that there is genuine hope that the future holds something brighter. In Africa, it was tough to present much optimism about the future for most people. Except for those who could benefit from the services or charity that we were offering, the situation genuinely seemed bleak.  If your child gets sick, she will likely die. If your husband loses his job, he will likely not find another one and your family will starve.  You will never get an education because you have no money and there are no resources available to help you.

A picture that stands out in my mind is of a group of able-bodied young men sitting by the side of the road surrounded by trash. No one is picking it up. The passengers of cars driving by throw more trash onto the road. When I first arrived this made me furious and it was impossible to understand, but after a couple of weeks, it made complete sense. The internal drive to pick up trash or to do anything to improve one’s environment requires the underlying belief that you have the power to make things better, and requires that you have the hope and expectation that life will go on for some time in the future.  For many Sierra Leoneans, life is measured one day at a time, and very real events including a horrific civil war and the inability of the government to rebuild basic infrastructure even 10 years later, have taught them that bad things will happen and there is nothing they can do about it.

Our sweet surgical patients had a similar resolve to put up with anything that we would do to them, no question asked. When faced with a terrifying situation like having a spinal anesthetic placed in an operating room, followed by a surgery that they didn’t really understand, they simply laid still and let it happen. The look in their eyes was a mixture of terror and complete disempowerment, complete surrender to anything the future might bring. They had just given up, they had no fight. After what they had been through, including genital mutilation, teen marriage, prolonged labor, the death of their baby, some type of horrific procedure to remove the dead baby followed by a fistula and the life that goes along with leaking urine constantly, the most surprising thing to me was that they were not all suicidal.  The hope that we might be able to cure them of their fistula problem might have been the only hopeful event that they had ever experienced.

What I learned is that the single most important gift that we have all been given by living in this country is HOPE.  With rare exceptions, no matter what terrible situations we find ourselves in, we can be hopeful that someone will help us, there is usually a reason to believe that tomorrow might be a better day.  We have opportunities, sometimes too many to choose from, and many of us struggle to decide which path our lives should take from the many that are presented to us.

It is easy to criticize people in the developing world for not getting their act together and fixing their own situation, but to do that requires hope and opportunity that is simply not present.  What I learned is that hope and opportunity are gifts, gifts that I didn’t earn or deserve, but were given to me by the fortunate accident that I was born in the Western World. In providing hope to our surgical patients, teaching them that good things can happen and that people do exist who will treat you with love and compassion and that life can be better tomorrow, I hope that I started the process of reversing the plague of learned helplessness. We can pump money into Africa but what they really need is to learn that they can do things themselves.  I like to think that our fistula program is not just about fixing holes in the bladder; it is fixing holes in the heart and in the psyche.  I pray that some of our patients will be inspired to want something better for themselves, and not to repeat their parents’ mistakes with their own daughters. One woman at a time, perhaps we can make a change.