By Gabrielle.

Yesterday I learned about Fistula. At it’s most basic, it means a hole. A hole that can be repaired with a few stitches in a surgery that takes as little as 45 minutes. But what it really means to the women who experience it is: a stillborn child, loss of a husband and marriage, loss of dignity, and total ostracization from their community.

The basic story is this: A woman goes into labor. (Imagine her as a late teen or in her early twenties, but it can happen to anyone in child-bearing years.) She lives in a rural area and has little or no access to health care. She is delivering the baby at home with her mother or grandmother. They are not midwives. They have no training.

There is a complication with the labor. The baby is stuck. The husband or parent does not think to send the girl to a hospital, they just wait, assuming the baby will be born eventually. They don’t know how to recognize the signs that this is a real complication that requires medical attention and ideally an emergency c-section. (Honestly, I wouldn’t know the signs either. I don’t have to know, because I have access to doctors.) And even if they did understand, that is likely not an option.

There might be a clinic in her region, but the road to the clinic may not be drivable or passable. And if it is drivable, there may be no ambulance or other vehicle. And if there is a vehicle, the family may not have money to hire it. They may need to sell a goat first, which might take a week. Or so.

So the woman (or girl) labors for 3 or 4 days. The baby dies of suffocation. The tissue of the woman’s body, where the baby is stuck, dies as well. Eventually, days later, the stillborn baby’s head shrinks and the baby is able to be pushed from the woman’s body. The dead tissue is pushed from her body too, leaving a hole in her bladder, or her rectum. Or both.

Sometimes it’s a tiny hole. Other times, her entire bladder is  gone. Either way, the effect on her is the same. She can no longer control her bodily functions.

At that point, her husband rejects her and sends her back to her family. They often reject her as well. She loses all dignity and is ostracized by the community. She has no education. She has been taught her whole purpose is to marry and bear children and she can’t do that now, so she is ashamed. She is suicidal.

But here’s the thing. Fistulas are extremely fixable. Extremely fixable! Over 90% of treated cases go on to FULL recovery.

And now, we get to the Hamlin Fistula Hospital. It has 140 beds, and sometimes, there are 2 people to a bed because they never turn anyone away. The women are treated for fistula, but not just that. They’re not sent home the next day. The approach is whole. The women are counseled, they receive physical therapy, they learn to read, they’re taught marketable skills like embroidery, basket making, sewing. They get their dignity back. They get their life back. And when they’re healthy — whether it takes 3 weeks or 3 years (in the really disturbing cases) — they are sent home with a new dress and transportation money to get home. Wherever home might be. The hospital’s services are free of charge.

Women in Ethiopia used to live with fistula for an average of 3 years. Today, the average is 6 months. A few years ago, patients were as young as 13. Today, the average age is 24. Families used to universally reject their daughters with fistula. Today, over 50% accept them back after their treatment. There are even cases of husbands who understand this is a treatable condition and bring their wives to the hospital themselves. Change is happening. Progress is happening.

What I walked away with:

Sometimes, it comes down to one-on-one.
Once you know how fixable fistula is, the first thought is: We must tell all the women affected as quickly as possible so they can get to a hospital! We need a major media campaign across the whole country! But here’s the thing, that’s been tried, and big campaigns don’t work for something like this. It is too private and there is too much shame and stigma around fistula. What works? Representatives from the hospitals have to literally go door to door in the rural areas. They have to talk with an individual woman one-on-one, share stories of fistula repair person-to-person, privately. And then help the woman get to a Fistula Hospital.

Education. Education. Education.
One of the doctors we met with is about 55 years old. She’s one of the only two female fistula surgeons in the country. She’s fantastic. She was not raised in the city. She was born in a tiny rural village, but her father insisted that she be educated. Fifty years ago, very few rural kids were educated. Parents couldn’t afford to send them. And if they could afford it, they sent the sons. But her father sent both his son and daughter. Like I said, insisted on it. None of his friends supported this. They thought he was crazy. So did his wife. She said, “You’re taking my one daughter, and you’re sending her to school?” But he did it anyway. And she excelled. And she still excels. And in her 20+ years of being a fistula surgeon, she’s helped more women than we can count.

One person + passion can make a real and enormous difference.
The Hamlin Hospital was founded by Dr. Hamlin from Australia. She saw the need. She knew she could help. She raised the money. She made it happen. Because of Dr. Hamlin’s efforts and determination, the Hamlin Hospital and satellite clinics reach 6000(!) fistula patients every year. This treatment drastically improves their lives. Drastically is an understatement.

Doesn’t that make you want to dedicate your life to something awesome? Me too.

P.S. — We were asked not to take photos at the hospital (of course!), so the picture at top, taken by Karen Walrond, is from yesterday’s visit to FashionABLE. It was Amazing with a capital A. I shared a bunch of photos on Instagram and I’ll write up a report soon. Today, we’ll be traveling to a city called Mojo, about an hour and a half from Addis Ababa, to visit a DFID education site. I look forward to seeing what the landscape is like outside of the city!


This week, I’m in Ethiopia at the kind invitation and expense of The ONE Campaign, a nonpartisan, advocacy organization dedicated to the fight against extreme poverty and malnutrition, particularly in Africa. ONE works to convince governments to invest in smart programs that save lives. While here, I’m with a group of parenting bloggers to observe how the organizations for which ONE advocates are effecting real change in Ethiopia.

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