Dispatches From Ethiopia: Part 2

October 9, 2012

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.

ONE doesn’t ask for your money, just your voice. If you’re moved by anything you read or see here, or on the ONE blog, please consider adding your voice, and join ONE by filling this form. Your information will remain confidential.

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ONE | Dispatches From Ethiopia: Part 2
October 9, 2012 at 2:21 pm
Ethiopian News and Opinion Journal
October 29, 2012 at 10:11 am

{ 31 comments… read them below or add one }

1 Whitney Hardie October 9, 2012 at 12:03 pm

I am so excited that you got to be there! I learned about fistula from the documentary A Walk to Beautiful, and was so moved about the remarkable strength of these women. My husband and I have given to The Fistula Foundation and I remain so inspired by the lifelong dedication of Dr. Hamlin and those like her who devote their lives to improving the lives of others. Sorry such a long comment, but obstetric fistula is one of those causes near and dear to my heart.

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2 Giulia October 9, 2012 at 12:09 pm

I had heard about Dr.Hamlin and her hospital on Oprah. Once again it reminds me how important education is. This is so sad, but encouraging at the same time.

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3 Miggy October 9, 2012 at 12:30 pm

I too remember hearing about this hospital on Oprah. From what I remember fistulas can also happen when a woman (or girl) has been raped (gang raped usually). I hate even typing those words. BUT the healing and hope from that story and from your words above are beyond amazing. And yes, it does make me want to be a better person and do something amazing with my life. What a great opportunity for you to see and witness all this for yourself. Hugs.

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4 Cheryl October 9, 2012 at 12:33 pm

I have to agree with Whitney, the documentary A Walk to Beautiful is incredibly moving and informative and really highlights how easily some of these devastating issues can be to fix, at least medically. I highly recommend it to anyone who would like to know more or loves documentaries.

http://www.walktobeautiful.com/

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5 nicole Feliciano October 9, 2012 at 1:00 pm

Such an easy fix. Your mission to raise awareness is so important. Keep up the amazing coverage.

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6 Christa the BabbyMama October 9, 2012 at 1:01 pm

I was shocked when I first learned about this – and so appreciate someone with a platform like yours spreading the word. More people need to know that this happens and that there are things we can all do to help!

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7 Chrysula October 9, 2012 at 1:20 pm

Obstetric fistula is one of those issues that literally changes you once you know about it. Thank you for telling the story in such a dignified, respectful and clear way. Praying for you all to be safe this week, and for your collective audiences to fall in love with the stories you are sharing. I certainly have.

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8 elita October 9, 2012 at 1:20 pm

i’m glad others have come across ‘a walk to beautiful,’ as well. i saw it for the first time last week, on pbs. i believe its available in its full-length on the PBS.org site.

what a cause!

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9 Whitney Smith Cripe October 9, 2012 at 1:37 pm

THANK YOU THANK YOU THANK YOU! And please, everyone – take the time if you were moved by this information to read Half the Sky by Nicholas Kristof and Sheryl WuDunn – the book and the recent PBS documentary (of the same title) really get to the heart of women’s issues the world over. Obstetric fistula is also a result of FGM – a brutal and all too frequent practice/tradition (especially on the African continent) – thanks Gabby for going on this journey and for being a “field reporter” – your words reach many! Knowledge is power!

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10 Koseli October 9, 2012 at 1:37 pm

Thank you for sharing and opening my mind, Gabrielle. Going to watch Walk to Beautiful tonight.

Here’s the full movie on PBS for anyone interested: http://video.pbs.org/video/980049841

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11 Christina @ Homemade Ocean October 9, 2012 at 2:07 pm

Wow…..what an incredible post.

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12 Lisa October 9, 2012 at 3:23 pm

You are once again doing wonderful things and inspiring everyone of us. Thank you for explaining the fistula concept and a short summary of what is going on in a place far away. I tried to sign for ONE but it doesn’t accept my zip code. Is it only for US residents? I’m in Europe.

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13 alexis_gentry October 9, 2012 at 4:37 pm

My heart is so touched by this! Thank you.

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14 Emily October 9, 2012 at 6:48 pm

What an incredible experience you’re having! I learned about fistula from the book Cutting For Stone, which I highly highly recommend. Might be a good read for after your trip!

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15 Jimmy October 9, 2012 at 7:22 pm

Wow, what an amazing adventure. I recommend the novel Cutting For Stone as a great story about fistulas and medicine – a great read!

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16 coucoumadame October 9, 2012 at 7:35 pm

this was an incredibly eye-opening post. my heart is also touched by this. i also love what you wrote about the father of this Dr. and how he insisted that she be educated. thank you!

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17 diane bowe October 9, 2012 at 8:28 pm

What a privilege to see the work of Dr. Hamlin and the team. I’m on the board of an organization working in east Africa to eradicate fistula…One by One (www.fightfistula.org). Such a devastating malady, but so treatable! Thanks for spreading the word and work of these amazing women!

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18 Kace October 9, 2012 at 9:21 pm

I first learned about fistulas when my mother had one (as a side effect of chemotherapy for her breast cancer). And I have since talked about them in my college economics classes with my students when we discuss income inequality and the developing world as a simple example of something that is easy to fix and can mean a world of difference for women who are treated as (less than) second class citizens. God bless, Gabrielle!

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19 mom in mendon October 9, 2012 at 9:49 pm

I want to know the name of the heroic father who knew he should educate his daughter. Some thing important should be named after him.

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20 Sara October 9, 2012 at 11:00 pm

We are living in Addis Ababa right now with the US Embassy and I was thrilled to see you are visiting. How wonderful. Ethiopia is a very unique and interesting place to live. We all love it here. If you have a chance to visit a few places in Addis you should try Salem’s in Bole and Sabahar in Mekannisa

http://www.ouryuppielife.blogspot.com/2012/07/salems.html
http://www.ouryuppielife.blogspot.com/2012/07/sabahar.html

Both are wonderful textile shops with wonderful missions. I wrote a travel piece for the embassy newsletter about both. A visit can be very enlightening.

Sadly, I know you don’t have a lot of free time on your visit. If I could I’d take you to our very favorite coffee shop that’s been in Addis for a very long time. I’m sure you are falling in love with Ethiopian coffee. Try to stop by TO.MO.CA. if you can to get a bag to bring home.

http://www.ouryuppielife.blogspot.com/2012/09/tomoca-coffee.html

If we had all the time in the world I’d invite you to lunch at Selam’s Children’s Village and then we could tour all the neat spots to find Ethiopian antiques and treasures to bring home.

http://www.ouryuppielife.blogspot.com/2012/08/selams-childrens-village.html

I hope you love Ethiopia as much as I do.

As a side note, there are some really great people like myself who are living here and would be interested in helping out if needed.
Ciao,
Sara

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21 Sara October 9, 2012 at 11:13 pm

Oh and I didn’t mean to not acknowledge the very serious topic that this blog posted touched on. I have a few friends who volunteer at the clinics in the area. I think you will find all around this country are people willing to give and help. Dr. Hamlin is a wonderful example of this. On a daily basis I see a child or a mother in need of very basic health care. The children are really what get me.

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22 Lauren October 9, 2012 at 11:16 pm

There’s so much hurt, but also so much hope in this post. It really makes me want to be able to DO something!

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23 Jennifer October 9, 2012 at 11:24 pm

wow and thank you.

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24 Kelly October 9, 2012 at 11:30 pm

Thank you for this post Gabrielle.

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25 Amanda October 10, 2012 at 2:49 am

This is amazing. I felt a range of emotions as I read this post: sadness at the thought of a woman (or girl) being ostracized, happiness knowing fistula can be fixed, hope that word will spread and more people will be helped, thankful for people who help each other in whatever way they can.

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26 Caddy October 10, 2012 at 9:21 am

I remember first hearing about this problem when Dr. Hamlin was a guest on Oprah. I truly admire her and her husband. Major kudos for the work they’ve done.

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27 jenny also October 10, 2012 at 12:23 pm

Gabby, What an incredible post! I love how you use clear, unflinching, yet totally respectful language to speak compassionately about such a difficult subject. You, theses women, and this good work touched by heart today.

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28 jenny also October 10, 2012 at 12:30 pm

p.s. I just became a “one mom.”

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29 tere October 10, 2012 at 1:21 pm

Great post! Thanks for sharing this life we need to remember about. Send ethiopian women a bit of love from here!

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30 Zola October 10, 2012 at 2:55 pm

What a simple and strong message. Thank you for the post and we will all help you along the way.

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31 Katie October 11, 2012 at 11:47 am

It’s funny, the day you announced that you were going to Ethiopia, I finished the most wonderful book set, primarily anyway, at a hospital in the capital of Ethiopia. Treating fistulas become an important practice area for two of the characters. Truly a beautiful treat of a read – Cutting for Stone by Abraham Verghese. You should check it out.

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