Wednesday 21 March, 2001
Fistula Women
Fistula affects millions of women and girls worldwide, thousands in Ethiopia alone. It is an unpleasant and painful condition caused by complications in childbirth that leads to the death of the child and often the mother.
In Ethiopia fistula treatment is available, but access to it is limited and women often travel miles to be seen by a doctor. As a result about 1,500 new patients arrive at The Fistula Hospital in Addis Ababa every year. In Health Matters, Pauline Newman visits Ethiopia and joins the patients and staff of the hospital to discover the plight of the fistula women.
The Fistula Hospital
In the early 1960s, Doctors Catherine and Reginald Hamlin travelled from Sydney, Australia, to work at the General Hospital in Addis Ababa. During their three-year stay they became aware of the plight of the 'fistula women'.
Realising that they could help, the couple decided to stay and between them they developed a surgical procedure that could repair the damage. In the first year they treated 32 women, but by the third they had treated over 300 women and in 1974 they opened a purpose built 50-bed hospital close to the city centre, where treatment is completely free of charge.
Dr Reginald Hamlin died in 1993, but Dr Catherine Hamlin continues her work and in 1995 she was made a Companion of Australia, the country's highest order.
Women still travel for miles, days and even weeks, to receive treatment at the hospital. They are often poor and have been cast out from their society. The hospital, therefore, not only provides physical help, but is a psychological haven for the sufferers.
Fistula Explained
Fistula is tragic, unpleasant and not widely recognised, but it affects millions of women and girls worldwide, thousands in Ethiopia alone. It's caused during childbirth when the delivery goes wrong and, in the absence of a caesarean operation, the baby gets stuck inside the mother.
After hours, and sometimes even days of pushing, the pressure of the baby wears a hole between the mothers vagina and bladder so her urine constantly leaks out and her clothes are soaked day and night. The baby is stillborn and the mother often dies too.
One young girl tells of her three-day bus journey to reach the hospital. To raise her bus fare she had sold firewood and had saved for nearly six months. An examination by Dr Hamlin revealed a large hole in the teenager's bladder that had been caused by a long, obstructed labour. She also had partial paralysis in her leg where the infant had pressed on the nerve endings.
Dr Hamlin explains:
'Her baby was stillborn, she had five days of labour – the baby wouldn't stand more than a day of labour. That's the reason why they can finally deliver, because the baby gets small when it is dead and it can be squeezed out through the vagina. During that process the baby damages the birth passage and gives the woman these holes.'
Pain and Sorrow
Most fistula patients are less than 20 years old and though the problem can arise with a difficult birth at any age, it's more likely in girls who marry very young. The extreme poverty and illiteracy in the countryside where most people live means that they're badly nourished and their bodies aren't big enough to have children in their early teenage years.
However it is often not just the pain, discomfort and offensive smell that is a problem. In many cases, particularly if this is their first child, the husband leaves his wife, and frightened and alone, she lives in social isolation.
In addition, the hospital also treats women whose legs have been tied together for years on end in the misguided hope that this will heal them. As a result, 10% of the fistula patients are crippled and need long and painful physiotherapy before surgery can even begin.
Jenny Bassford travels to the hospital several times a year to provide this therapy and has passed on her knowledge to three of the hospital's nurses. She details the circumstances of one of her most challenging patients:
'She couldn't actually stand up; she had been tied together with a rope. She had basically been left at the side of the road to die.'
'When she arrived at the hospital, she had her knees bent up to her chest and she couldn't straighten them out. Also she couldn't open her legs and this is extremely important in order for an operation to be done.'
Prevention and Cure
The Fistula Hospital boasts a success rate of over 90% and as word gets round, so the women keep making the journey for treatment. Whilst Dr Catherine Hamlin is delighted by the success of the treatments, she is also anxious that the girls who have been treated do not end up as patients again:
'Before they leave we give them a new dress and we give them a little talk. If they haven't got a husband, we tell them to wait four months and then they can marry again. If they have a husband we tell them not to sleep with him for four months. We also tell them that when you get pregnant again be sure that you start walking towards a hospital when you feel the baby walking around inside your stomach.'
Of course the best solution to the fistula problem would be to give all pregnant women good medical care, but this is virtually impossible in a country short of doctors, trained midwives and roads. At the few existing hospitals in the country, women already wait in the surrounding villages for the last few weeks before their babies are born and as a result fewer fistula sufferers are being reported from those areas.
Meanwhile at The Fistula Hospital in Addis Ababa Dr Hamlin teaches fistula surgery and approximately 20 former patients are now employed by the hospital as nurses' aids. In this way the hospital can continue to welcome the pilgrims and help to rebuild the bodies and lives of the fistula women.
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| Obstructed Labour |
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Obstructed labour occurs in 5% of all pregnant women. In the West such births are carried out in hospitals, sometimes by caesarean section.
In countries such as Ethiopia, where medical aid is limited, it is not uncommon for a woman to endure labour for up to five days, with no medical attention.
Whilst fistula figures are unclear, some estimates put the number of sufferers in the developing countries at three million.
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