Dear Friends Worldwide,
It is good to be in touch with you all again and to know of your continuing interest and deep concern for our poor patients. They are the reason for all we do! To see the joy they display when cured is just such a reward! We so hope that one day we will have set up so much medical help for labouring women where ever they live in Ethiopia that the fistula problem will be prevented and a mother and baby saved too – and that the huge country of Ethiopia will remain free from this still neglected preventable injury, but there are many hurdles to be overcome before this will be a reality; the worst hurdle is the widespread lack of rural doctors. None want to work in such areas so now our country hospitals are run by health officers, trained to do emergency surgery. This should not be, as every year Ethiopia is graduating a good supply of doctors, but few want a job in rural Ethiopia! And most of our country hospitals need to be improved with a good nurses’ home attached and a doctors’ house as well, so that doctors and nurses and midwives would go there to work readily! I know that this will take time, but I am sure the Ministry of Health is doing much to bring such improvements about - they are treating this as a priority. Our own midwives, where they are now being employed in the more distant rural countryside will be involved as well, as they will be referring any obstructed labour cases to these hospitals for their delivery, mostly by Caesarean Section operations, which only a well trained health officer is able to do.
And so we hope to one day have plenty of our own well trained midwives in these remote areas and only then will we see a change which will surely solve the fistula problem, as in Europe and America and other so called developed countries.
We are graduating every year a few more midwives from our college; this year 25 students will graduate on October 11th after four years of training. Most will have done over 60 to 70 deliveries on their own and seen all sorts of obstetric complications as part of their training. They spend time in Attat Hospital, a very good Catholic missionary country hospital south of Addis Ababa. There they are taught much with our own tutors participating. We have had good news about our graduate midwives already deployed: so far all have been placed within a reasonable distance of our own rural fistula hospitals and so are able to have help from own gynaecologist if a mother needs a Caesarean Section or other help. But this will eventually become impossible if the midwives are placed in more remote antenatal clinics and patients need a Caesarean Section to deliver; our midwife must in this case go to the nearest rural hospital to get help from a health officer to operate, hoping he is one that has been trained for such surgery.
Most of our antenatal clinics are very busy, as our midwives are becoming trusted by the local village women. We have two trained midwives working together at the same antenatal clinic; we also have senior trained staff who visit all our clinics regularly to assess them from time to time, bringing news and requests to us in Addis Ababa if they are in need of extra drugs or equipment etc.
Our work is hampered by not having a gynaecologist in all our five country fistula hospitals and so we have to send one of our three surgeons to two of these hospitals when they are full of patients! This is indeed another hurdle for us to cope with as few medical graduates want to be fistula surgeons. We have recently agreed to admit some of the many women in rural Ethiopia suffering from a prolapsed uterus, an important health issue for women often caused by hard physical work; it is also a cause of much incontinence. There is a need to help these women as many are young and also poor, so need to be admitted freely. Many too are of childbearing age and so require surgery to restore rather than remove the prolapsed uterus, allowing them to bear children again. Already two of our hospitals in Bahr Dar and in Makelle are admitting these patients for operation, aiming to do 10 to 15 in a month for this neglected need.
Our medical director Dr Fekade has been trained in Germany to do some special urinary diversion operations to treat those patients who have severe damage or destruction of the bladder after an obstructed labour. He is now teaching our other fistula surgeons this skill.
I know that one day, hopefully in this century, all our Ethiopian mothers will have safe deliveries, even in the remote countryside and these repairs will no longer be needed.
Our Addis Ababa main hospital is still busy with full wards; we have also now opened a ward for mothers coming back pregnant again after a successful fistula repair, often married to a new husband. All are admitted, some arriving in good time others quite close to delivery date, but all receive a Caesarean Section for a safe delivery. It is such a joy to see them with their first live baby; a visit to that ward is always a delight! We have had a good year so far, with much to be grateful for; I want to thank you all for your continuing commitment and financial help over so many years.
I send my love to you all,
15th August 2014