Women's Health

Ethiopia Trip: Fistula Hospital

They bring back their dignity.

It only took us 15 months and two trips across the world, but we finally made it to the remarkable Addis Ababa Fistula Hospital.

You wouldn’t believe how disappointed we were in 2017 when we pulled up to the hospital gate to find out we had missed the tour day.

We finally got a peek inside this week, and what we found was both incredibly sobering and inspiring. Hundreds of women are treated at the hospital every year for fistula, a condition that develops after a long and obstructed labour – we’re talking three or more days spent straining to deliver a child, usually without medical care – and causes severe urinary or rectal incontinence.

Ethiopian government health officials estimate that close to 40,000 women across the country are suffering from fistulas today. Another 3,000 develop the condition every year.

As if the pain, discomfort and fear isn’t enough, women who have fistulas are often desperately ashamed and isolated. Without access to medical care, women who suffer from the condition in rural areas are often ignored and ostracized – even by their own families – because of the smell.

Val, Shelley and Megan with Zenebe Mesfin, Fistula Hospital Chaplin and our tour guide.

Val, Shelley and Megan with Zenebe Mesfin, Fistula Hospital Chaplin and our tour guide.

“Women would be abandoned at the hospital doors because people thought it was a curse,” Zenebe Mesfin, the hospital’s chaplain, told us on our tour.

It was the same reality that greeted Dr. Catherine Hamlin and her husband, Dr. Reg Hamlin, both gynecologists from Australia, when they arrived in Addis in the 1950s to start three-year contracts in the capital city, Addis Ababa.

That dream led to the Fistula Hospital – known by those who have read Catherine’s books as “Hospital by the River” – now a global foundation that raises funds to support the surgeries and medical care, not only in Addis but at five regional hospitals around Ethiopia, plus a midwifery clinic that trains medical students from rural areas.

(Our amazing volunteer Tracy even reviewed the book on our blog! Check out that post here.)

The Hamlins opened the Addis Ababa Fistula Hospital in 1974. It was the first modern-day hospital focused on treating obstetric fistulas.

Zenebe told us it was one of the only charity projects run by foreigners that remained under the Derg, after a high-ranking official toured the facility and saw the overwhelming need.

Addis Ababa Fistula Hospital

Addis Ababa Fistula Hospital

And it remains an active hospital today. We saw so many parallels between the work done at Fistula Hospital and the life-saving surgeries to treat prolapsed uteruses that we fund in Soddo.

Mothers has donated thousands to that project – enough to provide medical care and transportation for more than 150 women. In a series of emotional interviews on the last trip, patients at a rural health clinic told us about the impact of the prolapse uterus surgeries.

Most of those women were hidden away in shame and fear. They lived with unbearable pain and an awful smell that was humiliating. Some of the women’s partners abandoned them or forced them to have sex despite their condition.

The prolapse surgery recipients told us they felt like completely new people after they were treated.   

In the same way, the Fistula Hospital seems like something of an oasis for women who have been through unbearable pain. And we’re not just talking about labouring for five, six or seven days in a remote village or suffering through embarrassing incontinence.

Zenebe told us that their youngest patient was four years old. She had been raped.

The hospital regularly treats girls that are 12, 13 and 14.

Val takes in the beautiful gardens on the grounds.

Val takes in the beautiful gardens on the grounds.

But the property is peaceful and beautiful, lush with green grass, flowers and shady trees (it probably helps that we’re here during the rainy season!). Catherine brought flowers from countries around the world, and the beauty of the hospital grounds were an important part of her vision.

“She believed this beauty was part of the treatment,” Zenebe said as we walked through the hospital property on meticulously cleaned paths and took in the trees, flowers, and landscaping.

The goal at the Fistula Hospital is holistic care, treating not just physical issues, but also addressing psychological health with a focus on reintegration for women who have been hidden away and borne the burden of stigma that comes with female healthcare issues.

“The women feel life is meaningless. ‘I am useless, no one needs me,’” Zenebe told us. Women who can’t go back home can also spend time in what’s called the “Joy Village” where they learn income-generating skills and receive seed money to launch their own small businesses.

Patients that leave the hospital are presented with new clothes and new shoes, which Zenebe said is a symbol of new life.

“That woman (who is discharged) is a completely different one,” he said.

Like the prolapse surgeries, treatment at the Fistula Hospital gives women a new lease on life. Zenebe and the rest of the staff – many of them former patients – see that on a daily basis.

“They bring back their dignity," he said.

The Hospital by the River: A Review

I had barely cracked the spine of this book and I knew I was in for an emotional and inspiring read. The prologue had captured my heart before the autobiographical story even began. Here's the synopsis that Kobo provides for its customers:

Gynaecologists Catherine and Reg Hamlin left Australia in 1959 on a short contract to establish a midwifery school in Ethiopia. Over 40 years later, Catherine is still there, running one of the most outstanding medical programmes in the world. The Hamlins dedicated their lives to women suffering the catastrophic effects of obstructed labour. The awful injuries that such labour produces are called fistulae, and until the Hamlins began their work in Ethiopia, fistula sufferers were neglected and forgotten - a vast group of women facing a lifetime of incapacity and degradation. Catherine and Reg, with their team of dedicated fistula surgeons, have successfully operated on over 25,000 women, and the Addis Ababa Fistula Hospital, the hospital they opened in 1974, has become a major teaching institution for gynaecologists from all over Ethiopia and the developing world. Since Reg’s death, Catherine and her team have continued the work.

What a synopsis can't tell you it what it felt like to read Dr. Hamlin's story. I couldn't escape the thought, "How can this be happening today?" The chance of a Canadian woman suffering an injury like a fistulae is small because labour and delivery are so well cared for by medical professionals. If there is an injury during labour or delivery, our medical system immediately intervenes. So, to know that there are women who are suffering from something that is so readily preventable and treatable in Canada absolutely broke my heart. Their pain is physical and emotional, most often being cast aside from their communities because of their medical condition.

But this book doesn't just present a problem, it documents the lives of two doctors who have made a tremendous difference to both treat and prevent child-birth related injuries. This couple was determined to create a lasting change against all odds, and they did it.

The other wonderful thing about this book is the depth of insight the reader is given into the history of Ethiopia in the past century. The Hamils lived through regime changes, civil unrest, peace and war. Catherine teaches the reader about Ethiopia's fascinating history as a consequence of it being interwoven with her story.

The work that the Hamils have done in Ethiopia is closely related to the prolapse uterus surgeries that MWAHFE sponsors. These women's health issues deserve to be talked about because there are real and tangible solutions for preventing and treating them. In light of Dr. Hamil's story, I am even more glad to know that we have Dr. Mark and his team at Soddo Christian Hospital doing life-transforming surgeries in Ethiopia!

Want to read this great book? I couldn't find it in the local libraries but here are some places that you can get a copy. (I got a "like new" copy from Amazon for less than $7 including shipping!)

Chapters Online

Have you read this book? Leave a comment below and tell us what you thought!

Reviewed by Tracy Dunham