Your questions answered: how do we find women living with obstetric fistula?

In the third of our Clinical Conversations series, Tolera Adamu, Patient Identification Officer, explains how he finds women living with childbirth injuries in Ethiopia’s remote and rural communities.

What is the most difficult part of your role?

The challenging part is finding suspected obstetric fistula patients because there are many barriers: cultural and geographic.

On one field trip, I remember meeting a woman who lived extremely far away, with the nearest town almost four hours from Addis Ababa. We travelled to the town, drove for another two hours, then reached a point where there was no road access for our car. After walking for another hour, we finally reached her.

She was happy to travel for treatment, but her husband hesitated; he didn’t want her to leave with us. He didn’t believe she had any problems and thought she was healthy. We convinced him that treatment was available, and that it was free of charge. Eventually he said okay, and we brought her to the hospital. She was treated and able to return home, completely cured.

Why is the Patient Identification program important?

It is crucial if we are to identify patients and treat the backlog of women with childbirth injuries. As a patient identification officer, I also function as a bridge between the Hamlin fistula hospital and the patients living with this terrible problem.

Finding obstetric fistula case is difficult. First, we will arrange an awareness campaign in a rural area and conduct health screeningss. We collaborate with a range of stakeholders, including health facilities and government agencies, who will help us to assess women with suspected obstetric fistula patients. We might screen more than ten patients before we identify one with fistula.

Those women who have an obstetric fistula are transported to one of the six Hamlin fistula hospitals for treatment. Sometimes we will visit women at home, even if it means walking to get there.

What role does the community play in the identification process?

Families and community members help by disseminating information, and by getting suspected obstetric fistula cases to the health facility for screening. Our public awareness sessions are usually in places where we can speak to large groups of people – for instance, a market. A person might hear the information and share it with their family member.

The other key role families play is in convincing the patient to get treatment. They can let them know that a cure is available, and there is no cost involved in the treatment.

How did you meet Hawwa* and what was her story?

Hawwa was living with obstetric fistula. She lost her husband. She lost her babies. This had taken a huge emotional toll on her. But she remained hopeful that one day she could be treated. She was so happy when we found her.

The Hamlin team organised transport and everything she needed for the journey, including incontinence pads so she could travel without any inconvenience.

Hamlin’s patient identification program is especially important for patients like Hawwa.

Some women don’t know where to find treatment and can’t afford treatment at a private clinic. Others know nothing about fistula and are unaware that treatment is even possible. They think that it is a curse.

So, our program of searching for patients, and transporting them to the hospital, is so important for those women with no money, who live in very remote and rural parts of the country, where there is no transportation and no health facility. It benefits them so much.

What is the three-pronged approach of Project Zero?

First, we find and link women to a hospital so their obstetric fistula can be treated. We want to resolve the enormous backlog of the untreated obstetric fistula cases.

Second, we need better infrastructure to prevent new fistula cases from occurring. This can include ambulances; emergency, obstetric, and neonatal care for women and their babies; maternity waiting homes where patients from remote areas can stay prior to their delivery so they don’t face the risks that accompany home births.

Our third area of focus is education. This involves refresher training for mid-level health professionals working in rural areas where obstetric fistulas often occur. It can mean educating the local community and encouraging them to deliver their babies in hospital. Also increasing their understanding of antenatal care, and offering family planning services, to avoid unwanted pregnancies.

 How will you feel as more woredas are declared fistula-free?

I will be so very, very happy. And it is possible. As Dr. Catherine Hamlin once said, I can’t eradicate in my lifetime, but you can in yours.

We can eradicate obstetric fistula. We can make sure communities are better educated. We can improve health facilities. We know what to do to avoid more women experiencing obstetric fistulas.

I would also like to thank Australian supporters for helping us to identify and treat women living with obstetric fistula. Please keep on helping us. Thank you so much.