Dr. Darius Maggi is working on the next step in a journey he began almost 20 years ago.

Maggi (pronounced ‘Madge’), a retired Texoma physician, took his retirement to a new level when he began spending all his time helping patients in Africa in 2001. A hiatus last year actually helped Maggi focus on what he should do next for the people of the “Dark Continent.”

“In the back of my mind. It’s what I’ve always wanted to do,” explained Maggi, who is still based in Denison. “I want to teach local doctors to do the surgery. I plan to go to Kenya in June to do my first teaching with doctors there. I’m looking forward to it.”

According to Maggi, it’s the natural progression of what a longtime local OBGYN has been doing in west coast African countries for almost two decades. ‘The surgery” Maggi mentioned is a specific one: obstetric fistula surgery. Maggi explained that a “fistula” is a hole which presents itself in an organ for whatever reason, and an obstetrical fistula is a hole in the uterus due to prolonged labor. The fistula usually continues into adjacent organs, including the bladder.

“These women have uncontrolled urine running down their legs almost all the time. They are shunned and ostracized by everyone in their village,” Maggi said. “They are told they have bad spirits in them. They are ridiculed. Many of them go off in the bush and die rather than live that way.”

These obstetrical fistulas are basically unheard of in the western modernized world because there is no such thing as “prolonged labor,” as women who have access to modern healthcare simply have a C-section, if necessary. In Africa, where healthcare is almost non-existent, women have to endure whatever labor happens to them. Usually, it’s the baby’s head that rubs the uterine wall to create the fistula, as the baby is there a significant amount of time— thus making a hole possible.

“I’ve met African women who have endured 15 days of labor— not 15 hours, but days of labor,” Maggi said. “When we first started seeing them, there were hundreds of women waiting to be seen. The line went outside for days on end. All of them with fistulas, all of them having this problem.”

Maggi made four trips to Ghana, a small country on the west coast of Africa, in 2001 - 2002, and then was told of Sierra Leone, a nearby country situated west of Ghana that had been devastated by a decade-long civil war. The need was greater, and Maggi heard the call to move further into the continent. Sierra Leone was considered the poorest country in the world at that time. The war had just ended when Maggi arrived in November 2002; there were still 17,500 UN troops on site to “keep the peace.”

“The whole country was just war torn and destroyed.

Another doctor (Dr. Mimi Gettinger, of New York) went with me to help with the amputees,” Maggi recalled. “The rebels loved to cut off body parts when they came to a village during the war. They would ask people which hand or arm or foot they wanted to keep and then cut that one off anyway. It was a cruel game to those rebels.”

Along with the problem of obstetric fistulas, the people of Sierra Leone were also facing a population with severe amputees. It was a radically different climate than that in the western world. Sierra Leone’s economic situation bled into their healthcare system, as Maggi explained that local doctors had no vaginal surgery training, as other types of surgery were more lucrative.

“It was really a sad situation. The doctors there would like to do them (vaginal surgeries), but no one had money for those procedures, so the doctors didn’t (perform) them,” Maggi said. “A man traveling through Ghana heard of what I was doing and told me of the situation in Sierra Leone. It seemed the perfect place to do my work.”

Maggi would spend the next 15 years in Sierra Leone— five years in Freetown and ten in Bo, where he was stationed at the largest hospital in the country. Maggi added that many of the women had tried witchcraft and voodoo in order to get some sort of relief from their fistulas. The graveyard next to the hospital gave the women incentive to try anything, including the American doctor who actually gave them results.

“They prayed for relief,” Maggi said. “We saw a woman who had lived with a fistula for 50 years. One was even worried we would sell her into slavery now that she was ‘dry.’ Most didn’t know their age or where they were born. They couldn’t read or write. They just hoped we could help them.”

Even with 400 beds in the Bo hospital, fistula patients were two to a bed, according to Maggi. The staff had to feed the women just to try and get them up to surgical weight. Maggi remembered one woman who only weighed 65 pounds. Maggi and his staff dealt with challenging conditions such as spotty electricity, lack of supplies, local officials’ corruption and even an Ebola outbreak in 2014. There was “drop foot,” malnutrition and bladder stones to worry about, too.

“The maternal mortality rate was the highest in the world. More than 2,100 deaths per 100,000 women,” Maggi recalled. “And one in three children didn’t make it to age five. We were up against it.”

“Their mental state was horrible,” Maggi added. “But everything changed after the surgery.”

According to Maggi, the women were “so happy” when they left the hospital after surgery that they would try to pay with chickens, pineapple, mangos and palm oil— anything they had.

“So many were malnourished when they came in. They had typhoid and Lassa fever,” Maggi said. “We worked on all that, too. We bought them dresses and gave some manicures to help them feel better about themselves. We would hold ‘discharge ceremonies’ where the women would wave goodbye to their catheters.”

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Maggi is still working to help the people in Africa, even as local and national governments put a wrench in the works from time to time, including now.

“I’ve had to put on hold my work in Sierra Leone with all the changes in the government there. There is a new president and I’ve only go to go twice last year and not at all this year,” explained Maggi. “But it’s given my mission a new focus. I’ve been to Africa 48 times and I feel extremely blessed and fortunate to give back. These people don’t know what an obstetric fistula is and they’ve never heard of a C-section. It’s very gratifying to help them.”

As part of his work, Maggi created the West Africa Fistula Foundation (waff.org), which uses all donations for direct work with patients in Africa. The doctors who work with Maggi (including Maggi himself) pay for their own travel and accommodations when they give of their time to this medical charity.

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Maggi takes on a more serious tone when he discusses his motivations and the history of his work in Africa. It began innocuously enough, but another aspect of the medical world focused his energy into helping those living on a distant continent.

“I’ve always wanted to help people in Africa. This comes from being a boy in church all those years ago and listening to missionaries talk of their work there,” Maggi confessed. “Even then, I wanted to go and wondered what I would do.”

However, it was a more practical event that put Africa square in Maggi’s sights decades later. By then he was a long-practicing physician, but the act of “being a doctor” was becoming harder and harder, and in Maggi’s opinion, not what he wanted.

“I was fed up with the system by then. The bureaucracy of insurance, costs, regulations and litigation was overwhelming,” he said. “The paperwork alone was astronomical. Doctors must protect themselves from the courts. It became such a waste of time, money and energy just to be a doctor.”

“I realized I wanted to do something that helped people without all the hassle,” Maggi continued. “Once I found I could do something in Africa, all those feelings from childhood came back. I knew what I had to do. I just wish I had done it earlier.”

It quickly became apparent that Maggi had made the right decision. The work was helpful to people and gratifying for him.

“You can do so much for so little in Africa,” Maggi said. “You can help so many more people than anywhere else. That’s what I wanted to do. There is no greater feeling than seeing a patient get better after suffering all her adult life and (seeing) how grateful she is! You can’t put a price tag on that feeling.”

Maggi learned of the need in Africa in the normal course of his doctoral training, during his residency at New Orleans’ Charity Hospital in the 1970s at hands of Dr. Jack Robertson.

“He came to give a lecture at the hospital. I talked to him afterward and he told me of his work in Africa,” Maggi recalled. “He planted the seed in me then. I knew I wanted to go someday, but didn’t know what I would do there.”

Robertson, who died in 2015, was a “distinguished man of medicine,” said Maggi. “I had a lot of respect for him. We began a dialogue over the years. I even visited him in California, where he practiced. He did such good work and was a super nice guy.”

From that first chance meeting at Charity, Maggi has gone on to do some 1,600 obstetric fistula surgeries and more than 600 other surgeries on those in Africa. This work will not end, but Maggi is happy to take the next step in helping those in need in the largely poor countries of Africa.

“Teaching those local doctors how to do the fistula surgeries is the next step for them to get control of their medical situation,” Maggi said. “This is a brand new exploratory program. There will be four doctors going to Kenya to teach. We’ll start out slow and simple, then see what we need to add.”

“I always wanted to teach,” Maggi said. “The Sierra Leone situation was so intriguing because so many women needed help, but now the need is in Kenya. We are going out in the country, away from the bigger cities there. We can help so many more people in Africa this way.”

Maggi is a big believer in the concept of “paying it forward,” or passing it down to the next generation. But regardless of how this latest endeavor goes, Maggi will keep that first stop (Sierra Leone) close to his heart.

“I want to go back and check on the government there to see where we stand,” Maggi said. “I know that many local doctors there now have been trained in the U.S. and know something about fistulas. I would love to see them take over the project. They know the people and the culture; this is the way it should be. I feel I have done some good just to get it started.”

Yet Maggi doesn’t let his thinking be small as he looks globally in terms of the future of fixing the obstetric fistula situation.

“The goal is to prevent it worldwide some day, if possible,” said Maggi. “That’s what I’m striving for — to see the relief on their faces that wasn’t there before.”

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Though there is more work to do — and he plans to keep doing it — Maggi knows what he wants his legacy to be. To him, it’s simple — he does this work because it’s the right thing to do.

“I hope (my legacy) will be helping my fellow man” he said with a smile. “This is the kind of work that feeds your soul.”