ADDIS ABABA FISTULA HOSPITAL Quarterly Report July 2008 During the last quarter the number of patients coming to the hospital was 960 and we regularly had over 20 staying at our overflow bed space in Desta Mender. It has been a busy time but this is the normal patient load for us as the situation of obstetric fistula does not seem to be improving yet in Ethiopia. With our main centre plus 3 (soon to be 4) outreach locations we are now treating 230-240 patients per month, we are hoping to reach a total of over 2,750 patients treated in this 12 month period. This will have doubled the number treated before we commenced out expansion programme. Dinkenesh A patient s story Dinkenesh is a twenty four year old patient from Sekota, which is in the Amhara Region in the northern part of Ethiopia. She is very under nourished and looks like she is only a young teenager. When she was sixteen years old she saw that her mother was getting ready to have her married. Her mother had just become a widow and was looking for options to assure her own survival. Dinkenesh was given to a man who was thirty years old, he had lost his mother and was living with his father and younger
brothers. They were looking for some one who could be like a mother at their house, who would be responsible for the domestic chores, so Dinkenesh was the perfect choice. She would wake up 5:00 am or even earlier than that to begin her day and she also took care of her husband s three younger brothers and his father. Dinkenesh did not only do the home chores but also had to go to the fields and help her husband with the farming. When she arrived home at the end of the day she was so tired, she would go straight to bed. This routine continued even when she was pregnant, for there was no one else to do the work for her. When she was in labour she explained that the nearest health care centre was about half a day s walk away and usually there are no doctors there, so I would have had to go all the way to Sekota, which is about two day s walk away. For Dinkenesh to be taken to a hospital was difficult and her neighbours kept saying she would be alright and would deliver the baby soon. However she was in labour for three days and then she delivered a stillborn child, which was shocking news for her husband. The long labour had left her very weak and she could not control her urine, therefore she could not continue her daily duties. This meant that her husband now had to look after his younger brothers and his father and before long he sent her back to her mother s place so he could get married to another person who would be able to look after his family. Dinkenesh has been in the Addis Ababa Fistula Hospital for two months now. She told us she has lived with this injury at her mother s home for four years. She was very malnourished when she arrived and she has been taking nutritional food and a dietary supplement so that she will soon be strong enough for surgery. We hope that she will be fully healed and will be able to return to begin a new life. There is a Fistula Clinic in her Region and schools are opening, so she hopes that other people will not have to suffer the way she has. Training Training medical professionals in treating and caring for Obstetric Fistula patients has always been an important part of our work. Over the last 9 months we have been working with JHPEIGO (associated with John Hopkins University, USA), to develop a formalised structured training programme. This will be competency based with skill assessments and evaluation for those participating. The first draft of the trainers manual and the trainees resources has been completed and the first group of trainees have come to our hospital to trial the programme. This programme will run for a period of 6 weeks. Their initial feedback has been very positive. Once we have feedback from this first course, we will work to finalise the training documents. Our new training system is also being reviewed by FIGO (International Federation of Obstetricians and Gynaecologists), who will use it as a basis for their planned training system for Obstetric Fistula. We have had trainees from Liberia, (doctor and two nurses), Kenya, (doctor and two nurses through AMREF) and Afghanistan, (doctor and nurse from Care Hospital in Kabul). It is an exciting development for this key area of our work, we will keep you informed as to our progress. We are planning further courses for this year and also a possible advanced course. Desta Mender As you will be aware, our Desta Mender site, located 15 Km outside Addis Ababa, is the place where we work to rehabilitate women who have had such serious injuries that they are unable to return to their rural home areas. This is due to the fact that they often are living with a stoma bag attached to their body to collect urine, since their bladder is not able to function in the normal way. In the last months the total number of residents at Desta Mender has been significantly reduced. We have been successful in our skills training and have built the confidence of a number of women who have now taken up jobs and are living
outside of our facility. Twelve months ago there were 55 residents at Desta Mender and there are now 35, after 20 have taken up opportunities in earning their own income. Some of these women have been trained as nurse aids in readiness for our new Harar Centre and some have taken up positions as cleaners and cooks in the new Midwifery School. Others are working as tailors and in other roles. We are very pleased to see these women taking responsibility for their own lives. Plans for a new café and amenities block are now nearing completion and we hope to commence construction as soon as possible so that we have the roof in place before the rainy season. This will provide an opportunity for women who have been trained in catering to put their skills to use and generate an income towards the cost of their accommodation in Desta Mender. They will earn an income for themselves and this will build their confidence towards independent living. The Meeting Room by the lake will become an attractive venue for organizations holding day meetings and conferences. Our women will provide this service for a fee. Outreach Locations Bahir Dar Patients at Desta Mender The centre continues to be extremely busy. Dr Andrew Browning, his wife Stephanie and son William, travelled to Australia earlier this year for medical check ups. During his absence doctors from our hospital in Addis Ababa were able to operate on some of the patients who were waiting. We have installed a larger capacity water storage system and have not had further water shortages. There is a need for a small extension to the laundry building since the room is too small and we need to install a larger machine. The prevention programme has been continuing and a base-line study has been completed in two zones. Ato Birhanu is our most experienced outreach officer working in the area of patient location and prevention and he has launched the Amhara radio announcement, this will be a 3 minute announcement 2
days a week at 7:00pm and will run for 6 months. It began this week and already patients are coming for treatment as a result of it. Ato Birhanu also represented the Barhir Dar unit at a USAID/ UNFPA meeting in Ghana. UNFPA and USAid are now active partners in many countries of the world, assisting governments and other parties to set up programmes to treat and prevent Obstetric Fistula. This was a good chance for him to share his experiences with people from other parts of the world. Yirgalem In the last three months 193 patients have been seen at the centre. Not all of these were new fistula patients, in fact only 84 of them were, some were patients returning for a review of their case and to give information about the outcomes both physical and sociological. The ward now has a total of 37 beds and has had a 98% occupancy for this period. In some cases there has been up to 48 patients in the ward, 11 of them sleeping on mattresses on the floor. We are therefore keen to look at options for extending the capacity of the centre. We have been promised an area of land from the local Municipality, but to date we have not been able to acquire this to enable us to continue our plans to build a waiting ward and accommodation for guests and doctors. We hope to report some positive news about this in the coming months. Dr Einar Lande in the Operating Theatre in Yirga Alem Our centre has also had some difficulties with water supply and management of waste water. As a result we now have plans for increased capacity in storing water as well as a larger capacity septic system. We hope that this will be finalised soon.
In the area of prevention, workshops have been held in 3 localities and 445 people, including health personnel, community leaders and traditional birth attendants, have taken part. Clean delivery kits have also been distributed. Mekelle The number of patients being treated at our Mekelle centre has been low, but with outreach work to raise awareness and build connections with other stakeholders in maternal health, we are starting to see increased patient numbers. We would like this to significantly increase in the coming months, with a target of about 40 patients per month. Education and Awareness Raising meetings have been held with almost 150 representatives of community groups, health workers and TBA s. This will continue in the coming months and we hope that other partners will begin identifying patients for us as well as being part of the prevention strategy. Preparation for the new water storage and purification system has commenced. A storage tank of 40,000 litres will collect rainwater in the rainy season and also act as an extra storage for town water in the dry season. Town water is high in calcium and has caused damage to our sterilization equipment and water heaters. We are hopeful that this new system will be completed soon and as a result will prevent further damage of our equipment. Harar Our centre in Harar is now nearing completion and we are looking forward to this new resource for treating fistula patients. Dr Yifru is to be the Doctor in charge of this centre and he is undergoing the final stages of his training to enable him to take up this role. In the coming weeks Sr Kebebe and Sr Tesaye will travel to Harar to take up their positions and assist in preparation for the opening. They have been training at the Addis Ababa hospital and visiting other outreach locations in preparation for taking up their new role. Some of the staff who will be working at Harar in local dress
Midwifery School The Midwifery school is running well and the staff are developing their teaching resources for this first batch of students. We had a wonderful visit from Dr Carol Osburn representing the Caris Foundation that supplied funds to build the first two buildings of the college. Dr Osburn was pleased with the progress and the quality of the facility. Unfortunately the Caris Foundation has changed its funding priorities and will not be able to fund further projects. We were informed that they now have a plan to build and manage their own hospitals in Africa. The local Municipality has almost finalised the granting of a section of 12 Hectares of land to be allocated to us, beside our existing property at Desta Mender. This has enabled us to prepare the initial schematic drawings for the next stage of the Midwifery project. This land will also enable us to develop further our plans for Desta Mender and the self reliance projects that we are running there. We are still waiting for the final accreditation document to be delivered to us. This process has been terribly delayed. The Ministry of Education officials visited our site and told us that it was one of the best facilities that they had inspected. We are still waiting for a Midwife consultant to finish reviewing our curriculum material to give a final approval. We have been informed that the curriculum is good and innovative, but we are waiting for that elusive final approval document. The students have completed all of the basic foundation subjects and are now ready to commence the Midwifery subjects and to prepare for their first clinical activities. A recent important award Dr Hamlin receiving an Ethiopian Millennium Award for her contribution to Society and Humanity from the President of Ethiopia at an award ceremony in Awassa, south of Addis Ababa
Breaking News Hamlin College of Midwives News that the official papers, signed by the Minister of Education, giving formal accreditation to the College were received just as we were going to press. Here are some photographs of the latest position. Some of the early students at the College Readers may recall that it was the original intention of Dr Reg and Dr Catherine Hamlin to start a Midwifery School in Addis Ababa when they first arrived in Ethiopia in 1959. Beverley Stewart, a UK trustee and a midwife, talking to one of the new students
As it turned out, there were insufficient funds available in the country for this to be achieved, but they soon saw the plight of so many women who had the injuries now known as fistulas leaving so many of them with lifelong injuries and abandonment Part of the extensive library at the College which was funded from the UK A full report will be given of the Official Opening in future Newsletters Annette Bennett, who has sole responsibility for the College, in her new office
A map of Ethiopia showing the location of our hospitals in red. Desta Mender is in Addis Ababa