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New life after battered journey

Elfinesh Wate, 22, recently overcame one of the most difficult challenges in her life: years-long battle against obstetric fistula. She underwent an hour-long surgery to get cured at Hamlin Fistula Care Center in Yirgalem, a small town in the Southern Regional State. Having lost her child during delivery, Elfinesh is to a large extent satisfied with the procedure. The young woman will be mourning the death of her newborn but, on the flip side, she now feels that she has avoided the ignominy she had shouldered for years. Elfinesh, who resides in one of the remote villages in Sidama zone, developed fistula – the most devastating and serious of all childbirth injuries. Obstetric fistula is a hole between the vagina and rectum or bladder that is caused by prolonged obstructed labor, leaving a woman incontinent of urine or feces or both. As a result, the women who suffer from obstetric fistula remain detached from social life for many years. Only those who have relatives in cities can get the medical attention. And Elfinesh is among the lucky ones who got access to surgical procedure for free. The procedure usually cost some USD 450. This includes surgery, postoperative care and physical rehabilitation.

Since 1974 the Addis Ababa Fistula Hospital (Hamlin Fistula Hospital) has admitted tens of thousands of fistula patients from across the country until the regional care centers were beginning to assist in decreasing the flow in recent years.

The Yirgalem Fistula Care Center (YFCC) was established in 2006 to mitigate one of the highest burdens of fistula in the country. YFCC is found in Yirgalem Hospital – one of the oldest hospitals built by King Olav of Norway, making it the 5th in the country in the 1960s.

“We are very comfortable with the specialists who are available,” Abebe Desta, head of YFCC, says. According to him, the two surgeons serve twice a week at the center to help hundreds of young mothers who had underwent medical examinations by experienced nurses. “We have many years of experience in dealing with this matter. We assist the surgeons with the operations since they are extremely busy practitioners,” Welela Workineh, head nurse at the center, says.

Providing service for more than a decade, hundreds of women have undergone surgery and were able to rediscover life after many years of misery. Women from Wolayta, Sidama, and other zones of the region are said to be highly affected by fistula.

“We started with only 40 beds and now we have 60,” Welela says. The head nurse, who has served at the center since its establishment, states that they have successfully executed almost all of the surgical procedures. “Since the cause is pretty similar it can usually be cured unless the bladder is damaged,” she says. According to researches, only 0.03 percent of all deliveries end up with obstetric fistula globally as the developed world saw its eradication many decades ago.

According to Catherin Hamlin (MD), co-founder of Hamlin Fistula Hospitals, an estimated 4,000 women are set to undergo surgery for obstetric fistula every year while the World Health Organization (WHO) takes the figure as high as 7000 per year. In 2014, the Ministry of Health (MoH) launched a strategic plan to tackle fistula by providing a full-scale delivery service across the country. Nevertheless, despite the country’s highly appreciated efforts to meet the target in reducing maternal and new-born deaths, according to WHO, fistula remains to be one of the huge burdens for many young mothers in rural communities. However, reliable data on obstetric fistula are hard to come by because of the stigma associated with the condition. Describing it as the most devastating of all pregnancy-related disabilities, the United Nations Population Fund (UNFPA) says obstetric fistula affects an estimated 50,000 to 100,000 women around the world every year and is particularly common in sub-Saharan Africa, where populations face challenges to obtaining quality healthcare. The World Health Organization estimates that at least 8,000 Ethiopian women develop new fistulas every year.

The condition occurs when a woman — usually one who is young and poor — has an obstructed labor and, lacking a skilled birth attendant and emergency obstetric care, does not get a Caesarean section when she needs it. The obstruction may occur either because her pelvis is too small, the baby is badly positioned, or its head is too big. Underlying causes include childbearing at a very early age, poverty, malnutrition, and lack of education. According to Welela, the young mothers who often visit the center have problems with literacy. She also says that the compassionate nature of the husbands in the region when compared to the rest of the country, is one thing that benefits the women. “I think the husbands in the South are somewhat compassionate and rush to take their wives to the health centers nearby. They have a sense of responsibility,” she says.

The other problem is finding transportation. And that is also what the hospital is, i.e. by providing transportation to the sick. “I think the hospital should be appreciated for the contribution it has made together with the regional health bureau,” she says lauding the role the hospital plays in facilitating transport.

After having endured difficulties for years and finally undergoing a major surgical procedure the women can finally start to lead a healthy life; however, there are patients who develop injuries to the repaired fistulas. According to physicians, this would often happen when the mothers are willing to give birth the same way they did before that consequently let them to develop fistula. Although it has always been difficult to alter traditional practices in the villages Hamlin, a pioneer in performing obstetric fistula, has always been outspoken that men should always be careful not to ruin the restored lives of their wives. "In these cases, the women have often got new husbands who display the same behavior as their previous ones. Her new husband forbids her to have her baby in the hospital and insists that she have a home birth like other village women. She's got no say and is completely under the thumb of the man," she told Population Reference Bureau of the United States. At 92, Hamlin, looks strong enough to leave a legacy of compassion and humanity in Ethiopia, her second home where she has spent a significant part of her life accompanied by her first two fistula patients at the hospital.

A major fistula hospital in Addis Ababa and four more outreach centers in the region will definitely ease the burden of the country which aspires to become a middle income country by 2025, commentators say.

Many like Elfinesh are now aware of the available healthcare and are determined to come back to the center if there is anything that threatens their lives. “I don’t think I would get pregnant again but God knows what will happen in my life. I’m well aware of it now so that I will get back here for anything,” she says with tears of joy rolling down her cheeks.