Hope to Ethiopia’s women

Gareth Maguire, photos Pierre Virot, OMS

In Ethiopia, a vast and varied country at the centre of the Horn of Africa, it is often all to easy to overlook the huge difference a small number of dedicated individuals are making to improve the health of the country’s 66 million inhabitants. At present only half of the country’s mainly rural population are able to access any modern health care facilities and often die of illnesses and complications that can be successfully overcome with proper medical attention.

Nestling in the suburbs if Addis Ababa is a very special hospital, the only of its kind in Ethiopia, which has served the country’s women for over 25 years. One out of every twelve women in Africa dies in childbirth and many more find their lives ruined by childbirth injuries caused by untreated obstructed labour. In Ethiopia alone, thousands of women and girls are affected by this condition, termed fistula. When child delivery goes wrong, and in the absence of caesarean operation, the baby gets stuck inside the mother. After hours and even days of labour, the pressure of the baby causes internal injuries, until it is finally stillborn. These internal injuries manifest themselves in incontinence, and as such it is not just pain and discomfort the patient suffers, but social isolation and humiliation through no fault of their own.

Opened in 1974, the Fistula Hospital has been the life’s work of Drs. Reginald and Cathrine Hamlin who came to Ethiopia from their native Australia in 1959. Originally expecting to set up a training program for midwives, the couple saw so many cases of fistula that they sought a land grant to establish a forty-bed hospital specifically for women with childbirth injuries. Since its opening, the hospital has treated over twenty thousand women, completely free of charge, and has grown to become a major teaching institution for surgeons all over Ethiopia and the developing world. Since the death of Reginald in 1993, Catherine has continued their work, and for her efforts has been recognised with several awards including being made a Companion of the Order of Australia, the country’s highest honour, the ANZAC peace prize and a Gold Medal from the Royal College of Surgeons.

Women travel for days to reach the hospital. Once there they are clothed and fed until their surgery date. The operation to close fistulae is relatively simple, and many patients are completely cured and able to bear children again. Currently the hospital provides surgery for 1000 victims of fistula every year, and over 90% of the patients are completely cured. The hospital has a busy physiotherapy department that which helps as many as 40 patients at a time restore the use of their legs. Once they are cured, they and their families are given clothes and money for the journey back home.

The hospital provides more than just physical treatment, its goal is also to provide social and spiritual assistance to fistula patients. These women have often been socially excluded from their community, and if it is her first child, will have been sent away by her husband. They are unable to fulfil their roles in rural life, and with it their sense of self worth. Every day Dr. Hamlin sees the profound gratitude of cured patients, because it offers a return to normal life after months and sometimes years of lonely misery. Some women who are severely damaged, such as those that are unable to walk, or those whose fistula surgery was unsuccessful, need enormous moral and psychological support. They often find this with their fellow sufferers at the hospital. Patients are taught basic literacy and numeracy, and together can work for the hospital on jobs such as recycling and sterilising gauzes for surgery, or at the hospital’s nearby farm producing food.
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ﾀ p. 32 young girls who have delivered a stillborn and developed fistula. This has stimulated the hospital to raise awareness against childhood marriages, as young girls, with small and underdeveloped pelvis, are more likely to suffer long, obstructed labor. One doctor commented on how innocent the girls seem when sitting with new friends recovering from their surgery in the hospital, ‘they don’t really know what has happened to them’.

Dr. Hamlin is anxious that the girls do not end up as patients again, telling unmarried girls to wait at least four months before marrying again. If a girl is married, she must not sleep with her husband for four months, but most importantly, when she is pregnant again, she must begin walking towards a hospital once she feels the baby ‘walking’ around in her stomach.

The hospital trains health care providers throughout Ethiopia, including nurses and physicians, in dealing with obstetric fistula. As fistula is largely preventable, most of these women need never make the long and painful journey to Addis Ababa if identified by a skilled health professional and receiving some form of assisted delivery. These training programmes represent a great opportunity to reverse the tragic lack of maternal health service provision in the remoter areas of Ethiopia, and reduce the unnecessary suffering of thousands of women annually.