Hope for the women

ADDIS ABABA—The walls and ceilings of the walkways at the Addis Ababa Fistula Hospital were being painted, with flakes of old paint scattered about the floor. Our group of women journalists from Asia and Africa were initially flattered that the staff would go to so much trouble to welcome us, but the sprucing up it turns out was for another guest: US Secretary of State Hillary Clinton who was scheduled to visit the next day. But it so happened that a volcano in Eritrea erupted the day we were at the hospital, so Clinton had to cut short her trip and missed visiting “the hospital by the river.”

The Addis Ababa Fistula Hospital is famous the world over for the pioneering humanitarian work it does for “fistula pilgrims,” women who came from all over Ethiopia to be treated for a childbirth-related injury that results in either urine or fecal incontinence (or both). The injury not only results in rather horrible physical suffering, but also in social isolation and shame. Reeking of urine and feces that trickle uncontrollably, the women are often abandoned by their husbands, while their families place them in separate, isolated quarters.

The hospital’s brochure describes obstetric fistula as: “an injury resulting from long unrelieved obstructed labor. When a baby is too big or poorly oriented it may not pass through the pelvis of the mother and may result in obstructed labor. The constant pressure of the unborn baby’s head against the mother’s bony pelvis in unrelieved, prolonged and obstructed labor over many hours or days, leads to the death of tissue and an abnormal opening between the birth passage and bladder, and/or rectum. Labor proceeds, and, if the mother survives, usually results in a stillbirth.”

Obstetric fistula can be remedied only by surgery. But it is caused not just by oversized babies or a young mother’s narrow pelvis, but also by poverty and a poor health system where medical facilities with trained attendants are not available to assist at childbirth. That is how fistula develops in the first place, and for many women in Ethiopia suffering from obstetric fistula, relief seems an impossible goal.

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THE story of the Addis Ababa Fistula Hospital is linked to the story of a remarkable couple: obstetrician/gynecologists Reginald and Catherine Hamlin who came to Ethiopia in 1959 on a three-year assignment to set up a midwifery school. That three-year assignment evolved into the work of a lifetime, and the establishment of the hospital where women suffering from fistula could be treated for free, receiving not just top-notch medical care but also more long-term therapy to enable them to live independent lives and, perhaps, become mothers again.

In her book “The Hospital by the River: A Story of Hope,” Dr. Catherine Hamlin observes that “if a woman in a developed country has obstructed labor, she simply goes to hospital where she may have a forceps delivery or a caesarian section. By contrast, obstructed labor in some remote part of Ethiopia, far from medical help, places a woman in terrible trouble.”

Hamlin tells how, early in their work at the Princess Tsehai Memorial Hospital, they would find women huddled by the gate or hiding from the security guards, seeking relief from their condition. It was difficult to hide them because the reek of urine and feces would announce their presence. Through research, consultations with renowned experts, and trial-and-error, the Hamlins evolved a methodology that has resulted in over 25,000 patients successfully treated and rehabilitated.

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FOUNDED in 1974, the hospital is set amid a sloping landscape of gardens tended personally by Catherine Hamlin. It doesn’t look like a conventional hospital, but is instead composed of small structures linked to each other by hallways. As we made our way from the physical therapy room, we found a sign that announced the building as being the “Oprah Winfrey Center for the Women of Ethiopia,” funded by the world-famous TV personality after she interviewed Catherine Hamlin and was so inspired by her and her colleagues’ work.

The women were everywhere, clad in simple printed cotton shirts or else in the more traditional white robes made from thin cotton that one sees all over Ethiopia. At first I was wary of looking them in the eye, afraid of causing offense. But their smiles were bright and their eyes joyful. We saw one woman walking about with a colostomy bag at her side. But there was no sense of shame about her as she chatted with the other women.

Sicay Alemayela, who works with the hospital’s public relations office, says that a patient stays an average of 34 days in the hospital. But more serious cases, including those whose limbs have atrophied due to months or years of immobility and thus need more physical therapy, can stay for as long as “six months up to one or two years.”

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KNOWING that there were more women in the more isolated areas of Ethiopia who were living with fistula, the Hamlin Fistula Foundation has also established five rural outreach centers, where the staff can perform fistula repairs, employ a holistic approach to the rehabilitation of women with childbirth-related injuries, and even perform caesarian sections for former fistula patients who become pregnant again.

At the same time, Hamlin Fistula runs the Hamlin College of Midwives to provide services not just to fistula patients but to all mothers of Ethiopia. A most encouraging development is that many of the most skilled and compassionate nursing aides (and one assisting surgeon) are themselves former fistula patients, passing on their optimism and hope to the women who continue to stream in, fearing that they are alone in their suffering and mired in despair.