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Guest Blog: Treating Prolapse in Ethiopia

March 26, 2019

Guest Blog by Dr. Rahel Nardos

Two women locked in deep conversation like long-lost friends caught my attention in the hospital ward. They were lying on mattresses on the floor of the Hamlin Fistula Center in Mekelle, awaiting care in their hospital gowns.

They were so wrapped in each other’s company and oblivious to the bustle around them, I was compelled to find out what was so captivating. I was still in my scrubs, having just stepped out of the operating room where I’d spent the morning guiding two of our five Ethiopian Urogynecology Fellows through a three-hour pelvic reconstructive surgery. I sat on the floor next to the older of the two women and asked if I could talk to them for a few minutes. The nurse had to translate my Amharic to Tigrigna, but the big smiles on their faces didn’t need any translation.

When I asked Tsehaitu, the older of the two women, how old she was, her face lit up with pride. “I’m 86.”

Having been born and raised in Ethiopia myself, I know most people older than 50 — and even those who are younger if they are from rural towns — don’t know their date of birth for sure. Tsehaitu, however, was very confident about her age saying she was 3 when the Italians came to colonize Ethiopia, albeit unsuccessfully.

This historic fact is hard to dispute. My own grandmother, who is now 98-years-old, uses this historic year to silence all of us age-doubters in the family.

The two women weren’t, after all, old friends. They’d met at the hospital and bonded over their common experience with pelvic organ prolapse. Tsehaitu said she’s had the debilitating condition for 25 years. Her uterus and bladder have been protruding outside of her vagina for a quarter of a century. My heart sank. As a urogynecologist who has spent the last 11 years taking care of U.S. and Ethiopian women with this injury, I am terribly familiar with the devastation it causes.

Rahel and Blake with fellows and graduatesPelvic organ prolapse is a type of injury a woman can develop from multiple prolonged childbirths. Over time, muscles supporting pelvic organs weaken. The organs drop, push against the vagina, and sometimes fall out.

This injury seriously impedes a woman’s ability to do physical activities. Even basic bodily functions, such as emptying the bladder and bowel, can be extraordinarily difficult. But above and beyond the physical limitations, you cannot underestimate the psychological trauma this has on their body image, ability to engage in sexual and social activities, and fear of not knowing what this is or why it is happening.

Even in the U.S., where women are relatively well educated and have access to medical information, patients sometimes end up in emergency rooms at night drenched in cold fear that this “thing” that suddenly fell out between their thighs is cancer.

Prolapse and incontinence are still taboo topics in the West. In rural Ethiopia? Most women are illiterate, extremely modest, and have little access to medical information, often explaining ailments as bad luck or God’s retribution for their sins.

Tsehaitu told me she sought care many years ago at a hospital, but she was told that in order to have surgery, she needed a family member to donate blood on her behalf. This, I believe, is the only way the hospital is able to voluntarily collect blood for any emergency situations. It highlights the challenges of suboptimal health systems in resource-poor countries.

In my 11 years of volunteer surgery work in Ethiopia, I had not heard this particular barrier to care, and I was taken aback. I asked Berhe, Tsehaitu’s friend, how long she had her prolapse. 10 years. She cited the same reason for why she hadn’t received care.

Blood donations won’t be a barrier this time. Tsehaitu and Berhe will receive free and effective care, thanks to the ongoing partnership between Worldwide Fistula Fund, Mekelle University, Hamlin Fistula Ethiopia, and Footsteps to Healing at Oregon Health & Science University.

Ethiopian Fellows and 2018 Graduates.What makes this partnership unique is that it has resulted in the creation of the first formal Urogynecology Fellowship Program in Ethiopia. Our first two urogynecology fellows graduated in 2018. They have stayed on to provide training to our five new fellows alongside our partner faculty. The program also includes a team approach to care that includes nurses, doctors, and pelvic floor physical therapists.

Our fifteen-member team spent two memorable weeks in Mekelle. On this trip, I was deeply humbled by the unwavering commitment to learn and elevate the care of women in Ethiopia demonstrated by our fellows. Our fellows rose to the occasion and performed pelvic organ prolapse surgeries for more than 30 women under our mentorship.

After a combined 35 years, Tsehaitu and Berhe will receive the treatment they deserve. It’s moments like this that remind me why I became a surgeon, and I hope it’s stories like these that remind you why you support this wonderful organization.

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