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Addis Ababa Fistula Hospital
In 1959 Dr. Reg and Dr. Catherine Hamlin came to Ethiopia to set up midwifery training centre at the Princess Tsehai Hospital in Addis Ababa. They were touched by the difficulties faced by women with fistula injuries and were angered by the lack of healthcare and treatment available to them. They began offering surgery and as word spread, more and more women arrived. They started getting into trouble with hospital, as often the patients couldn't pay, so in 1975 the Hamlins opened their own 50 bed hospital.
The Addis Ababa Fistula hospital is still going strong today and In 2011 the doctors treated over 2500 women.
What is a Fistula?
A fistula is an injury that occurs during a prolonged labour where the pressure of the baby's head causes a hole between the woman's bladder and her vagina. If left untreated, the woman becomes incontinent. The offensive smell that this causes means women with fistulas in Ethiopia become social outcasts; ostracised by their families and friends, rejected by their husbands and forced to leave their jobs and homes. Some believe that by lying down the flow will stop and many who visit the hospital have severe muscle wastage from months, in some cases years, of lying still in the hope of remedy.
Fistulas occur in Ethiopia for two main reasons. Pre-natal and maternal healthcare is often unavailable and in Ethiopia girls as young as 4 or 5 are betrothed and intercourse often takes place before their teens. Many of these girls are simply not ready to carry children and so complications arise when labour starts.
Fistulas can be repaired with a simple operation, which lasts less than an hour. The cost of surgery is only €300. Many of the women treated go on to have more babies. Each patient stays at the hospital for three weeks to allow for recovery. For some, this is longer as they require intensive physiotherapy to build up their strength for the operation following long periods of lying down and the inevitable muscle wastage.
The nurse aides at the hospital are all ex-patients who, for different reasons, have been unable to return to their homes. The hospital encourages them to regain as much independence as possible and providing them with work is one of the best ways to achieve this.
The hospital trains women who are recovering from their operations in tailoring skills to help them to find work making dresses and uniforms after returning home. When a woman has fully recovered she is given a new dress and the means to get home. She is also instructed in how important it is to get to hospital for any future births. Each patient is provided with a card they can present to doctors on their arrival, explaining that they may be in need of a caesarean section.
The Addis Ababa Fistula Hospital has also opened four outreach centres across Ethiopia. Patients are referred to the centre by doctors working in hospitals or private clinics. The centre's public health officer visits local areas to locate patients and raise awareness about avoiding fistula through good midwifery practice. Surgical staff visit provincial hospitals and remote villages with equipment to perform operations on site. They teach local doctors and educate villagers about harmful traditional practices and the importance of proper medical care during childbirth.
Prevention is better than cure
Lack of education is a major problem for many Ethiopians, but when it comes to childbirth, it can literally be deadly - currently one in 27 Ethiopian women will die during childbirth. Less than one third of women in Ethiopia see a doctor during their pregnancy, and only 6% of women have someone with any medical training present at the birth.
The Hospital's new midwifery college trains midwives to work in rural areas where antenatal care is desperately needed. The college is wonderfully equipped and training is in full swing. After training, the midwives work in clinics in remote areas providing ante-natal care and attending child-births. In the case of obstructed labour the midwives will refer the women to the nearest hospital, improving the chances of a healthy childbirth and decrease the number of women falling victim to injuries such as fistula and worse.
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