Source: The Observer
Petite women pace the verandas of the Hamlin Fistula Hospital (formerly Addis Ababa Fistula Hospital) pulling multicoloured knitted blankets over their bodies to shield from the cool breeze that sweeps the well kempt trees and manicured lawns of their safe haven.

At the entrance, a visitors’ tag reads that no photos are allowed unless with special permission. These women’s stories and fear in their eyes tell the need for privacy; they have been through enough already.

According to the hospital’s brochure, fistula is an injury that results from long unrelieved obstructed labour. When a baby is too big or poorly oriented, it may not pass through the mother’s pelvis, resulting in obstructed labour.

And if the constant pressure of the unborn baby’s head against the mother’s bony pelvis is unrelieved, prolonged and obstructed labour over many hours or days leads to the death of tissue and an abnormal opening between the birth passage and bladder, and/or rectum.

Following this traumatic experience the woman becomes incontinent and can only be cured through surgery. A constant trickle of waste products makes the woman unhygienic, becoming a social outcast in her own community. But fistula is not only caused by oversized babies or a young mother’s narrow pelvis.

It is also caused by poverty and a poor health system where medical facilities with trained attendants are not available to assist at childbirth; only 6% of women in Ethiopia deliver with a skilled attendant. For many women in Ethiopia suffering from obstetric fistula, relief seems an impossible goal.

The hospital website states that Ethiopia’s population stands at 79 million people, with 17 million women of childbearing age. These are served by 163 obstetrician/gynaecologists, of which only 64 work in government institutions. This means that there is one gynaecologist for every 276,343 women in Ethiopia with most working in the capital Addis Ababa.

There are also 1,509 midwives, one for every 13,480 women compared to the WHO recommendation of 1:5,000. For medical facilities, there are 131 hospitals in Ethiopia meaning that one hospital serves 135,007 women most of which are in the cities.

There are also 600 health centres. The nearest health centre is two days’ walk. Fistula can also develop as an aftermath of rape.

Raped and shamed

To hear saddening stories such as Mahabouba Mohammed who was sold into slavery at eight, raped by her master at 12 and left alone in the bush to deliver her baby at 13 years is heartbreaking. After five days of gruelling hard labour, Mohammed delivered her baby dead and she was left crippled with internal injuries.

At her age, Mohammad’s pelvis was too narrow for easy passage of the baby and the long labour left her with fistula. Now a nurse at Hamlin Hospital, Mohammad says she was left for the hyenas to finish off her smelling body but she fought them off and found a helper who transported her to Addis Ababa Fistula Hospital.

Mohammad’s story is replicated in countless women who lie on clean white beds in the hospital. Through the window you can see cleaners on standby with mopping brush and bucket to clean up any urine or faeces from the women. The cleanliness alone is part of their healing process because they thought they were condoned to a dirty and smelling world.

Outside, the men work tirelessly with sandpaper and paint brushes to give the hospital a fresh coat of paint in time for a visit by US Secretary of State Hillary Clinton. 
The women with fistula (especially in third world sub Saharan Africa) are the modern day lepers in their communities.

Sisay Alemayehu, the assistant Public Relations Officer of the hospital says that 64% of the women in Ethiopia with fistula automatically become outcasts. Their families reject them because of the unpleasant odour, lock them away with poor feeding, drenched in urine and faeces some refusing to eat to minimise the free flow of the wastes.

Some women have spent seven years under lock and key because of the injury.

Help arrives

When Dr Catherine Hamlin, an Australian gynaecologist arrived in Ethiopia in 1959 with her husband, Reginald Hamlin to set up a midwifery school, fistula cases were few because the victims lived in far off villages.

But one day, a woman curled up near Princess Tsehay Memorial Hospital gate asking to seen Dr Hamlin. Then another and another and Dr Reginald and Catherine Hamlin knew this was a deep rooted problem.

Theirs was a condition that the Hamlins had never encountered because back in Australia and England where they had worked, such cases had been eradicated by 1920 when caesarean births were practised in cases of obstructed labour.

But in Ethiopia, professional obstetrician, gynaecology and midwifery medical practitioners were few. Women lived far from the few health centres that dotted Ethiopia and buses would refuse to take labouring women. The long distance made labour even more difficult.

“Some say ‘why me?’ and try to commit suicide,” Alemayehu says.

The Hamlins treated the first 30 cases at Princess Tsehay Memorial Hospital but even there, the women were not comfortable; fellow patients still shunned them for the awful smell.

The Hamlins then thought it fit to start a hospital just for fistula patients. Through fundraising from Ethiopia’s monarch and abroad, the doctors opened Addis Ababa Fistula Hospital in 1979, the only medical centre in the world dedicated exclusively to fistula repair.

Forty-two years later, the hospital has treated 30,000 women for free with a success rate of 92%. When the women arrive, they are well received and admitted - no woman is turned away. They undergo surgery with one of the 10 gynaecologist.

Seventy-five percent get cured on the first surgery while some spend between six and two years undergoing multiple surgeries until they heal. The average healing time is 34 days. If not managed well, the disease can cause kidney failure leading to death.

The hospital does not stop at just surgery but takes a holistic approach to the recovery. Because of sitting or lying down in the same position for long, women develop atrophied; a nerve and tissue damage that leaves their ankles and feet deformed.

If a woman lies on her mat for a prolonged period, waiting for the urine to dry, she may also develop contractions of the joints of her legs, as her muscles and tendons shorten from lack of use, rendering her unable to walk. Fistula victims also suffer profound psychological trauma resulting from loss of status and dignity.

At the hospital, they undergo physiotherapy so that they can walk out of the hospital with their heads high. They are also taught simple economics and mathematics to equip them with knowledge of starting a new life when they get back home.

When they are about to leave, they are given a white flowery dress and sent home with a smile on their faces, restored dignity self esteem and hope. 
“Patients pay us back by spreading the news and referring other patients here. Second is we ask them to make sure they go to a hospital if they get pregnant again because it can reoccur,” Alemayehu says.

Hamlin Fistula Foundation has also established five rural outreach centres, where the staff can perform fistula repairs. For those whose fistula cannot be cured, the Hamlins created a haven, Desta Mender, meaning Joy Village.

They are fitted with an external bag to collect the urine and continue to receive medical care which they cannot get from their homes. Surrounded by compassion, encouragement and beauty, they farm, maintain the grounds and sell embroidery and crafts.

The hospital restores their esteem and worth by allowing them to live a life where they feel they belong.



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