By Rachel Pope

I was lucky enough to spend time with the physicians, nurses, and patients at the world-renowned fistula hospital this summer in Addis Ababa, Ethiopia. A socially stigmatizing condition, an obstetric fistula is highly operable and in most cases, completely curable. Therefore, after physicians Reginald and Catherine Hamlin moved from Australia to Ethiopia in the early 1970’s to work as missionaries where they encountered many fistula patients, they decided to open a facility solely serving the needs of women with obstetric fistulas.

A beautiful and pristine facility, one cannot help but sense a “medical utopia” as much of the staff is made up of previous patients and the women there not only get 24-hour medical care, but also benefit from physical therapy, literacy education, and other sorts of counseling. The hospital is well-thought out and well-supported. As I walked through the grounds of the hospital, I had to smile when I saw on one of the buildings, “Oprah Winfrey’s Center for Women.”

This place was far from usual, even by Western standards, and I began to wonder how in the world something so comprehensive could be replicated in all of the other developing countries where obstetric fistulas exist. Would someone be willing to set up a fistula hospital in say, Niger, or Tanzania? And if they could, would that be the best long-term solution? In most of those countries, Ethiopia included, thousands of women are still getting fistulas during childbirth. Whether they’re due to child marriage and hence pregnancy, lack of infrastructure, healthcare shortages, or a combination of all of the above, fistulas are preventable. These problems that interfere with safe childbirth lead to a plethora of other medical emergencies besides fistulas and if these aspects of health care and society could be addressed simultaneously and with the same vigor as the after-affects are sometimes addressed, there would be no need for a special fistula facility funded by Oprah and others.

Of course, today there are thousands of women who have already sustained injuries during childbirth and need the treatment and care offered by places like the fistula hospital, but over time, hopefully there would be so few women needing repair that they could obtain it in a regular public hospital. I am so grateful for the time I had at the fistula hospital and the skilled surgeries I was permitted to watch. I do not by any means want to belittle the work done there, only suggest that the time, effort, and love I witnessed being put into that facility be emulated in all areas of health services, especially that of prevention. One of the ways the Fistula Hospital is doing this currently is by beginning a Midwifery College. They actively recruit high school students in rural areas to train as midwives under the conditions that they return to their homes and work in a government-funded maternal health center. This is something I believe will make a lasting impact on the welfare of women in Ethiopia, and I hope that it continues and expands in its efforts.

Maybe it is more difficult to convince outside donors to give money to something that does not result in immediate change such as an annual large number of repaired women compared to an unidentified and vague number of ordinary women who escaped a fistula because of adequate emergency obstetric care. As future physicians, we should consider how to do this convincing.
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Rachel Pope, a second year medical student, Medical School for International Health, Be’er-sheva, Israel, can be reached at [email protected]