News Archive - May 2003

NEWSLETTER
from
Dr Catherine Hamlin AC
Addis Ababa Fistula Hospital, Ethiopia
May 2003

Patients are moving into "Desta Mender"
This is the first good news! Two houses are fully occupied and there is one new patient to go there today or to-morrow.

She is Minte and was operated on a few weeks ago by Dr Ambaye with Mr. Gordon Williams of Hammersmith Hospital London, helping her.

The plight of Minte
She is a sweet little patient, only 18 years old. Minte came from the distant North West Province of Gojam, which is a fertile area growing much "teff", (our staple grain used in making this unique "injera", eaten by all Ethiopians). At present they badly need rain.

Minte arrived last January with a fistula in her bladder and her rectum. She had managed to get to a nearby clinic for the delivery, but only after being in labour at home for 4 days. So of course the baby was stillborn. It was her first pregnancy. This is such a common story for many patients and only in desperation is such a long and difficult journey undertaken. If a clinic or hospital was nearby many of these stillbirths and resulting fistulae would not occur! Minte at first had her rectum repaired successfully, but at that operation it was found that her bladder had been destroyed during the long labour - its blood supply cut off, and the bladder tissue dying as a result, so there was nothing left to repair!

Her only hope of being continent was to have an ileal conduit operation and an abdominal stoma. Of course, lots of tests and X-rays had to be performed before this could be done, and more importantly the little patient needed counselling and an explanation of what was planned for her future. All this was done with care and love, and now she is making a wonderful recovery physically and mentally to her new life. Nobody from her family has visited during these five months, and she believes her husband may have re-married.

It was fortunate that our wonderfully kind urologist Mr. Williams was flying out from London one weekend in mid April to operate on another patient as an emergency. He was able to help Dr Ambaye with Minte's operation that same Saturday morning. Now she is a happy bright little girl, looking forward to her life in the village.

New Life in the Village at Desta Mender Jock and Louise at the Village Jock and Louise Nicholson (my youngest brother and his wife) have already made the Village a wonderful home for the girls. Louise, especially, is like a mother to them all, and planning lots of things for the future! They all love collecting the eggs, and helping with milking our cows. These are more like pets, so quiet and easy to manage! A calf was born with Jock's help, when the mother was in "obstructed labour", it is a special favourite.

The girls play volley-ball together, and in the evening they sit in the community hall, to perhaps, sew or knit and make baskets.

On Thursday this week we have a Canadian lady visiting who is spinning and weaving silk, for a silk worm farm not too far away. She feels that our girls could easily be trained to do this. So, when you next visit Ethiopia we may even have some silk material to show you!

Now the Desta Mender garden and lawns are looking very nice. There is still lots to do, which will keep us busy. I especially want a lovely garden there. Here at home, we have seedlings of shrubs and trees and flowers ready in plastic containers to take out. But with the heavy rainy season soon to start, we will not do planting out or start the vegetable farming just yet.

The dam area is looking lovely with lawns around it and soon the willow tree plants (already established in containers) will be planted out, perhaps on the island and the others around the banks. Jock has many willows at his own home farm in Australia! He will really feel at home when they are established!

Expert help for the Village patients
We have recently had a visit from a very highly trained nurse from Cape Town, South Africa. She is a stoma therapist. Her visit was only for 8 days, but in this time she saw all the girls with abdominal stomas, including many who are working at the Hospital too, and gave us wonderful advice for each one individually. We were excited to have her here. I had met her on my two visits to Cape Town some years ago and was able to arrange for her to visit us.

She was so enthusiastic and so helpful. It was such a tonic for us all! Now she is arranging for all the equipment that we need for these patients to come from South Africa. The firms we have been dealing with have businesses in Cape Town. This will be a great saving, not only in money, but also in obtaining the equipment more easily and speedily. We see in all these events God's wonderful provision for these "special" patients, and we are so thankful.

Our friends in Australia are the ones who have provided almost everything for these girls, and we cannot thank them enough.

Gift of land next door to the Hospital
Now, to tell you further good news. Our new mayor of Addis Ababa has given us, without any adverse conditions, a 90 year lease of the land adjacent to our Hospital compound.

For years we have been trying to secure this piece of land to be able to expand our Hospital. It is a long narrow piece between one boundary of our compound and a disused Italian quarry, running right down to the river. Now, at last it is ours, unconditionally. The transfer is just being finalised. So we can proceed to build a new 30-bed hostel on this land. Our Ethiopian Architect, Joseph and Rachel, have designed a suitable building. We plan to approach the same builder we have had for all our recent projects, and hope very much he will feel inclined to help us with, what is for him, a small project!

This additional hostel will help us house our poor waiting patients. Some travel great distances to reach us, and we cannot turn them away. There is a large group now sitting clustered round our entrance. Some are able to sleep at night in rented space in town. They pay 1 Birr (about 20cents) for a sleeping space on the floor in a room, in a "village" nearby. This is a great worry to us. The number of patients arriving lately, has been so great, that we can only help them by giving to each one some money for food and allowing them to use our taps for water and washing.

Our kitchen is already overworked and all our hostels full, some with two in each bed!

Dr Andrew Browning At the end of March, Andrew and Stephanie Hall were married at our small Anglican Church in Addis Ababa. Family and friends came from Australia to attend the wedding and as always our own staff came to share in the joy of their Dr Andrew.

At the end of the lovely church service our own Sister Ruth Gadissa sang a few songs. We then all drove off to Jarra Park where we had a splendid meal and great fun together. Andrew's aunt Valerie Browning had many of her "Afar" friends with her, who put on a show for us. The day ended with many of the wedding party joining in the colourful dancing bringing to an end a most enjoyable occasion.

At the moment, Dr Andrew Browning has joined the Mercy Ship in Lome harbour in Togo, West Africa. There is an increasing number of fistula patients coming to the Mercy Ships for surgery. Mamite, (who is one of our original patients who has since become highly skilled with fistula surgery) is working with Andrew on the Mercy Ship.

They have operated on many fistula patients, and are enjoying the challenge. Mamite is a great favourite and has even been given her "own" deluxe cabin on the top deck!

Andrew is evidently teaching her to surf! Reg and I tried to do this in Kenya some years ago on one of our Malindi holidays! But did not succeed very well.

Dr Catherine Hamlin AC

The Hospital's plan for an Outreach Program
There have been the regular outreach trips our medical team has been making to more remote parts of Ethiopia and other African countries. On these outreach trips the Hospital's team has been able to help upgrade the skill of the local surgeon and to operate on fistula patients. The local nurses are being trained at the Fistula hospital for one month on management and care of the woman with obstetric fistula. The local population is provided with information about safe motherhood.

This is sadly not meeting the desperate need of the rural women so we are planning on a more permanent type of assistance. Many are in a very tragic plight and quite incapable of travelling the long distance to Addis Ababa.

AMDD of Colombia University has graciously given funds for operating tables, operating room lights and complete sets of instruments for four of the centres that the team visit. This has strengthened the resident gynaecologist and encouraged local hospitals to provide this service to women with obstetric fistulae.

Despite all these efforts we have noted that the small regional hospitals are unable to adequately provide their normal operated cases, much less obstetric fistula cases, which are considered non-urgent and often pushed to the side or forgotten.

For example, in one centre, the hospital was built to accommodate 30 patients. It now has over 300, so they simply cannot find space for the "Outreach Team" to operate on 20 women during the one-week visit each year!

The plan is to try and establish a safe motherhood and fistula department at or near five of these regional hospitals.

Five towns in strategic locations, north west, east and south, in Ethiopia have been selected. Mekelle, Bahr Dar, Harer, Metu and Yirgalem.

It is then intended, over a period of time, to build either in the existing grounds of four of the hospitals (or on land adjoining the hospital) a small ward, with beds for fistula patients and high-risk mothers. The building will also have an office, toilets, showers and other facilities.

Staff to run the "safe-motherhood and fistula" department would be an experienced obstetric nurse or midwife from the local area. She will receive special training at the Fistula Hospital in Addis Ababa and have ongoing support from the Hospital's mobile team. Complicated cases can be transported or referred to the Fistula Hospital.

One of the great benefits of this scheme is that it will provide a local centre for the care of women who have already had fistula surgery. It will also be a centre where women can have ongoing instruction in safe motherhood, and in particular about the hazards of unsupervised pregnancy and labour. Another component is to provide services to women who may have stomas, and want to live in their own village and not at Desta Mender. We will be able to have her come periodically for check-ups and supplies to the centre, which will not be so far away as Addis Ababa.

Initially, the Hospital is planning to try and develop one such centre. If this is successful the others will be developed.