Saliati grew up in a remote village, where misconceptions about medical care had made the community wary of maternal health services. As a result, she endured an obstructed labour without help and needlessly suffered from a debilitating obstetric fistula injury. For seven long years, Saliati was hidden from her community, until she was found by a Hamlin Patient Identification Officer and taken to the closest Hamlin fistula hospital – her hope rekindled.
Ingrained distrust towards maternal health care
Saliati was born and raised in the rural village of Darolebu in eastern Ethiopia. Growing up in Darolebu, life was difficult for Saliati and her sister. It was difficult to get balanced meals, which led to malnourishment. School was not an option for the children, so Saliati spent her childhood working hard to help support her family. She was expected to marry young and then manage a household and start a family.
Soon after she was married, Saliati became pregnant. The distance to the closest medical clinic was not Saliati’s only deterrent to having a prenatal check-up. In Darolebu, like in many remote Ethiopian villages, many childbirth injuries, as well as infant and maternal mortality, are scarily accepted as a common risk to pregnancy. Common misconceptions about the effectiveness of health professionals – such as the belief that doctors and medical equipment risk harming the foetus during routine check-ups – have engendered mistrust in the community towards midwives and maternal health care, meaning that almost all births in Darolebu are unattended by a medical professional. More broadly in Ethiopia, 70% of births occur at home without a doctor or midwife present.
A preventable tragedy
Saliati had planned on delivering her baby at her mother’s home. Saliti’s labour began, and didn’t end. She was in agony for hours, which soon became days. Her labour was obstructed so she was unable to progress without medical support. “Oh, it was too painful. I laboured for two protracted days and became unconscious. I remember it like a dream when I was eventually taken to the closest hospital lying on a handmade stretcher,” recalls Saliati. Heartbreakingly, Saliati’s baby was stillborn on the way to the hospital.
The loss of her child was not the only tragedy that Saliati suffered. Upon returning home, she discovered that she was soaked with urine and had suffered an injury in childbirth. “My husband and I thought it was the side-effect of the long labour and hoped that it would soon stop, but that didn’t happen. I felt ashamed of myself and agonised,” explains Saliati. She didn’t know why she was leaking and she didn’t know how to stop it, so she lived with it – in shame and misery,
For seven agonising years, Saliati lived with fistula and without hope, not knowing what to do about her condition or where she could go for help. “I restricted myself to the home: I never visited sick neighbours or went to funerals or any other community events,” says Saliati. “I was lucky that I have a good husband who stood by my side the whole time. He brought water to wash me and my clothing. If it was not for him, I may have been dead.”
After seven years of living in the shadows, Saliati was found by a Hamlin Patient Identification Officer. Officers like Mohammed travel hundreds of kilometres every week to find women living with untreated fistula injuries, as part of Hamlin’s Patient Identification Program. They visit remote communities, that are strategically selected, to teach local health officers about obstetric fistula and how to identify it.
Health officers share information with the community, raising awareness of available treatment in small gatherings at churches, mosques and markets. They then go from door-to-door, often travelling on foot for kilometres to find and identify women living with obstetric fistula. They carry and spread hope around the country.
Hamlin Patient Identification Officer Mohammed has seen first-hand how essential the program’s work is. “Many women living with obstetric fistula are uneducated and can’t express their needs or medical concerns,” he says. “They are often ostracised from their communities, and have no access to transport, which also prevents them from getting help.”
Saliati wasn’t aware that a cure was possible. After her fistula injury and the possibility of a cure was explained by Mohammed, she agreed to go with him to the closest Hamlin fistula hospital for fistula-repair surgery. In mid-February 2021, Saliati and five other fistula patients were located and transported in an ambulance to Hamlin’s Harar Fistula Hospital.
After two weeks of preoperative physiotherapy, medical check-ups and nutritious food, Saliati underwent fistula-repair surgery from Harar’s Head Fistula Surgeon, Dr Leta. Since beginning at Hamlin in September 2020, Dr Leta has performed over 70 life-restoring fistula surgeries on women, including Amina, Sekina and Saliati.
For the first time in seven years, Saliati was dry.
“I couldn’t believe that I would be cured in such a short time after I unbearably suffered from this problem. It was the same when I told my husband the good news. He is so happy – even more than me! I thank my husband and everybody here at this hospital. You can’t imagine what you’ve done for me. It is like a rebirth. Thank you!” Saliati exclaims
A journey to new beginnings
There are still an estimated 31,000 women living with devastating obstetric fistula injuries in Ethiopia. With 80% of the population in these areas having little or no access to quality health care, an additional 3,000 women continue to suffer fistula injuries every year. These injuries leave them trapped in a life of pain, shame and isolation.
Hamlin Fistula Ethiopia’s immediate priority is to find and treat all existing and new cases, that’s why our Patient Identification Program is so important. “The smile on the face of my patients when their dignity is restored is the best part of my job. It’s why I won’t stop until Ethiopian mothers can enjoy a safe pregnancy, delivery and life with their children,” says Dr Leta.
Mohammed is one of the many Hamlin Patient Identification Officers who travels extraordinary distances each week to find, identify and transport fistula patients like Saliati. Dr Leta is one of the many Hamlin fistula surgeons who performs life-saving fistula repair surgery on women, restoring their health and dignity. We exist to make sure women like Saliati who have survived the heart-breaking and preventable childbirth injury, obstetric fistula, can live full, happy and healthy lives.
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