HEALING A Global Commitment to Improving Womenâ€™s Health in Rural Ethiopia
By Rahel Nardos, MD and Philippa Ribbink, MD Photos and personal stories by Joni Kabana
A WOMENS LIFE IN RURAL ETHIOPIA “She is uneducated, married at a very young age to a man she has never met.” She performs hard work to get through the day. Before the sun rises, she wakes and prepares breakfast for the family. She fetches water from the river, often miles away, carrying her large clay pot on her back, walking barefoot for hours daily. She carries the young on her back while she makes “injera”, the staple bread, inhaling the smoke from the open fire in the corner of her windowless oneroom mud “tuckul”.
She collects firewood from the forest, carrying the load on her shoulders through mountainous terrain. She repeats this daily from sunrise to long after sunset, 365 days a year while bearing multiple children and hoping that she has earned the good will of her husband at her time of need.
Amognesh’s Story “Will I see my daughter walking again?” Amognesh’s mother asked repeatedly with a sense of urgency and fear, while Amognesh, emaciated and weak, barely whispers a word. The mere act of sitting up seems to exhaust her. Amognesh is about 20 years old and comes from a region in central Ethiopia.
Three months prior, with her first pregnancy, she was in labor for three days tended to by traditional birth attendants at home. The fetus was stuck in the birth canal, unable to dislodge. “My husband was away working for days and I didn’t have anyone to carry her to the health center” said her mother, when asked why no one sought care. The closest hospital where surgical delivery can be done was a one-day trip from where she lived, including several hours on foot.
When Amognesh finally made it to the hospital, the baby was already dead. â€œThey took my baby out vaginally piece by piece, without anything to help the pain,â€? Amognesh whispered with a blank and tired look on her face. For women like Amognesh, most are abandoned by their husbands. They become weak and immobile in order to avoid contaminating their surroundings, to the point that their limbs are contracted and their bodies are emaciated, unable to move. This was Amogneshâ€™s predicament as she sat outside a health center outside of Bahirdar awaiting for a transfer to one of the nearby fistula hospitals.
The nurse aid, who was also a previous fistula patient, sat next to Amognesh roasting coffee on a coal fire. She has been feeding Amognesh and performing physical therapy until she is strong enough to have her fistula repaired. Her mother tearfully and eagerly awaits the day that her daughter will become healthy again. Amognesh had what is called “destructive delivery” in which instruments (often makeshift and not sterile) are used to crush the fetal head and deliver parts vaginally.
“Her mother tearfully and eagerly awaits the day that her daughter will become healthy again.”
Following this, Amognesh suffered one of the most terrible consequences of obstructed labor: vesicovaginal and rectovaginal fistula. The blood supply to the bladder and rectal tissue that surrounds the compressive fetal head becomes compromised, causing the tissue to become necrotic and slough off, leaving behind a hole between the bladder and vagina and/or the rectum and the vagina. The consequence of this extends far beyond the urine and fecal incontinenence, physically, psychologically and socially.
Jisseâ€™s story â€œJisse lies in her hospital bed waiting to be seen.â€? Several months ago she heard about the prolapse project at one of the outlying clinics. One of the nursing students walked three hours to her village to remind her to come in. She has lived with complete uterine prolapse for five years, and the mucous
membranes of her cervix is cracked and ulcerated. Living with prolapse has made it hard, if not impossible, to work in the fields and gather firewood. Her son sits next to her in the open hospital ward. When the team walks on the ward, he rushes up to them to make sure Jisse gets seen. This is her only chance to have surgery.
Like most Ethiopian women, Jisse does not know how old she is. After 20 years most woman stop keeping track of their age. When the team asks her how old she is, she guesses 30. She knows how old her oldest son is and he is 25 she says, making it unlikely that she is 30. The doctors point this out to her, and she giggles. If she is nervous on her way to the operating room, she does not show it. She hears that these are the “good doctors” and that she will not be hurt. Four days later, it is time for her to go home. She puts on her new donated dress, and gets ready for the long walk home with her son. She is ecstatic to have been one of the fortunate few to be healed of this dreaded condition. She cries uncontrollably as she thanks the hospital staff.
“Like most Ethiopian women, Jisse does not know how old she is.”
Uterovaginal prolapse is a condition in which the uterus and the vagina losses its support and protrudes out of the vaginal canal causing difficulty with bowel movements or urinating, pain, fatigue and sexual dysfunction. In Ethiopia, women with complete uterovaginal prolapse with severe ulceration and infection of the exposed vaginal tissue are often simply given antibiotics and sent home to live their days sitting in one position.