ADDIS ABABA FISTULA HOSPITAL

ADDISABABA FISTULAHOSPITAL
Quarterly Report October 2OO7
"Nothing can equal the gratitude of the woman who, wearied from constant pain, depressed
by an ever growing sense of the humiliating nature of her infirmity, and desperate with the
realization that her yery presence is an ofience to other^s, finds suddenly that she is restored
to full health and able to resume a rightful place in the family - who find, as it were, that life
has been given anew and that she has again become a citizen of the world."
(Chasser Moir - Fistula)
ln the big Hamlin ward over on the far right side of our hospitalgrounds are four beautifulyoung women.
Two of them have bed cradles,these are frames to keep the weight of the bed clothes off their limbs;the
other two no longer need these frames.All four have contractures. They delivered their dead baby, and
they lay in bed waiting for someone to take them to a place where they could be helped. They were
mourning the stillbirth of their baby,they had lost the control of body waste and so they curled up small
in that sad little foetal position we often associatewith depression.They did not move nor did anyone
else move them, so their legs became permanently stiff, they developed muscle wasting, so the very
muscles that would enable them to walk were no longer functional. Their wasting muscles would no
longer hold them up.
These are the ones carried into our hospital,they go through physiotherapy;they must wait until they can
wdk before surgery and so they exercise.They cry when it hurts and we give them tablets to relieve their
pain. The physiotherapydepartment knows how important it is for them to walk; they know the value of
complete rehabilitation. Wotate came to our centre in Yirga Alem, she weighed twenty two kilos, (3
stones 6 lbs) we worried about her as did Dr. Einar the fistula surgeon.After treatint various infections,
the doctors thought that some other hidden problem might be delayingher recovery, so Wotate was sent
to Addis Ababa for further investigations.I hardly recognized her when I saw her; she had gained eight
kilos (l stone 4lbs) and now weighedthirty kilos! (approximately4 stones l0lbs) Soon we will consider
surtery for her. What joy we have seeingthese darling wounded women become strong and smiling and
healthyagain.
Ruth Gadissa - Senior Stoma Nurse
Watching the medicalstaff care for each patient and seeingthe joy of the healed/ cured patient reflected
in the face of the surgeonas the woman finds out she is dry is one of total job satisfaction,the server and
the served are satisfied.Many of the severely injured women with rectal injuries were checked by our
own Dr. Ambaye (home for two weeks leave) and Dr. Brian Hancock. One young woman from Tchad
was operated on before Dr. Ambaye went back to UK to complete her MPH. That patient is going home
(to Tchad) cured, as I write this report! We also had Dr. Kees Wallik from Nigeria here and he
demonstrated some of his unique ways of doing fistula surgerywhich our stafffully appreciated.
Dr Haile - one of the hospital's surgeons
So many return to us and our small ten-bed ward (BethlehemWard lower) has this very happy band of
beautiful pretnant women, such a sight to warm your heaft. The smilesof the new mothers coming back
with their little bundlesis like a one millionwatt bulb! Stunninglytouchingand electricallywarming!Sadly
one tiny wee mother lost her baby who came too soon, we pray that next time she will havea live baby.
The sewing / craft room has become quite a gathering place,the teachers club together and buy coffee
and popcorn and after lunch the women come and sit with some of the teachingstaff.They sit around and
chat"this informal little group brings healingbecauseit is not medical,it is normality returning along with
hope.
PastorJohn, a Kenyan Bible teacher was here four afternoons teachingus how to tell Bible Stories simply,
the staff loved it and are applying this to various aspects of their lives as well as sharing it with the
patients. We always remind the women that they are loved by God and that they are not cursed! Over
one hundred women askedfor prayer this past month and were comforted.
Knowledge Sharing
The Addis Ababa University and Jimma University continue the two month attachment of post graduate
residents in obstetrics/grnaecolory;five doctors have been with us this last quarter. The more recent
residents from Jimma University have been great and we appreciate the calibre of these men coming to
us.
This quarter was exciting with many firsts, Drs. Kees Waliik and SundayLengman,from Nigeria were here
as were Dr. Tom Raassesnfrom AMREF. Dr. Brian Hancock (a UK trustee), who does many Fistula
Safaristo Uganda, accompaniedby our own Dr. Andrew Browning, Drs. Reimer from Bahr Dar, Melaku
from Mekelle and Lande from Yirgalem were also here to learn from each other. At that time the
lnternational Society of Obstetric Fistula Surgeons (ISOPFS)was formed, Dr. E. Catherine Hamlin is
presideng Dr. Kees Waljik is Vice Presidentand Dr. Biruk Tafesseis Secretary.
Our medical team has been busy working on papers for the Jhpiego set assignments.Dr. Jeffery Smith,
from Jhpiegohas helped us to develop a training packagefor team training in obstetric fistula management.
Our staff worked hard with him to produce the work which is ongoing with many assignmentsleft to do
over the no<t few months.
Dr Hamlin with teachers at Desta Mender
We had Mr. Patrick Hogston from the Royal College of Obstetricians and Gynaecologistsin UK come to
assist us in finding a meanswhereby internationaltrainees might apply for, upon completion of their
training, a certification by an international body / organization.
Both nursesand doctors have produced papersthat have been sent offfor review, there is a large amount
of work that still needs to be done. Dr. Ambaye has finished her studies in UK; Dr. Biruk presented his
classification paper at the Ethiopian Society of Obstetricians and Gynaecologists and also at the
PortugueseUrological Societyin Portugal.He has now completed his MPH from Gondar Univeristy.
Dr. Mulu worked with Professor Torvid Onsrud from the University of Bergen, preparing data for
research. Dr. Haile has been to Germany and our two newer doctors Drs. Habtemariamand Yifru are
learninga lot from their seniors.
We have had some $eat folk visiting us, Mr. John Limle, who co-authored "The Hospital by the River"
with Dr. CatherineHamlin,is here working on a sequelthat shouldcome out next year! This book will be
about the people at the hospital and what has developed since the last book was completed. BBC
produced an Africa-wide one hour protramme about fistula wherein both Dr. Hamlin and Sr. Ruth
Kennedywere able to havea part. Every liale bit helps!
Adequate Capacity
There is no question regardingthe need for extra beds!
Mr. Ridley Smith from our Australian Trust came and helped us think through some of our plans and we
are veD/ grateful.
We appear to be making some inroads into the extra land needed south of the hospital;the land and the
old woodwork factory have been promised to us. The area measuresapproximately4,9@ square metres
and the municipalityhas approved this. We have a map of the designatei site and we will hopefully know
how much comPensationwill be required to finalizethis transaction. Wheels move exceedinglyslowly in
Ethiopia! The plans have now been handed to the Kifle Ketema (next step down adminisirative$ to
come and oversee the transfer. The surveyors have checkedand measuredand we are making small steps
towards gainingthe woodwork fuctory. Our Administrator, Ato Abebe is working on obtaiiing this and
again,he is a very patient man!
keepsgoing back again
"n6
The idea we have for the woodwork factory is to make a large, low cost, low maintenancehostel with
more self sufficiencyfor the waiting patients. This hostel would not need nurses but simply a firm
housemother to keep the placeneat, clean and tidy. Someoneto make sure there is enoughfood and that
no one is sick,the oneswho are sickwould be brought to the hospital.
Office spaceremainsa challenge,Dr. Hamlin is loathed to have more buildingin our green area and
anyway'our hospital is in a 'town-designatedgreen zone' by the governmeng so we are not permitted to
build even if we wanted to!
An American lady has rented a house and she lodges some of our waiting patients. She has called the
house"Rebekah'sHouse" and Matron and Ruth went to see her. lt is very smalland has bunk-bedsfrom
wall to wall; the women stayingthere are pleasedthat they do actually have a bed. There are another
thirty women waiting at Desta Mender where two of our trained nurse aides look after them. Then here
at our own hospitalwe have nearly fifty women waiting in our two hostels.
Our medicalstaff has increasedby one and we still require another one to enableall the medicalsj3ff ro
have time to write, Present and publish papers, do research and keep up to date with professional
journals.
Yirga Alem Outreach
Centre
Sr. Welela and Sr. Saraare working well with Dr. Einer Lande from Norway and housing has now been
kindly provided for him. The land for the nurses'home is being surveyedand we hope to have plansto
developthat soon,we are so pleasedabout this landbecauseit is so closeto the fistulacentre.
Report from Dr. Einar: "The highlight of this quarter was rhe visit of Dr. Hamlin, Ruth Kennedy and
Mamitu' Their time was spent very efficiently with Mamitu and Dr. Hamlin taking command of the
Operating Room to the pleasureof everyone. Unfortunately we did not have rn"ny p"Ii"nts for them, but
Dr. Hamlin showed us how to make a new urethra on a patient planned for reieiral to Addis. Mamitu
showed Sr. Sarahow the operations are performed the Hamlin way! This was a great inspiration to all of
us. They also looked at the outpatients department and saw the padentssoon to be discharged.
Ruth Kennedy and Dr. Hamlin went with Dr. Einar to the Regionaland Zonal Health Bureau. They
discussedthe Hamlin College of Midwives,which the day after led to a successfulrecruiting campaignin
Aleta Wendo. We then discussedthe possibilitiesfor spreadingthe news of our centre. ih" n"*i d"y
(while Dr. Hamlinand Mamituwere busyin the hospital)Ruth Kennedy,Sr. Welela and Dr. Einarwenr to
the secondaryschool in Aleta Wendo. We had a meeting with the principal there and we talked about
students for the midwifery school. As I am writing this, we are informed that there are already 13
interestedstudentsin grade 12.We also discussedthe possibilityof us addressingthe studentson fistulae
to increase the awarenessin the society about our existence. We hope to visit them during the noct
month.
For the time being we tet our water supplyfrom Yirga Alem Hospital without any expenseson our side.
It is very important to us that we solve our water problem soon. Ruth also looked into the need for
more beds and as I write this we havealready receivedextra beds from Addis Ababa".
Sisters Ejigayehu (Matron), Tsedu and Metasabia (Pharmacist)
Concerning the guestion of gettingthe PeoPte to laow we are hete:
We have today visited the Dalle Woreda, in the old town of Yirga Alem. We would like to form a
workshop with the extensionworkers and midwivesin their Woreda to increasethe knowledgeof how
to identify fistula patientsand how to prevent fistulae. Our meetingthere was very positive.They will
enforce their information about fistulaeand our centre to their health centres and health posts, even
though they said that all health posts had a good knowledgeabout this. I promisedto take the financial
paft further to our administrationin Addis Ababa.
We have also had a meeting with the Sidamo Radio here in Yirga Alem and they are prepared to give
informationabout our centre as soon as we give them a written letter of information.They might also
interview one of the staff about our work and perhapsalso patients,but the correct consent protocol
must be respected."
Desta Mender
Desta Mender (oy Village)is where ten houses nestle for the chronic fistula patients.There are at
present 55 women livingthere with chronic long-term injuries and a further 30 pre-operativepatients
who are patiently waiting for a hospital bed. The area is now expandinggreatly with the vegetablegarden
growing well and the fruit trees bearingfruit.
Ato Ephremis managingand working efficientlywith the staff and residents.Various projects for future
developmentof these women are coming along and we hope to have some plan developedfor each
residentere long. Sr. Elfenishis now in chargeof nursingand Sr. Beletechhas been missedby everyone
sinceher retirement.
Produce at Desta Mender
John and Louise Nicholson,Dr. Catherine Hamlin'syoungestbrother and sister-in-lawhave been here;
they were the ones who officiallyopened Desta Mender for us so there was great reioicing amongst the
residentsout rhere when they met up with their belovedSr. Louiseand Mr. Jock! An amazingfeast was
preparedin their honour!
The work at our other Outreach Centres in Bahr Dar and ]'lekelle continues unabated,
whilst the construction of Harrar is almost undervay, and the work at Metu will begin next
Year.
Hamlln Community Mldwife College
Drs. Reginaldand CatherineHamlin cameto Ethiopiain 1959to train midwives,they trained seven.The
plight of the fistulapatientsbroke their hearts and they took off in another direction helpingthese poor
women. The need for midwives has never been greater, more mothers are dying than ever before;
complications from maternal health related matters are increasingdaily, leading to Poorer economies,
increasedabandonmentof childrenand completebreakdownof fumilies'
Excitingprogressis beingmadefor our Hamlin MidwivesCollege;the site for the first buildingadiacentto
Desta Mender has been cleared. Money has been providedfor this buildingand for runningcosts,funds
for suppliesand furnishingetc. The foundationsare going down and soon the walls will be up! We hope
ro have fifteen midwives placed in 2010 in nine rural localities and agreementshave already been signed
with Tigrai, Yirgalemand Amhara RegionalHealth Bureaux.
Ato Solomon, Ato Wudeneh and Sr. Giday went to Yirga Alem, Bahr Dar and Mekelle resPectivelyto
examine students from selectedrural high schools.Both in Bahr Dar and Yirga Alem the students were of
a very high standardand were ableto completethe examinationwell. The final touchesare beingapplied
to the curriculumwhich ProfessorAnn Thomson from Manchester,UK was graciousenoughto help us
with. This is to be bound and presented to the Ministry of Health for their final approval and then they
will present it to the Ministry of Educationfor the accreditation
The work at our other Outreach Centres in Bahr Dar and Mekelle continues unabated,
whilst the construction of Harrar is almost underway, and the work at Metu will begin next
year.
A simplified summary of the hospital's r€cent performance
Hospital Perforrnance
Hospital Activities
Outpatients seen
No of admissions
No discharged
Nurse Aides admitted
Desta Mender patients
High Riskmothers
Bed Occupancy(Avge)
Training
EthiopianDoctors trained
Foreigndoctors trained
Nurses& Nurse aidestrained
Surgical interyentions
Minor
Major
Physiotherapy
Post op
Rehab
Stressexercises
Stoma Therapy
No consultations
No bagssupplied
Testing
Ultrasound
Urodynamics
X-Rays
Counselling
HIV (new)
Psychotherapy
Groups (new)
Individual(new)
Outreach patients
referred
to Addis Ababa
Main
Bahr
Hospital
Dar
12 months toJune 2007
Yirga
Mekelle
3,244
1,077
883
56
37
76
144
933
324
27
7
35
l4
Alem
335
2
Total
4,836
4,077
883
56
37
lt2
t44
49
24
24
43
43
277
1,t46
277
614
t72
r5 8 2,090
t.il 7
t.t t7
240
398
240
398
356
698
356
698
368
159
368
t59
3t7
3t7
39
39
t97
197
r08
r 08
30
26
4l
97