L. Lewis Wall

L. Lewis Wall

Professor Emeritus of Sociocultural Anthropology and of Obstetrics and Gynecology (School of Medicine)
Selina Okin Kim Conner Professor in Arts and Sciences for Medical Anthropology
DPhil, Oxford University
MD, University of Kansas
Master of Bioethics, Monash University
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    Professor Wall's research interests involve the intersection of biology and culture, with particular reference to women’s reproductive health. 

    Wall is particularly interested in the social and clinical aspects of reproductive health problems in developing countries and has been actively involved in a variety of clinical projects in Ethiopia, Uganda, Nigeria, Ghana, and Niger. 

    At present he is working with the College of Health Sciences at Mekelle University in northern Ethiopia on a variety of clinical projects involving utero-vaginal prolapse, urinary incontinence, obstetric fistula, gestational trophoblastic disease, and other women’s health concerns. He is working with the university to improve residency training in obstetrics and gynecology, as well as to develop a multi-center collaborative fellowship training program in urogynecology and reconstructive pelvic surgery.

    In addition to the clinical work with the College of Health Sciences, Wall is engaged in a large collaborative project to improve the lives of adolescent schoolgirls in Ethiopia. The Menstrual Dignity Project is a collaborative effort between Mekelle University, the Mariam Seba Sanitary Products Factory, and a St. Louis-based non-profit charity called Dignity Period. Menstruation is difficult to discuss in Ethiopia and many Ethiopian girls and women do not have access to satisfactory menstrual hygiene management.  Approximately 85% of the population of Ethiopia lives in rural areas, and many girls are too poor even to afford underwear, much less commercially-produced disposable menstrual pads.  As a result, many adolescent girls stay home from school three to five days each month, fall behind in their studies (or suffer devastatingly-embarrassing menstrual hygiene accidents while in school), and stop their education.  In addition to carrying out detailed ethnographic research on menstrual beliefs, attitudes and practices in northern Ethiopia, The Menstrual Dignity Project will provide low-cost, re-usable, environmentally-friendly, locally-produced menstrual pads and underwear to the girls and women of Ethiopia, improving the quality of their lives while removing barriers to their education and social advancement.

    Over thirty years of clinical experience as a practicing obstetrician-gynecologist has made me keenly aware of the lack of compassion that is often found in institutional healthcare settings.  In search of a way to improve this situation, Wall completed training in 2013 as a Certified Compassion Cultivation Teacher in the inaugural cohort of instructors trained in compassion cultivation through the Stanford University School of Medicine’s Center for Compassion and Altruism Research and Education (CCARE).  He has periodically taught an 8-week course in compassion cultivation and currently am preparing a course on “The Anthropology of Compassion.”

    His current and long-term writing projects include completion of a book-length manuscript on historical, clinical and sociological aspects of obstetric fistula for Johns Hopkins University Press; an ethnographic, historical, and ethical study of the work of the controversial 19th Century gynecologist J. Marion Sims; and a book looking at the contemporary practice of medicine from the perspective of virtue ethics.

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    Selected Publications

    2020.  Wall LL.  The nature of suffering, healthcare “providers,” and the opioid crisis.  Obstetrics and Gynecology (in press).

    2020.  Wall LL.  Henry Van Roonhuyse and the first repair of a vesico-vaginal fistula (~1676).  International Urogynecology Journal (in press).

    2019.  Wall LL.  Tears for My Sisters:  The Tragedy of Obstetric Fistula.  Baltimore:  Johns Hopkins University Press.

    2019.  Emasu A, Ruder B, Wall LL, Matovu A, Alia G, and Garageine JK.  Reintegration needs of young women following genitourinary surgery in Uganda.  International Urogynecology Journal 30:1101-111.

    2019.  Kuhlmann AS, Berquist EP, Danjoint D, and Wall LL.  Unmet menstrual hygiene needs among low-income women in St. Louis, MO.  Obstetrics & Gynecology 133:238-244.

    2018.  Wall LL, Teklay K, Desta A, and Belay S.  “Tending the monthly flower:” A qualitative study of menstrual beliefs in Tigray, Ethiopia.  BMC Women’s Health 18:183.

    2018.  Ouedraogo I, McConley R, Payne C, Heller A, and Wall LL.  Gurya cutting and female genital fistulas in Niger:  Ten cases.  International Urogynecology Journal 29:363-368.

    2018.  Ouedraogo I, Payne C, Nardos R, Adelman AJ, and Wall LL.  Obstetric fistula in Niger:  Six-month post-operative follow-up on 384 patients.  International Urogynecology Journal 29:345-351.

    2017.  Kuhlmann AS, Henry K, and Wall LL.  Menstrual hygiene management in resource-poor countries.  Obstetrical and Gynecological Survey 72(6):356-376.

    2016.  Wall LL, Belay S, Bayray A, Salih S, and Gabrehiwot M.  A community-based study of menstrual beliefs in Tigray, Ethiopia.  International Journal of Gynecology and Obstetrics 135:310-313.

    2014.  Berhe Y, Wall LL.  Uterine rupture in resource-poor countries.  Obstetrical and Gynecological Survey 69(11):695-707.
    2014.  Berhe Y, Gidey H, Wall LL.  Uterine rupture in Mekelle, northern Ethiopia, between 2009 and 2013.  International Journal of Gynecology and Obstetrics 130:153-156.
    2014.  Wall LL.  A ‘bill of rights’ for the patient with obstetric fistula.  International Journal of Gynecology and Obstetrics 127:301-304.  

    2012.  Preventing Obstetric Fistulas in Low-Resource Countries:  Insights from A Haddon Matrix.  Obstetrical and Gynecological Survey; 2012;67:111-121.

    2012.  Obstetric fistula is a ‘neglected tropical disease;’ PLoS Neglected TropicalDiseases 6(8): e1769. doi:10.1371/journal.pntd.0001769

    2012.  Overcoming Phase I delays:  The critical component in obstetric fistula prevention programs in low-resource countries; BMC Pregnancy and Childbirth 2012, 12:68;  http://www.biomedcentral.com/1471-2393/12/68

    2012.  A framework for analyzing the determinants of obstetric fistula formation; Studies in Family Planning 2012;43(4):255-272.

    2011.  Ethical concerns regarding surgical operations on vulnerable patient populations:  The case of obstetric fistula.  HEC Forum 2011 DOI 10.1007/s10730-011-9153-x

    2010.  (with A Browning and J Allsworth).  Female genital cutting and obstetric fistulas.  Obstetrics and Gynecology 2010;115:578-584.

    2009.  Wall LL (with D. Brown).  The ethical perils of commercially-driven surgical innovation.  American Journal of Obstetrics and Gynecology 2010;202:30.e1-4. (Published online 16 July 2009; doi:10.1016/j.ajog.2009.05.031)

    2007.  (with D. Brown).  The high cost of free lunch.  Obstetrics and Gynecology110(1):169-173, July.

    2007.  Did J. Marion Sims deliberate addict his first fistula patients to opium? Journal of the History of Medicine and Allied Sciences 2007;62(3):336-356, July; published online:  DOI: 0.1093/jhmas/jrl045.
    2007.  (with AB Wittman).  The evolutionary origins of obstructed labor: Bipedalism, encephalization, and the human obstetric dilemma.  Obstetrical and Gynecological Survey 2007;62(11):739-748, November.

    2006.  Obstetric vesicovaginal fistula as an international public health problem.  Lancet 368(9542):1201-1209 (30 September 2006).

    2006.  (with SD Arrowsmith, AT Lassey KA Danso).  Humanitarian ventures or ‘fistula tourism’?  The ethical perils of pelvic surgery in the developing world.  International Urogynecology Journal 2006;17(6):559-562; published online doi: 10.1007/s00192-005-0056-8. 

    2006.  (with D. Brown).   Refusals by pharmacists to dispense emergency contraception:  A critique.  Obstetrics and Gynecology 107(5):1148-1151.

     2006.  (with D. Brown)).  Regarding zygotes as persons:  Implications for public policy.  Perspectives in Biology and Medicine 2006(4):602-610.

    2006.  The medical ethics of Dr. J. Marion Sims:  A fresh look at the historical record.  Journal of Medical Ethics 32(6):346-350.

    2004.  (with JA KarshimaJ, CKirschner, SD  Arrowsmith.  The obstetric vesicovaginal fistula:  Characteristics of 899 patients from Jos, Nigeria.  American Journal of Obstetrics and Gynecology 190:1011-1119.

    2004.  (with D. Brown).   Ethical issues arising from the performance of pelvic exams by medical students on anesthetized patients. American Journal of Obstetrics and Gynecology 190:319-323.

    2004.  (with JA Karshima, C Kirshner and SD Arrowsmith).  The obstetric vesicovaginal fistula: Characteristics of 899 patients from Jos, Nigeria. American Journal of Obstetrics and Gynecology 190:1011-1119.

    2002.  (with D. Brown).   Pharmaceutical sales representatives and the doctor/patient relationship. Obstetrics and Gynecology 100:594-9.

    2002.  Fitsari 'Dan Duniya': An African (Hausa) praise-song about vesico-vaginal fistulas. Obstetrics and Gynecology 100:1328-1332.

    1998.   Dead mothers and injured wives: The social context of maternal morbidity and mortality among the Hausa of northern Nigeria. Studies in Family Planning 29(4):341-359.

    1996  (with S.D. Arrowsmith and E.C. Hamlin).   "Obstructed labor injury complex:" Obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstetrical and Gynecological Survey 51:568- 574.

    1996.  Ritual meaning in surgery. Obstetrics and Gynecology 88:633-7.

    1996.  (with K.A. Danso, JO Martey and TE Elkins).   The epidemiology of genito-urinary fistulae in Kumasi, Ghana, 1977-1992. International Urogynecology Journal 7:117-120.

    1996.  The "noble savage" in labor; or, Claude Levi- Strauss has a baby. Perspectives in Biology and Medicine 40:33-44.

    1988.  Hausa Medicine: Illness and Well-being in a West African Culture. Durham, NC: Duke University Press.

    1985.  The strange case of Mary Toft (who was delivered of sixteen rabbits and a tabby cat in 1726). Medical Heritage 1:199-211.

    1976.  Anuak politics, ecology, and the origins of Shilluk kingship. Ethnology 15:151-162.

    Honors and Awards

    Rhodes Scholar, The Queen’s College, Oxford University
    Fulbright-Hayes Scholar, Ahmadu Bello University, Zaria, Nigeria
    International Social Science Doctoral Dissertation Fellow
    Fulbright Scholar, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
    Mekelle University Gold Medal for meritorious contributions to medical education
    Teacher of the Year, Department of Obstetrics and Gynecology, Washington University in St. Louis.
    National Continence Care Champion, National Association for Continence
    Washington University School of Medicine Distinguished Faculty Award for Community Service
    St. Louis Ethical Society James F. Hornback Award as Ethical Humanist of the Year