By Seleshi Tessema
ADDIS ABABA, Ethiopia
Surgeon Fekadu Aynachew and his colleagues have been caring for patients at a fistula hospital in Ethiopia.
Many visibly withdrawn and painfully shy young women are resting on the benches of the waiting room of the hospital, secluded from the hustle and bustle of the capital Addis Ababa.
They all suffer from fistula, a disease caused during childbirth which results in the loss of bladder or rectum control.
The Hamlin Fistula Hospital, built in 1974, is Ethiopia’s first specialized fistula hospital.
Obstetric fistula is caused by a long and obstructed labor without timely access to medical assistance, or a surgical error, said Aynachew, who is also medical director at the facility.
“It results in an abnormal opening between the birth canal and the bladder or rectum. And consequently the inability to control urine or feces.’’
The condition is life-threatening and the treatment lifelong.
9,000 cases each year
In all cases, body fluids are rerouted to a Stoma bag attached to the patient’s body, which is changed every three to seven days.
“Among those treated, very few can give birth,” he said.
According to World Health Organization (WHO), annually between 50,000 and 100,000 women are affected by obstetric fistula.
More than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa, the WHO estimates.
In Ethiopia, each year about 9,000 cases of fistula occur, mostly among uneducated, poor, and rural women, and girls who have been forced into early marriages.
In a national health survey, the Ethiopian Health Ministry said the proportion of births in health facilities has risen significantly, from 6 percent in 2000 to 28 percent in 2016.
While the disease was eradicated a century ago in the developed world, Ethiopia still has a long way to go, Aynachew said.
Ostracized for life
Asrebeb Yalew, 25, and Meron Ali, 27, are two of the 80 fistula patients seeking treatment at the hospital.
“I was married to a man, a farmer, and got pregnant with my child. One day I felt the contractions coming,” said Yalew, a resident of the northern Gonder zone.
“I suffered labor pains for seven days and fell unconscious,” she said.
When she regained consciousness everything had changed. “My child was dead, my bed was wet with urine and feces, and I was smelling.
“I have tried to commit suicide several times, but I could not because I was paralyzed and bedridden for seven years.’’
Her husband walked out on her.
“My family was ashmed of me. And because of the bad smell, no one visited me,” she said.
Ali also went through a similar trauma in her remote village in the eastern Harar region.
“We were very far from a clinic and my husband wanted me to deliver at home assisted by a traditional midwife.”
After days of labor she developed painful childbirth injuries which infuriated her husband and his family.
“I was ashamed of my condition and fate, and my husband divorced me and married another woman.’’
Trauma and recovery
Beletssachew Tadesse, head of the Rehabilitation Center and College of Midwives, told Anadolu Agency that these patients suffer from post-traumatic stress for a long time.
“After they are healed they feel happy, because [it's almost like] they were brought back from the dead. But at times they feel angry at themselves, their husbands who betrayed them, and those who ostracized them,” he said.
At the center they get vocational training, entrepreneurship ideas, and financial assistance.
Tadesse added: “We have seen many loving and caring husbands who despite external pressure, refused to divorce their wives, and remained with them. And a few lucky patients even gave birth."
The Hamlin Fistula Hospital is the brainchild of an Australian gynecologist, Dr. Catherine Hamlin, 94, who with her late husband Reg Hamlion co-founded the health center.
Hamlin retired from active medicine due to her age but continues to live at the hospital premises.
She has healed 50,000 poor rural patients and built five regional hospitals and a college for midwives.
The institution has trained practitioners from Nigeria, Burundi, Zimbabwe, Rwanda, and Tanzania.
Patients affectionately call her Amharic, meaning our mother.
Interestingly, she has always had at her side 69-year-old Etetu Gashe, who has never been to medical school but is one of the best fistula surgeons in the country.
She has even been certified by the Royal College of Surgeons based in the U.K.
When she was 15, she too had fistula surgery and was trained at the center.
“She has been teaching certified local and international surgeons for years. I am one of them, her practical skills and the techniques of surgery are amazing. She is a symbol of fistula survival,” said Ayanchew.