Addis Ababa Fistula Hospital ETHIOPIA

                                                   

 

        Project Brief

 

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Addis Ababa Fistula Hospital

17 years –

1 October 1993 to 30 September 2010

Background

Three million women in Ethiopia become pregnant each year: of this 0.3% will develop obstetric fistulae. This represents approximately nine thousand new cases each year, plus those with an existing condition that have not been previously reached. 
Obstetric fistulae occur when the pressure of an unborn baby’s bony head against the mother’s bony pelvis in unrelieved, prolonged and obstructed labour leads to death of tissue and an abnormal opening between the vagina and adjoining organs.  Labour proceeds, often resulting in a stillborn baby. 
Without surgery, women are likely to experience continued pain and infection, and they constantly emit a body odor and body fluids, thus making them vulnerable to stigmatization and ostracization. They become social outcasts and the pain, rejection and isolation make them demoralized, as it becomes apparent that the injuries appear to be permanent.
Drs Reginald and Catherine Hamlin, both Gynaecologist-Obstetricians, came to Ethiopia to work at the Princess Tsehai Memorial Hospital in 1959. They became pioneers in performing surgery for women suffering from obstetric fistulae that same year, and over the next 25 years, the need became so great that in 1974 they established the Addis Ababa Fistula hospital specifically for women with childbirth injuries.
The hospital is the principal medical facility in Ethiopia providing physical, social and spiritual assistance to women with obstetric fistulae disabilities. In the last three decades, some 33,000 women have come to the hospital to be cured. It operates successfully on average of 1,200 or more patients yearly from Ethiopia and surrounding countries. The hospital also provides physiotherapy to those women who have suffered from extensive nerve injuries and contractures due to prolonged unrelieved obstructed labor.
In addition to the above, the hospital also conducts training on post-graduate doctors specializing in Obstetrics and Gynaecology from Addis Ababa University in obstetric fistula care, management and surgery.

Development Needs

While the real figure is unknown, it is estimated that about 100,000 OF patients in rural Ethiopia live without treatment. In addition, about 9,000 mothers will develop OF in a year. Fistula treatment will sadly remain a necessity for years to come: it will take 40 years to deal simply with the backlog, at a desired rate of 2,500 operated women per annum. If this is increased to 4,000 per annum, it would still take 25 years to operate on these women and that is if there are no more new cases.
The hospital has also established medical centres in four additional Ethopian cities to provide medical care to women in remote areas who are not able to travel to Addis Ababa. A further centre is under construction in the town of Metu. However, as the treatment is free, funding is continually required to support the level of care provided, and to provide the ongoing educational programs, post-graduate medical training, and preventive measures designed to combat the condition.

How the Project Addresses Development Needs

The overall goal of the hospital is to provide services for those suffering from childbirth and related injuries, rehabilitating them to the point where they can be integrated back into their society with dignity and a sense of self worth.

The project aims to achieve its goal through the following outcomes:
Providing physical, social and emotional assistance to the patients as well as providing a voice for them.
Providing obstetric fistulae training for the health care professionals as well as informing the local and the international audience on the problems from obstetric fistulae and childbirth injuries.  
Educating the local public about the hazards of unsupervised pregnancy and labour and giving prenatal shelter for the possible high risk deliveries and post natal shelter for obstetric fistulae repair.

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Achievements to Date

An important aspect of the work done by the hospital staff is spreading awareness to the local public on the hazards of unmonitored term of pregnancy and unsupervised labour.
Women with a possibly high-risk delivery are always admitted at the hospital and cared for.  Simultaneously, they staff need to foresee the patient load and make sure there is enough capacity for emergencies. The hospital is looking at expanding its facilities due to the increasing success of the hospital.
‘Don’t be silent’ is a public campaign in Ethiopia. This public awareness campaign on obstetric fistulae targets the national as well as the international audience. Apart from posters and short stories used as tools for this campaign, a film has been released in Netherlands called ‘An Ox for a Baby’, about a woman suffering from obstetric fistulae.
There are a number of medical professionals from around the world who visit the hospital to learn and share their expertise. Obstetrics and gynecology postgraduates from the Addis Ababa University and Jimma University have a two-month internship programme with the hospital. The Hamlin Community Midwives College is building a centre in the locality and fifteen midwives will be placed in nine rural localities through them by 2010.

Next Steps

1. The current space is insufficient and there is a need to move to a larger space. As the new land is further away from the current centre, there is a plan is to build a large storehouse, a laundry and automotive shop as well as repair the existing beds and tables.
2. There is another proposal to build low cost housing for the staff members as the rental property prices have skyrocketed. This will free 25 places on site for patient care. A work plan is attached below to indicate the activities for the next two years to completion of the project.

 

Plan of Activities	Beneficiaries	Target	Year
Fistula operation/repair at central health site	Fistula Patients	1,500 +	2009
Fistula operation/repair at Bahr Dar Centre	Fistula Patients	700 +	2009
Fistula operation/repair at Mekelle Centre	Fistula Patients	400	2009
Fistula operation/repair at Yirga n Centre	Fistula Patients	350	2009
Fistula operation/repair at Harar  Centre	Fistula Patients	100	2009
Additional new centre at Metu	Not applicable yet	Completion	2009/2010
Educational Posters / flip charts	Public, stakeholders	3,500	2009
Training and Prevention Workshops / Activities	Health Extension Workers, nurses, midwives, health officers	1,000	2009
Prevention and Awareness/sensitization Programs	Community elders, religious leaders, women and youth association members, students, traditional birth attendants, community health agents, etc.	3,000	2009
Dissemination of video	Public	15	2009
Song and video clip re. fistula	schools	12	2009
Distribution of delivery (birth) kits	Traditional birth attendants found in regional woredas.	12,000	2009

Funding

Please note that should funds received exceed the matching amount World Vision is required to raise to meet this project's budget, the excess will be used in another, similar  project.

Evaluation and Reporting
World Vision Australia will conduct annual project monitoring, including site visits and the facilitation of the end of project evaluation.  Project progress and achievements will be closely monitored by World Vision Australia.  An annual report will be provided to project sponsors.

Contact Information
World Vision Australia,
Corporate and Donor Relations
Michelle Gale
Tel: 03 9287 2335
michelle.gale@worldvision.com.au