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Thursday, August 19, 2010

A hospital in Ethiopia repairs fistulas so women can rejoin the world.

I've been meaning to write about the documentary A Walk to Beautiful, which you can rent or watch instantly at Netflix. The movie shows the work of the Addis Ababa Fistula Hospital and won the 2007 Best Feature-length Documentary at the International Documentary Association Awards Ceremony. It galvanized me into sending a hefty donation (see the bottom of the post for links to donate or learn more).

You can also see it here, on YouTube (you'll have to endure a commercial first):

(From McClatchy News Service)

By the age when American girls start to attend preschool, girls in the Ethiopian countryside are already pressed into household labor, hauling buckets of water to help their mothers. Soon after that, they're handed the daily task of grinding grain with heavy stones to prepare injera, the spongy bread that's the staple of the Ethiopian diet.

"By the age of 8 they can carry weights that I can't carry," said Ruth Kennedy, a 54-year-old midwife at the Addis Ababa Fistula Hospital.

Hard labor and poor nutrition conspire against rural girls, who grow up sinewy and stunted.

But in traditional practice, girls are often married off by age 12 and expected to bear children within a few years. Their undersized pelvises are ill equipped to deliver fully formed fetuses, producing devastating complications, hospital nurses said. Some patients arrive at the hospital having endured up to seven days of labor.

At the end, the baby's head collapses and it emerges stillborn. The stuck fetus blocks blood flow to tissues in the pelvic wall, eventually tearing a hole.

Within hours the mother begins to leak urine and, in extreme cases where rectal tissue is also damaged, sometimes feces, nurses said.

Without treatment, women can leak from their vaginas for the rest of their lives, making it difficult for them to live among family and friends and forcing them to the margins of their close-knit communities. "Very few of their husbands keep them. They are spoiled," Kennedy said. "In a survivalist society, these little women become a burden."

The injuries to bladder and kidneys are extreme. "I smelled," [said one patient]. "No one talked to me. All my friends hated me. No one understood the condition." For several months Melise lay at home in bed in a fetal position, wracked by depression and trying desperately to stop the constant dripping of urine. She awoke one morning to find that her mother-in-law had thrown her things out of the house.

The humiliating injury is called obstetric fistula, a tear in the tissue between the vagina and adjoining organs, caused by prolonged labor in small, undernourished women—and now almost unknown outside the poorest countries of Africa and Asia. While the last recorded case in the United States was in 1895, researchers believe that 9,000 women will develop fistulas this year in Ethiopia alone.

Founded in 1974 by two Australian gynecologists, Catherine Hamlin and her late husband Reginald, the Addis Ababa Fistula Hospital has performed more than 32,000 free operations on women from across Ethiopia. More than 90 percent of patients fully recover

The couple performed the first fistula operations in Ethiopia as volunteers in 1959. Now the hospital, with support from nonprofit foundations and private donors, has grown into an internationally recognized center for fistula research and has trained doctors from 28 countries to perform the simple, life-altering surgery.

Their work has helped raise the profile of the debilitating but long neglected injury. In 2003 the United Nations Population Fund launched a worldwide "End Fistula" campaign, which is now working in 35 poor countries in Africa, Asia and the Middle East. In recent years Sudan and Nigeria have opened centers for fistula repair.

Whitney Tilson of the Motley Fool wrote about the Fistula Hospital on April 17, 2001

Life in Ethiopia is very hard for most everyone, but it's especially hard on the women. Like women in most of the developing world, they tend to do the most difficult, dirty work, yet generally do not have access to the few opportunities that exist for an education and a good job. Many are married off at a young age -- sometimes as young as 10 -- and often start bearing children by their early teens. Childbirth rarely occurs with a qualified attendant, much less at a hospital. If there's a problem during delivery, common given the lack of prenatal care, the babies often die and the mothers can suffer injuries.

A common injury is called an obstetrical fistula, which occurs when the baby tears a hole into the bladder and/or rectum, causing the mother to become permanently incontinent and constantly smelly. When this happens, the husband almost always abandons his wife, who returns to her family, often to be rejected again. These women have lives of unspeakable misery. One didn't leave her bed, much less her family's hut, for nine years before making her way to the Fistula Hospital.

The hospital specializes in the relatively simple surgical procedure that repairs the fistulas, allowing the patients to return to normal life and even bear children again. It heals more than 1,000 women annually, at a total cost of a mere $400,000 -- a pittance by Western standards, but a fortune in Ethiopia. (this is where I sent money)


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