Voices from the Field: Repairing Obstetric Fistula And Mending Lives

Tiblet’s life changed in an instant. Married the year before and still just 19, Tiblet had imagined bringing her first child home after she gave birth; instead she delivered a dead fetus at the health center, after laboring for three days at home in Ethiopia’s Adet Woreda. Two days later, she noticed she could not control her urinary function. Tiblet’s husband learned of her condition and believed it meant that an evil spirit lived inside of her. He feared the spirit transferring to him; thus, two weeks later, he divorced her.

Of the three million women who give birth every year in Ethiopia, 8,500 to 9,000 will develop obstetric fistula, which is caused by prolonged and obstructed labor and the lack of access to emergency obstetric care (especially caesarean section). Obstetric fistula is a hole that develops in the tissue between the vagina and bladder or between the vagina and rectum, or both, during labor. The result is the formation of an opening through which urine and/or feces pass uncontrollably (and continuously).

In a span of two weeks, Tiblet’s life shifted dramatically from the course it was on, and for five years, Tiblet lived—and survived—on a very different course.

Tiblet’s parents tried every traditional medicine to help their daughter, and none healed her. Afraid of their neighbors, they did not disclose her problem to anyone. Tiblet lived in a room apart from the rest of the family, even separate from where the cattle slept because Tiblet’s parents were convinced that the evil spirit would pass into anyone or anything to which she was too close.

“One might get used to the continuous dripping of urine and its foul smell,” Tiblet says of those five years, “but not to being friendless, lonely and detached from social interactions.”

Through the ACQUIRE Project, funded by USAID, IntraHealth led a one-year pilot program (2006–2007) to reach women like Tiblet in the Amhara region of Ethiopia.

Focusing on both prevention and repair of obstetric fistula, the program worked to:

  • Increase skilled care at births
  • Improve the ability of community-level health extension workers to recognize the danger signs of obstetric emergencies
  • Build a referral network to transfer obstetric fistula patients to the appropriate facility for repair
  • Support fistula identification and pre-repair care in communities and health clinics
  • Educate communities about causes, prevention and treatment of obstetric fistula.

“IntraHealth, on the grassroots level, has been invaluable in raising awareness in the villages that those women can actually get help,” says Dr. Andrew Browning, a doctor curing obstetric fistula at the Bahir Dar Fistula Hospital in the Amhara region. The hospital treated about 600 women over the last year. “Out of those, almost 200 came directly via the IntraHealth program, so that’s been a crucial role.”

A health extension worker, trained on obstetric fistula screening and referral by IntraHealth, noticed Tiblet on her visit to the district where Tiblet lived. The worker approached and eventually counseled and convinced Tiblet to try and resolve her medical problem. The health extension worker then contacted one of the fistula mentors in Adet Woreda, and Tiblet received pre-repair care and was transported to the Bahir Dar Fistula Hospital where she was cured.

The obstetric fistula pilot program in the Amhara region:

  • Ensured that 172 women were cured of obstetric fistula
  • Referred ten women to the Addis Ababa Fistula Hospital for expert evaluation and surgery
  • Trained 104 health care providers on fistula prevention, pre-repair care and referral
  • Trained 977 community-level health cadres and community leaders in community mobilization
  • Educated over 150,000 community members on obstetric fistula causes, treatment, care and prevention.

“My hope for the future is that IntraHealth will expand into other areas,” says Browning. “If IntraHealth goes out into these areas and—at the grassroots level again—raises awareness, we’d be having many more thousands of women knowing that they have a hope for being able to be cured.”

As for Tiblet, she returned home and started working in her parents’ field. She started to integrate into society again: she began attending church and other social gatherings like wedding ceremonies, she re-enrolled in school at the third-grade level, and—most recently—Tiblet re-married.

Partners and collaborators in the obstetric fistula pilot program, led by IntraHealth International, included: Addis Ababa Fistula Hospital, Bahir Dar Fistula Hospital, Ministry of Health of Ethiopia, Amhara Regional Health Bureau, Woreda health bureaus, and Pathfinder International. The ACQUIRE Project is led by EngenderHealth.