For L. Lewis Wall, M.D., D.Phil., professor of obstetrics and gynecology, understanding the origin and nature of human beings is essential to placing his own life and work in a greater social context.
As a boy, he dreamed of unearthing long-lost pharaohs in the land of Tutankhamun, and this love of discovery initially led him to the field of anthropology.
After completing a bachelor’s degree in anthropology and history from the University of Kansas in 1972, Wall earned a doctoral degree in social anthropology as a Rhodes Scholar at Oxford University.
But he began to rethink his path in life while living and working as an anthropologist in a mud hut in northern Nigeria on a Fulbright Fellowship: He decided that the world needed doctors more than it needed anthropologists.
The medical field was a familiar one. His father worked as a physician while Wall was growing up in a suburb of Kansas City, Kan., in the 1950s. Back then, Wall was certain of two things: He definitely didn’t want to become a physician, and he certainly didn’t want to have anything to do with obstetrics/gynecology, his father’s specialty.
But his experience in Africa changed that.
He returned to the United States and graduated from the University of Kansas School of Medicine in 1983.
While completing pre-med studies at the University of Kansas, he met Helen Pratt, an exchange student from England, who would become his wife.
When it came time to choose a specialty, Wall liked obstetrics and gynecology best.
“My father was very gracious about my decision, ” Wall says with a laugh. “He didn’t make me salt the crow before I ate it.”
Wall then completed a residency at Duke University School of Medicine and became fascinated by urogynecology, the sub-specialty that treats women who have urinary or fecal incontinence and prolapse (bulging) of the vagina, bladder and/or uterus.
“I was interested in urogynecology because it was a new frontier,” he says. “There was a pioneering aspect to it, and the diagnostic technologies were kind of mysterious and fascinating.”
He also knew that surgical repair of these problems could have a huge impact on women’s lives.
After fellowships in female urology and urodynamics at St. George’s Hospital Medical School in London and St. Mary’s Hospital for Women and Children in Manchester, England, Wall served for several years on the faculties of Duke University Medical Center and Emory University School of Medicine.
In 1994, Tom Elkins, M.D., head of the Department of Obstetrics and Gynecology at Louisiana State University (LSU) Medical Center, recruited Wall because of his African expertise. Elkins and Wall shared an interest in helping women in Africa who are injured during childbirth. Elkins also wanted Wall to develop a fellowship program at LSU.
In Africa, where girls often marry as young as 14, many girls are unable to deliver their babies safely because their birth canals are not fully developed.
The treatment for obstructed labor is a Caesarean section, but this care is not available in many parts of Africa. Instead, the young women who survive may be in labor for five or six days and deliver a stillborn baby.
They also may develop a fistula, an abnormal opening between the bladder and vagina that develops because their pelvis tissue has been crushed during obstructed labor. Fistulas cause women to lose bladder and sometimes bowel control.
Wall had seen the miserable lives of African women with fistulas. Many are divorced by their husbands, cast out by their families and must eke out a meager living without any marketable skills.
Fistulas can be repaired with an inexpensive surgery that costs about $300. During his five years at LSU, Wall made many trips to Ghana, Nigeria and Ethiopia to work with African doctors repairing fistulas and trying to raise awareness of the need for clinical facilities for these women.
“This is a desperate problem that has almost no resources devoted to it because people in the Western world are unaware that it exists,” Wall says. “In Third World countries, there are probably 3 million women with unrepaired fistulas, and there are somewhere between 30,000 and 130,000 new cases each year in Africa alone.”
In 1995, Wall established the Worldwide Fistula Fund (WFF), a foundation to raise money for fistula repair and for construction of clinical facilities that would provide these services. To date, the WFF has helped support and build a number of fistula centers in Africa. It also has provided money for training, facilities, patient care and supplies and to help raise awareness of the problem.
Steven Arrowsmith, M.D., vice president for international program development for the WFF, said he has great admiration for Wall, citing his combined expertise in urogynecology and anthropology and his tireless work on behalf of poor women in the developing world.
L. Lewis Wall
Education: Master’s degree in bioethics, Monash University, Victoria, Australia, 2001; medical degree, University of Kansas School of Medicine, 1983; doctorate in social anthropology, Oxford University, 1983; bachelor’s degree in anthropology and history, University of Kansas, Lawrence, 1972
Family: Wife, Helen, community volunteer and award-winning seamstress; son, Jimmy, senior at California Lutheran University; son, Tom, freshman at Washington University and president of the WUSTL Juggling Club
Hobbies: Reading, traveling, fine wine, jazz
“While the faculty and staff at Washington University know Dr. Wall from hospital rounds or from lecture halls, I know him from cramped bush taxis and smelly hospital wards in some of the world’s poorest places,” Arrowsmith says.
“Whether you realize it or not, you have, in Dr. Wall, a real treasure. His imposing academic credentials have given us entry into the highest levels of international policy, yet he is completely willing to work in hospitals where there is occasional electricity and where we re-use paper surgical gowns until they fall to pieces.”
Wall, who joined the WUSTL faculty in 2002, still travels to Africa a few times a year and has set up programs between the Ghana and WUSTL medical schools to exchange faculty and residents.
At the medical school, Wall divides his time between seeing patients with urogynecology problems, doing surgery, training residents and lecturing to second- and third-year medical students.
David Mutch, M.D., the Ira C. and Judith Gall Professor of Obstetrics and Gynecology, met Wall in 1984 when they were both training at Duke, and calls him a great friend. “He is perhaps one of the most ethical individuals that I know,” Mutch says. “He also truly embodies the academic physician in that he holds true to the tripartite mission of patient care, research and teaching.”
Wall also has a joint appointment in the Department of Anthropology and teaches “Anthropological Perspectives on the Fetus.”
Wall says he has to combine medicine with anthropology. “I think I realized a long time ago that medicine only exists and only works in a worthwhile fashion if you take into account the historical and social context,” he says. “You’ve got to see the bigger picture.”
James Schreiber, M.D., professor of obstetrics and gynecology and the former head of the Department of Obstetrics and Gynecology who recruited Wall to WUSTL, says Wall is a true academician. “He has studied the difficulties that women’s health faces in Africa, and most importantly, he has done something about it. He brings honor to himself, to the medical profession and to the University.”