Obstetric fistula is a complication of childbirth that occurs regularly in developing countries. Prolonged or obstructed labor results in a tear in the birth canal, which leads to chronic incontinence — and with that often comes social isolation and marginalization.
But most important, he has become a witness to faith for his personal commitment in the campaign for access to antiretroviral drugs for the HIV-ravaged population. He contracted HIV in 2002 due to his constant contact with tainted blood through surgery.
A 73-year-old Bolognese Italian, Father Marchesini entered the Congregation of the Priests of the Sacred Heart of Jesus (also known as the Dehonians) in 1961, while attending his second year of medical school in Bologna. He was ordained to the priesthood in 1969 and arrived in Africa in 1973, as one of the 1,200 doctors serving a population of 23 million spread throughout a territory that is almost twice the size of California.
In June, Father Marchesini won an award for his commitment to the lives of women in Africa from the United Nations Population Fund (UNFPA), an organization most known for its commitment to spread contraception, abortion services and sterilization throughout the globe.
“Living with the poorest ones is an extraordinary experience because, little by little, we can understand an important truth declared by Jesus: The wise and intelligent cannot understand the world’s secrets. On the contrary, these are open and clear to the poor and little ones,” he said in a July 28 interview with the Register. The rest of the interview follows.
Father Marchesini, how has your life in Africa unfolded?
As soon as I finished university, I was eager to arrive in Africa and start my missionary work. I’ve always been fascinated by Mary rushing to reach Elizabeth: “In those days, Mary arose and went with haste into the hill country, to a town in Judah” (Luke 1:39). I felt the same haste.
I arrived in Africa in 1973, a few months before my 29th birthday. I remained in Uganda for one and a half years. I lived with the Combonians [Comboni Missionaries of the Heart of Jesus], but I also had the extraordinary experience of living the unity of the Church and the communion of all the missionaries of the different religious families.
I was invited to spend one year learning the principles of surgery necessary in Africa from Comboni priest and doctor Giuseppe Ambrosoli, a surgeon who had just opened a great hospital in the midst of the savannah. It was an unforgettable year. We operated together on all the cases of elective surgery and all the emergencies, more than 800 interventions.
Later on, I spent some months in St. Mary Hospital of Lacor, near Gulu, directed by the great Canadian surgeon and lay missionary Lucille Teasdale Corti, who taught me a lot.
I’ll never forget the strength and courage of this extraordinary woman, even in the most difficult circumstances and interventions. Her funeral in 1996, when she was finally defeated by HIV-AIDS — contracted while operating on soldiers and injured people in the endless war in Uganda — provoked an immense wake of emotion all over Uganda.
What sanitary situation did you find in Mozambique, and how have you seen the country developing in 40 years?
In 1974, I reached my brother missionaries in Mozambique, and I was employed in the Provincial Hospital in Quelimane. At that time, Mozambique was facing the tremendous challenge of rebuilding the health-care system after the return to Portugal in 1975 of almost all of the physicians, nurses, biologists and technicians.
For many years, emphasis has been given on preventive medicine rather than curative care. Therefore, lots of vocational training courses have been created to form paramedical staff in all sectors of medicine: laboratories, radiology, physiotherapy, ophthalmology, dental medicine, obstetrics, etc.
Unfortunately, few efforts were invested in increasing the number of doctors and specialists. Sanitary network has been widened, but it’s still insufficient, as are the medical and pharmacological supplies. A lot needs to be done.
After the war that tore Mozambique apart from 1982 to 1992, what do you remember of the increasing epidemic of HIV-AIDS — the prevalence today is up to an estimated 11.5% of the population, concerning 1.6 million Mozambicans?
Since the beginning of the ’90s, my medical activity constantly put me in contact with HIV-positive people, whose sickness become more and more grave and painful until they died. It was a real torment for me, because, in the hospital, I was the oldest one, and my colleagues often asked me to be the one to inform the person and the family about the situation. [To] make them know the truth was really hard.
I cannot forget one of my young collaborators, a nurse, approaching me at the end of 2002 and, among tears, telling me that he had discovered he was HIV positive. He had three children and was full of anguish: Who would take care of them after his death?
I tried to comfort him, saying that the medicine was making great progress and that he might live many years with antiretroviral drugs. He seemed to take some kind of relief from my words, but he asked me to keep the secret: The stigma was stronger than ever. Three months later, I started to feel ill and discovered that I had become HIV-positive, too.
How did you feel at that moment?
I felt I had become a different category of person. I felt as if I was on a train, in a compartment that had been secretly swapped and that had started running parallel to the train.
I felt as if I were alone in the compartment, while the rest of the world, the rest of life, was thundering forward on another track. The two trains were forever separated, and there was no chance of getting back to the first one. I started to think about the reality of death. Not only my patients were dying; in a certain sense, I had started to die, too.
Dying makes you feel that you are no longer of worth, on a physical and biological level. It was a humiliation that I had to accept. I accepted it, and from that moment, the doors of a spiritual freedom that I had never known before were opened. I also discovered that I had had an enormously long life: This made me feel happy and “full of days.” But what really made the difference for me, regarding the comprehension of death, was a passage of St. Paul’s Letter to the Romans: “No one lives for oneself, and no one dies for oneself. For if we live, we live for the Lord; and if we die, we die for the Lord; so then, whether we live or die, we are the Lord’s” (14:7-8).
The double reality of life and death no longer existed: Whether I live or die, I belong to the Lord. This becomes the only true reality. It is exactly that peace of heart that allows one to be as happy to live as to die. Happy to live because I live for the Lord; happy to die because I die for the Lord.
I think that there cannot be a greater inner freedom, so great that it was necessary for Jesus to die and to resurrect to achieve it: “For this is why Christ died and came to life, that he might be Lord of both the dead and the living” (Romans 14:9).
Why did you decide to announce your diagnosis publicly?
Many people refused to undergo HIV testing because they were terrified to be refused by society. I was aware that since everybody knew me, I should publicly announce that I was HIV-positive and that I was being treated. I thought maybe that would help many people get over their fears.
How did you start your campaign for antiretroviral drugs?
Being Italian, I had access to all the drugs necessary. But I felt embarrassed by the thought that, in Quelimane, where 16% of the people were HIV-positive — meaning thousands are in a pre-terminal phase and will all die — “I’ll be the only one who’ll survive because I have antiretrovirals. I need to do something so that at least the people of Quelimane have a chance of being helped, too.”
You also become involved in the social emergency of 1.6 million orphans in Mozambique.
In a few years, I found myself living in a society full of children and young people without parents. Relatives open their arms to take care of these children, but it’s not enough. The number of cases without any help has increased; we have witnessed in the past 20 years the opening of many orphanages on behalf of religious institutions.
Feeding these children and giving them clothes and education creates an economic need that only solidarity in the name of the Lord, in the name of the Gospel, can fulfill.
How do you manage to get support for three orphanages?
I had seen the so-called distance adoption in many countries: I suggested to the nuns of various religious institutes to develop this system. We saw that the cost per month of every child, among feeding, education, housing, was around $35 per month. I tried to shed light on this reality through our website, asking our friends and patrons in Italy and elsewhere to raise funds and support us.
To maintain the interest in these children, you have to be writing, sending pictures, replying and taking care of the contacts. Without the help of my sister, Maria Teresa, who lives in Milan, and several other friends, it would be impossible.
You have become a master and teacher of surgery in Mozambique for the treatment of obstetric fistulas. How did you meet this particular category of sick women?
Among the first operations that I performed in Uganda with Dr. Ambrosoli, there were three cases of obstetric fistulas. This is a complication of childbirth occurring almost exclusively in places where basic maternal health care is unavailable: Prolonged or obstructed labor tears a hole in the birth canal, leading to chronic incontinence and, often, social isolation and marginalization.
The importance that Father Ambrosoli gave to these few cases caught my attention: He explained the painful consequences that those young mothers would have faced for the rest of their lives if they hadn’t found a surgeon who was able to operate on them.
He had learned how to do that and considered it of extreme importance that I learned, too. Since my first years of working, I have been struck by the tragedy and the discrimination of these unlucky mothers and by their moral strength. None of them came to my hospital and left without being operated on. The number of women with this kind of wound arriving in Quelimane increased, and I started to travel all over the country, to hospitals in Mocuba, Tete and Songo, to cure them.
For years, you were the only doctor in Mozambique treating their condition.
For many years, the obstetric fistula has been a neglected infirmity, and this has created a vicious circle. Little interest means few surgeons committing themselves to operating on them and, therefore, resigned acceptance of a difficult situation by the families, whereas the only solution is the surgical one. That’s why I committed myself to teach the surgical fixing technique to Mozambican young surgeons. It is calculated that, in the developing countries, two fistulas are formed per 1,000 childbirths. In Mozambique, with 1 million childbirths per year, every year there are at least 2,000 new obstetric fistulas.
In nearly 30 years, you have already trained 13 surgeons, and another 11 are learning. Have things improved, in your perception?
Yes, since the start of the new millennium, the World Health Organization has highlighted obstetric fistulas as a situation that deserves privileged attention; and the solution to this wound has been chosen as one of the “Third Millennium Goals”: All governments have been urged to undertake concrete measures.
I must say, after all these years, after this big number of patients has come into my life and has occupied a huge part of my time and of my energies, that seeing these women being operated and healing, and coming back to their families, is like assisting at the beginning of a new life. It is a priceless joy and satisfaction.
What are the main teachings that life in Africa has given you?
Jesus said: “For you will always have the poor with you” (Mark 14:7). Few truths are more self-evident than this one, especially for those who, during their lives, have had to dwell in those areas of the world where the most common sentence is: “There is nothing.”
Living with the poorest ones is an extraordinary experience because, little by little, we can understand another truth, also declared by Jesus: The wise and intelligent cannot understand the world’s secrets. On the contrary, these are open and clear to the poor and little ones.
To give you an example, I’ll tell you what happened at the end of the first obstetric fistulas campaign in rural areas that I could organize in 1987. At that time, I was alone, and it lasted almost a month. The last day, all my patients gathered in a hall to say good-bye. They were sitting on a row of benches, and I passed in front of each of them to shake their hands and say good-bye. I had just started when the third woman suddenly stood up, and, instead of shaking my hands, she hugged and kissed me. And after her, all the others did the same: They stood up and kissed me.
What surgical fee could be compared to such a reward that only poor people are able to give?
Indeed, it’s true: The most inaccessible world’s secrets are open and clear to the poor and little ones, as Jesus said: “I praise you, Father, Lord of heaven and earth, because you have hidden these things from the wise and learned and revealed them to little children” (Luke 10:21).
You received the World Population Award from the UNFPA for your commitment to maternal health care in Mozambique. How do you feel being the first priest of the Catholic Church to be awarded by such an institution, whose methods are notoriously in contrast with the teachings of the Catholic Church?
Although we have a different vision on sexual and reproductive ethics, we have a mutual esteem, and we work together on a common value, which is maternal health care in developing countries.
I have been constantly addressed as “Father” with the greatest cordiality, and they were sincerely happy that I was awarded. After all, the main difference between us regards the theological vision of the human being and the consequences of the interpretation of the revealed Gospel.
I also believe that a genuine love for the mother can only come from the Holy Spirit: He and love unite us. So I would say that this award is a gift of communion, a gift on behalf of Our Lord, God the Father, to his children.