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Guest Blog — Sacrifices for Surgery

February 24, 2016

Guest blog by Dr. Rahel Nardos

Dr. Rahel Nardos is a Worldwide Fistula Fund Board Member. Originally from Ethiopia, she travels to Mekelle, Ethiopia several times a year to train and provide surgeries. Dr. Nardos teaches at Oregon Health & Science University and is the Founder of Footsteps to Healing, a global women’s health initiative providing surgical services to rural Ethiopian women with pelvic organ prolapse and incontinence.


Dr. Nardos’ Mission to Heal Women in Ethiopia

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Our excitement was palpable as we arrived in Mekelle this past January. Composed of nurses, surgical technicians, residents, fellows, anesthesiologists, urogynecologists, biomedical engineers, radiologists, hospital management specialists, intensivists and, philanthropists, we were a truly interdisciplinary team. This group of US and Ethiopian healthcare providers was united by our vision that transcends borders, languages and, cultures: our mission to provide much needed medical care and capacity building through interdisciplinary education and teamwork.

We look different, we speak different, indeed, we act different and yet they were willingly to put themselves into our hands for this life-changing procedure. I’m so proud to have been a member of this team.

Mary Beth Yosses, recovery nurse

Our team provided 42 women with pelvic floor reconstructive surgery in just 2 weeks. These successful surgeries are the result of collaboration between Mekelle University, Hamlin Fistula Ethiopia, St. Paul Millennium Medical College, Worldwide Fistula Fund and OHSU’s Footsteps to Healing Global Women’s Health Initiative. Our team also provided clinical and surgical training to 3 skilled Gynecologists and Fistula Surgeons through our Urogynecology Fellowship Program - the first such program in Ethiopia.

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The women we provided care for came from remote parts of Tigray and surrounding regions of Ethiopia. Some have lived with prolapse for decades. Others were far too young to be experiencing such a severe manifestation.

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the pelvic floor organs. The uterus then slips down into or protrudes from the vagina. These women were all resigned to a socially and physically constrained life without access to care. The risk factors such as multiple vaginal deliveries, obstructed labor, and a lifetime of heavy lifting means these women manifested some of the worst conditions at an early age. With little to no access to trained pelvic floor specialists, symptoms continue to deteriorate. These women came for hope and surgical repair for the first time in their lives.

The Ethiopian government’s increased awareness of pelvic floor dysfunction was evident in their national television coverage of our surgical mission and their increasing support in identifying patients and facilitating care. They were particularly sensitive to the fact that this condition is often stigmatized and embarrassing for women who are forced to suffer in silence.

I came here against my husband’s will. He told me that if I go to the hospital, he will divorce me…He wants me to have more children but I am done with childbearing. I want my life back even if this means living alone.

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One of the most difficult moments for our team was the last day of surgery; we realized there were 3 women remaining. One of these women suffered severe prolapse for 20 years. She broke down in tears when she realized we couldn’t perform her surgery.

We reassured her that, starting this year, no woman with prolapse will return home this year without receiving care. The 3 Ethiopian Urogyencology Fellows, through our program, will continue to provide care to women like her while receiving ongoing mentorship.

The gratitude in our patients’ faces was overwhelming as they clapped and danced after surgery.  Each woman was transported to a place prepared by the Tigray Women’s Association to finish her recovery among many other women recovering from similar surgeries. The women received new dresses (courtesy of a donor), and small government loans to start businesses and restore their lives.

Being welcomed by the patients’ bright smiles and excited waves every morning reminded of me why I went into medicine.

Wan-Ju Wu, Ob/Gyn resident

In order to make a sustainable and comprehensive impact on women’s health in Ethiopia, we need to extend our efforts beyond the occasional mission trips, and prioritize capacity building through formalized and sustainable commitment to training and retaining local health care providers. Providing ongoing bilateral education in clinical care, hospital management and research is the key to this endeavor.

In this age of globalization where diseases don’t respect boundaries, where economic and social development are intricately connected with health, where we have an ethical responsibility to ensure the wellbeing of others who suffer from preventable and treatable causes, it is time that we engage in this work.

Photos courtesy of Joni Kabana, jonikabana.com