Published in the Daily Telegraph, 27/01/2016. Story by Angela Saurine.
Before she begins to translate, Beletshachew Tadesse pauses to apologise.
“I’m sorry, I’m not a very good interpreter,” she says.
She looks down, then stands up and walks to the other side of the room before heading outside to compose herself. Asrebeb and I look at each other and smile awkwardly as we wait for her to return.
During her four years as general manager of Desta Mender, Tadesse has heard some horrific stories, but Asrebeb’s is the worst of the worst.
She weighed just 22kg when she came to the attention of Hamlin Fistula Ethiopia, and had spent seven years lying in bed in a small hut, unable to walk after suffering severe childbirth injuries. Like many people from regional Ethiopia, Asrebeb isn’t sure of her exact age, but she was in her early teens when she was wed in an arranged marriage to a much older man. She fell pregnant soon after.
Malnourished as a result of poverty, her pelvic bones weren’t properly developed and she was too small to give birth naturally.
Dr Hamlin changing the lives of poor women ostracised by obstetric fistula in Ethiopia
With Caesareans not readily accessible in rural Ethiopia, she was in labour for several days before friends and relatives tried to carry her on a makeshift wooden stretcher to a faraway hospital. The stillborn baby was removed by an untrained midwife en route.
By then, Asrebeb was unconscious. Left with an obstetric fistula – a hole between her vagina, bladder and rectum, which led her to leak urine and faeces constantly, her husband left her. She was treated as an outcast in her village because she smelled, and felt ashamed.
“I used to cry day and night, Asrebeb says softly. I didn’t want to eat or drink because I didn’t want to live, and I didn’t want to leak.”
After three or four years her village heard of another woman suffering obstetric fistula, but it was two days drive plus four hours walk over mountains and rivers to the nearest medical clinic, and the community was divided. Some thought her injuries were too severe to be a fistula, and it must be punishment from God.
Eventually, health officials heard about Asrebeb and took her to a fistula centre at Bahir Dar, in Ethiopia’s north, where she met caring doctor Bitew Abebe.
His own aunt had a fistula for 30 years, and was only cured when he took her to Hamlin’s hospital in the capital Addis Ababa when he was studying. She made him promise he would work for them when he graduated.
After rebuilding her strength, Asrebeb was also transferred to Addis – where the most seriously injured patients are operated on, and spent five years there undergoing treatment and physiotherapy before moving to Desta Mender, or Joy Village.
On a 60ha property on the outskirts of the city, filled with juniper trees and surrounded by mountains, the compound was set up 12 years ago as a sanctuary for women whose injuries were so severe they could not return to their villages.
After years using a walker, Asrebeb can now walk without assistance, slowly.
She shares a house with seven other women, works in the staff kitchen twice a week sifting grain, and makes baskets and cotton scarfs. Every day, she thanks God that she was rescued.
“I would have been forgotten”, she says.
Addis Ababa Fistula Hospital was opened by Australian doctor Catherine Hamlin, who has appeared on Australian Story and The Oprah Winfrey Show, and her late husband Reg in 1974. Both obstetricians and gynaecologists, they had never seen a fistula before going to Ethiopia in 1959 to train midwives in a government hospital.
The condition had been eradicated in the western world by the 1930s when Caesareans were introduced. Dr Hamlin, who turned 92 in January, is still involved in the organisation, but spends much of her time with family in the UK now.
Each year around 1700 women suffering urinary or faecal incontinence after prolonged obstructed labour are operated on at the hospital, with some begging for years to raise the money needed to get there. Nearly two-thirds are cured after their first surgery, which costs around $600.
But a handful, like Asrebeb, cannot be fully cured. Some must undergo diversion surgery, where urine passes from the urethra directly into a collection bag. Those who are at risk of renal failure and have shorter than average life expectancy can expect to spend the rest of their lives at Desta Mender, but Tadesse is increasingly trying to help them return to their communities.
Around half of the women in Ethiopia are illiterate, so while there they are taught numeracy and literacy, health education, family planning, human rights and women’s rights, as well as provided with counselling.
A business plan is developed for each, with most now returning home after three months to launch small businesses ranging from running kiosks to goat rearing and dairy farming.
Tigist is one of the success stories. The 28-year-old was in labour for five days before giving birth to a stillborn baby. Her bladder was destroyed and her husband divorced her.
She was leaking urine for three years, and spent two years at Desta Mender before returning home and opening a shop. She returns to Bahir Dar Fistula Centre every six months to have her bag changed.
She is unlikely to marry again, but you never know. Tadesse knows of one former resident who wears a bag who has remarried, and had a baby.
The government has set a target to eliminate obstetric fistulas in Ethiopia by 2020, but Hamlin Fistula Ethiopia CEO Martin Andrews is not sure that is realistic.
“There are parts of Ethiopia where there isn’t even a plan on how to start,” he says. “There’s no health centres, the people are nomadic. In some parts it could be eliminated in the next five to 10 years, but in others it will be much longer.”
The Hamlin organisation survives through fundraising. It sells Ethiopian products at its Turramurra shop and runs annual tours to Ethiopia, where supporters can meet the patients, doctors and midwives in person and see where the money they raise is going.
The most donations come from Australia, followed by the UK and the US, and women like Asrebeb could not be more grateful.
“It’s because of them that I have another life”, she says.