UW Madison Alumna Sweta Shrestha and I visited the Hamlin Fistula Hospital on behalf of our students on Friday, December 2, 2011.

The fistula ward was not what I expected.  For one thing, I thought it would smell.  I had prepared myself to smile, stand close, show no sign of revulsion.  I did not want to add one iota to the pain or shame that these women (many were young girls, actually) had experienced,  having been shunned by their communities, where they were often relegated to an outdoor shack because of the odor and  incontinence related to fistulas the were caused by obstructed labor.

A series of paintings that hang in one of the entrance halls to the hospital (signed Dawit B.), tell the typical story of how these women got to this place. I could not help but think of the stations of the cross as the story unfolded, beginning with a very young bride and early pregnancy, during which time her in-laws expect her to do the heavy work like hauling wood, carrying water and grinding grain. Fasting might also be practiced, for all or part of the pregnancy, further compromising health.  Then, if labor is obstructed (small stature places a woman at higher risk) and no medical care is sought, these young women can suffer for 3-9 days, with a still birth the likely outcome in 96% of the cases.  Another common outcome is a hole in the bladder wall (fistula) that can leave the woman incontinent.  Her husband is likely to leave her.  Then his parents send her home to her own family, where she will sleep outside because of the leaking and odor.

There are 9000 new cases of fistula every year in Ethiopia, according to Dr. Gordon Williams, who kindly gave us the tour, and this year 2500 got care through this and affiliated fistula hospitals.  While they can accommodate  4000 patients/year (only enough to meet 1/2 the need) this capacity is not realized because the women who need care are isolated.  They do not know that other women are living with the same problem.  They do not know that there is a cure.   The journey of the “Fistula Pilgrims,” a term that  founders Reg and Catherine Hamlin used to refer to these women who came to them for help, is portrayed in a moving award-winning  documentary called “A Walk to Beautiful” (see trailer at http://www.walktobeautiful.com/) which tells the story of 5 women who make the journey to the Hamlin Fistula Hospital to seek care.

Fistula Patient –photo from Hamlin Fistula Hospital Website

When women arrive at the hospital they are given a clean gown and a brightly colored patchwork blanket that will be theirs to keep.  It provides warmth and comfort, and  later it is a reminder to them to tell others about the care and cure that is possible for women who suffer from obstetric fistulas. These blankets are donated by people who care from a distance all over the world.  I saw women in their beds, in the clean well-lit ward, urine bags in place, patches of color everywhere. They were at rest, comfortable, some smiling, a few reading (either because they are just learning or because they already had rudimentary skills). There is a garden on the grounds, and a “house” where they can go for a traditional coffee ceremony, and also hear taped stories in their own languages (since many speak languages other than Amharic).

Surgery will cure most of these women, but 25% of patients will need to try other strategies or continue to live with the incontinence.  To provide choices for women who can’t go home, the Hospital has also developed a rehabilitation center that includes a farm, a simple restaurant, and other income generating activities.   It was wonderful — and a lesson in what beauty truly is– to witness the healing of  these women, and to see them treated with such dignity and care.

Women with their blankets relax in the Garden at the Hamlin Fistula Hospital (from official website)

Of course I wish I could do more than just walk through the ward, smiling and saying “salaam.”  And thanks to my students I can ! Sweta Shrestha and I made this visit on behalf of our freshman honors global health students, who had learned about fistula and watched “A Walk to Beautiful” as part of a film series that Sweta has been leading for the past year.  The students  wanted to go beyond merely studying the problem — they wanted to do something personal for the women, to send a message of hope and care across the world.   Dr. Williams assured us that blankets and/or financial donations from UW-Madison students would be welcome, and we made sure we got the specs before we left.

For people from the Madison area: the UW-Madison students are organizing a showing of the film Walk to Beautiful  on campus on February 5th, 2012 (time and location TBD — check back here).   We hope to discuss the film, learn more about obstetric fistula, and make some blankets to send to Ethiopia.  There will be materials to work with at the event, but if you knit or crochet feel free to make some squares (10″x10″) in advance and bring them to the film showing.  We will patch things together and deliver them to the Hospital. The brighter the colors the better!   This is another way to celebrate and participate in the Wisconsin without Borders initiative.

More information about obstetric fistula and the Hamlin Fistula Hospital in Addis Ababa can be found at: http://www.hamlinfistula.org/index.html . Also, there is a chapter devoted to this site and work in a book I highly recommend,  Half the Sky, by Nicholas Krustof and Sheryl WuDunn (see Chapter 6: Maternal Mortality: One Woman a Minute, p. 93-102).   Dr. Catherine Hamlin (with John Little) has also written a book entitled, The Hospital by the River: A Story of Hope.  It is a straightforward narration of her life and work, and a very interesting read.