Menna Ayalew, Fistula Mentor

“People told me that there was no way we could cure her, that we should just let her die at home,” says Menna Ayalew, who works with the Fistula Care Project in Ethiopia. She is talking about Asrebeb, a 20-year-old woman who had given birth at home when she was just 14. Asrebeb did not have a skilled health worker to assist her and developed obstetric fistula—an injury caused by prolonged labor that produces a hole between a vagina and bladder, rectum, or both, through which waste passes uncontrollably.

Menna is a fistula mentor who identifies, screens, and transports women with obstetric fistula from rural villages to a fistula pre-repair center, where her team can prepare the women to undergo fistula repair surgery. Her previous work in maternal and child health departments at Metema Hospital and the Debark and Woreta health centers made her want to focus on maternal health, especially in remote communities. “A mother would come in after prolonged labor—days of labor—and sometimes the case was so complicated, and the referral too late, that the mother ended up delivering a stillborn baby.”

Menna is so devoted to her work that she lives in the rural town of Woreta during the week then travels 50 kilometers back to her husband and children in Bahir Dar on the weekends. “Women who have obstetric fistula suffer silently. I get great satisfaction from my role with the project,” she says, “especially when I see women whose lives are improving as a result of our work.”

One of those patients is Asrebeb. When she developed obstetric fistula at age 14, Asrebeb’s husband divorced her, the community shunned her, and her family became ashamed of her. Her mother placed Asrebeb away from the family, in a separate room with a bedpan that Asrebeb’s mother emptied for her. Because Asrebeb did not want to burden her mother, she minimized the food and water she consumed to the point where her extremities became numb as she became severely malnourished and developed anemia. 

Six years later, Menna entered the picture. As part of her work, Menna trains health extension workers and educates community members on what obstetric fistula is, its causes and predisposing factors, how to prevent it, and how to identify it. Days after one of Menna’s talks, a health extension worker called Menna about a potential case. Menna drove 50 kilometers to pick up Asrebeb.

“The driver and I felt great sorrow when we saw her: it was hard to see the whole person. She looked more like a collection of bones.” People told Menna not to bother with Asrebeb, but Menna did not listen.

Now Asrebeb has undergone repair surgery, is undergoing physical therapy, and has started walking with crutches. Asrebeb’s life, like that of so many other patients, has drastically improved. Satisfaction from helping people like Asrebeb is why Menna says her work with IntraHealth has made her own life better, too.

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