Obstetric fistula is a degrading injury which leaves women incontinent and ostracised by their community. Pregnant women in rural Ethiopia have little or no access to emergency obstetric services. If they are among the five percent of women worldwide who will face obstructed labour, they will be in agonising labour for days and days. They almost always lose their baby and suffer horrific internal damage – sometimes the bladder is completely destroyed, sometimes the rectum is also damaged. They leak constantly and are pushed to the edge of their society, too filthy to be part of village life and considered a curse.
“I thought I was the only one with this terrible problem. Since I gave birth to a dead baby boy I have leaked urine constantly. It has eaten away at the skin. The pain is terrible but the shame is much worse. When I came here, I could not believe my eyes, the whole world is here. So many other girls suffering in the same way. This is the first time I have been able to smile since the baby was born.”
Treatment, prevention and rehabilitation
Hamlin Fistula Ethiopia is working towards the eradication of obstetric fistula from Ethiopia altogether. This goal is being pursued through medical treatment, rehabilitation of women suffering from fistulas and preventative strategies, including the training of midwives and surgeons in Ethiopia.
Treatment for obstetric fistula is provided at the Addis Ababa Fistula Hospital and one of the five regional Hamlin Fistula hospitals. Our team of surgeons treat approximately 2,000 patients each year, using a surgical technique pioneered by the Hamlin’s in Ethiopia over 50 years ago. More than 50,000 patients have been treated to date with a 95% closure or success rate.
Obstetric fistula is treated with a surgical procedure to close the hole in the bladder and/or bowel. Simple cases take as little as an hour. Complex cases may require several operations.
Recent treatment solutions have also now been developed for women whose fistulas cannot be repaired.
Comprehensive health care is provided to all patients before and after surgery. Before treating the actual fistulas, Hamlin Fistula Ethiopia supports the patient’s general condition by improving nutrition, iron and vitamin supplements. For many patients, treatment needs extend beyond the obstetric fistula itself. Treatment often includes physiotherapy for severe nerve damage, stress incontinence management, specialised treatment for stoma patients, psychological counselling and extended medical care for other ailments. All treatment is provided to patients free of charge.
Hamlin surgeons have now begun a pilot program treating pelvic organ prolapse (POP) in all centres. Prolapse cases are found in significant numbers during rural outreach activities.
“I visited the prolapse patients and they were delighted! Dancing, kissing us, crying, they were so happy to be treated free of charge.”
In addition to the hospital providing treatment, The Hamlin College of Midwives is working towards preventing obstetric fistulas. A key preventative strategy is to increase the number of trained midwives across Ethiopia. 80 midwives have graduated from The Hamlin College of Midwives and been deployed in 34 partner health centres. Students have been recruited from across Ethiopia including Oromiya, Tigray, Amhara and Southern Nation regions and after graduation each midwife is deployed back to her home region to work in Hamlin-funded midwifery clinics, within government partner health centres. The number of institutional deliveries by Hamlin midwives now stands at more than 22,500.
Every Hamlin student will deliver a minimum of 50 babies before she graduates. Graduates are highly skilled and equipped to work in challenging environments. The Hamlin College of Midwives continues to work towards the goal of providing a midwife for every pregnant woman in Ethiopia.
Some interesting facts about the Hamlin College of Midwives, and midwifery challenges in Ethiopia:
- For a fast-growing population of over 90 million, Ethiopia has less than 7,000 qualified midwives
- The fertility rate in Ethiopia is 4.1 babies per woman
- 1 in 7 teenage girls give birth every year in Ethiopia
- 500,000 African women and girls die every year in pregnancy and childbirth
- 93% of obstetric fistula sufferers give birth to a stillborn baby
- It costs $4,500 per year or $18,000 for the four-year residential degree at the Hamlin College of Midwives
Hamlin Fistula Ethiopia stands by Dr Catherine Hamlin’s personal ethic of not just treating the hole in the bladder but treating the whole patient with love and kindness.
Following surgery many women require rehabilitative services to assist them to reintegrate back into village life, build self-esteem and /or find meaningful employment. Each patient has their own individualised planning prior to discharge from the hospital or rural centres. Hamlin Fistula Ethiopia provides comprehensive learning, health and reintegration services with specialist teams of teachers, social workers, psychologists, physiotherapists, and nurses.
In October 2015 six women came to the end of their stay at Desta Mender and were farewell in fine style with a moving graduation ceremony. Each women has a business plan and income-generating skills to help her transition back to village like. Some women plan to open coffee houses, while others are thinking of starting small shops. The Hamlin team will conduct follow up visit to make sure they are settling in well.