Patient Identification: The first step to freedom

Women with fistula are hiding in shame.

They can be cured, but first they must be found.

Ethiopia is a country of 130 million people, most of whom live in rural areas that are incredibly difficult to access.

Most women suffering the devastating effects of obstetric fistula in these isolated areas do not know there is a cure for their condition. Even if they do, they live too far from the nearest hospital or can’t afford to travel. Many have lived in social isolation for years, sometimes decades, and been shunned and humiliated by their communities and even their own families.

Unique Ethiopian challenges

For the Hamlin team, finding and treating these women is a top priority, but also a significant challenge.

As Catherine Hamlin said: “Our country is very mountainous and full of rushing rivers and ravines and deserts, and it’s difficult to traverse. The average walk of our patients is two days to get to a main road and so their difficulties are enormous. The maternal death rate of these women, these are just the survivors of those that don’t die.”

Hamlin Fistula Ethiopia is determined to accelerate the rate of change for women with fistula in Ethiopia.

In 2020, Hamlin Fistula Ethiopia embarked on an ambitious Patient Identification Program to find and treat the backlog of Ethiopian women living with untreated fistula injuries.

The role of Patient Identification Officers

Tolera is one of Hamlin’s Patient Identification Officers, based at the Addis Ababa Fistula Hospital. His role is to seek out every woman with fistula in remote rural communities and transport them to the nearest Hamlin hospital for specialist treatment and holistic care.

He and his team travel for hours, sometimes by foot, to reach remote villages and provide women with transport to hospital. Tolera told us:

“Some patients live in very remote and rural parts of the country, where there is no transportation. If there is no road, we will walk to find them.

A bridge from patients to treatment

The Patient Identification program is a bridge between the Hamlin Fistula Hospitals and patients living with this awful problem. But there are so many different factors in finding suspected fistula patients like cultural barriers and geographical locations. And the patients don’t know there are services or how to get them.”

Ethiopia is a diverse country with dozens of ethnic groups and languages. Tolera’s team works hard to earn the trust and respect of local communities in each woreda (district) they visit. Their community outreach with health and women’s groups, clinics, religious and community leaders is the first step in identifying women living with fistula.

A trusted intermediary

Many women with fistula are afraid to leave their homes so their family and neighbours play an important role in sharing information about treatment. If a woman or her family is unsure, Tolera and his team will reassure them that treatment at a Hamlin fistula hospital is safe, effective and importantly, free of charge.

When we asked Tolera how he will feel when woredas start to be declared fistula-free, he says,

“I’m very, very happy. After treatment, women can live freely. Physically, psychologically and even economically, they can be free. Once Dr Catherine Hamlin said, ‘I can’t eradicate it [fistula] in my lifetime, but you can in yours’ so we can eradicate obstetric fistula and then I’m very happy.”

Donate now to help us find and treat more women with untreated fistula injuries so they can start their lives anew.