Case Study

Operation Fistula: Implementing AI Frontline Teams Can Trust

At a Glance

Operation Fistula is a global nonprofit, partnering with grassroots organizations to fund and coordinate fistula treatment for women and girls with the least access to surgical services. With a small program team stretched across a growing footprint, Operation Fistula worked with Vera to build two Claude skills that streamline surgery data review, surgeon follow-up, and program data queries, all within a HIPAA-compliant environment.

The Client

Operation Fistula funds and coordinates fistula surgeries performed by local surgeons across 22 countries, tracking outcomes through CommCare, Airtable, and Google Sheets. The organization works to raise awareness of obstetric fistula, a treatable childbirth injury that remains widely misunderstood, and to ensure women and girls affected by it have access to surgical care and support.

The Challenges

As Operation Fistula scaled across countries and expanded its scope of services, the operational load on its small program team grew. Reviewing surgery records for data quality issues, drafting follow-up emails to surgeons in multiple languages, and running ad hoc queries across systems were all high-volume, repetitive tasks that pulled program officers away from deeper analysis and implementing program improvements.

The organization had informally explored AI tools but had no structured approach, governance framework, or clear view of where AI could add the most value. As a global health organization handling sensitive patient data, any solution also had to meet HIPAA compliance requirements.

Key challenges included:

  • Manual, record-by-record review of surgery data for quality issues 
  • Individually drafted multilingual follow-up emails to surgeons 
  • Program data queries that required technical knowledge or help from the most technical team member 
  • No governance framework or structured approach to AI adoption 
  • A hard requirement to keep patient data within HIPAA-compliant systems

The Solution

Vera led the engagement across four phases: 1) discovery, 2) design, 3) build, and 4) enablement. The team scoped and prioritized use cases from more than 20 initial ideas, assessing each against both technical feasibility and ethical fit, including a recommendation against a facial recognition approach to duplicate-record detection due to bias risk for the populations Operation Fistula serves.

The Enterprise edition of Claude for Nonprofits met the HIPAA compliance requirement. Vera configured Claude’s native connectors for Airtable, Google Sheets, and Gmail to Operation Fistula’s existing schema and workflows, keeping data within current systems rather than introducing new infrastructure.

  • Surgery QA and Surgeon Email: A skill that batches the review of surgery records from Airtable, surfaces flagged entries by severity on a dashboard, and drafts multilingual follow-up emails to surgeons based on QA flags. Clean records can be batch-approved in a single action, writing back to Airtable, while flagged ones generate a draft email in English, French, or Portuguese that sits in Gmail for human review before sending. 
  • CommCare Data Analyst: A read-only, plain-language query skill that lets any team member ask questions about program data in Airtable, such as iatrogenic fistula rates by country, without needing to understand the underlying data structure. 
  • Governance and documentation: An end-user guide, technical documentation, a usage policy, a governance framework, and a structured backlog of future improvements the team can pursue independently. 
  • Enablement: Working sessions for program staff to practice hands-on editing skills and querying live data, building the team’s confidence to maintain and extend the system without ongoing consultant support.

The Results

Working tools were in place within five weeks of the project kickoff. The surgery QA and surgeon email workflow has turned a high-volume, manual, record-by-record process into a structured, session-based review, with multilingual emails now generated directly from a QA flag rather than individually drafted. Program data that once required a manual export or the most technical team member on hand can now be queried in plain language in seconds.

Operation Fistula also gained a governance foundation, including a usage policy and documentation built for two audiences: end users and AI administrators. The team plans to independently build on this foundation in the near term, starting with monthly surgeon performance nudges and newsletter drafting, and is further exploring a future data layer with MotherDuck to bring CommCare, Airtable, QuickBooks, and Google Drive data together for deeper analysis.

“There are levers to control everything… so many levers that you need somebody to help you guide you through that process”

– Seth Cochran, Founder & CEO, Operation Fistula

“It’s amazing to do things like get my program manager’s totals for the first six months of the year, and then be able to use that human-generated, human-validated number to test Claude and to test whether it’s accurately pulling numbers. And I can tell you that it has been [accurate].”

– Helen Davies, COO, Operation Fistula