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Ethiopia

WFF is dedicated to improving the capacity of low-resource countries to meet their own women’s health care needs. High quality, in-country medical education is a key component toward achieving this goal and to enabling Africans to solve their own problems. One reason African countries suffer a shortage of OB-GYN specialists to address childbirth injuries is the lack of formal training in comprehensive advanced pelvic reconstructive surgery. This may force some to leave their countries to seek training elsewhere, greatly decreasing their chances of returning to their home countries to provide their services. We hope to change that. Since 2013, our partner for in-country African medical education programming has been Ayder Referral Hospital/ College of Health Sciences at Mekelle University in Ethiopia.

Mekelle Medical Education Collaboration (MMEC)

Since 2013, the MMEC has successfully provided enhanced obstetrics and gynecology education for students, residents and faculty at Mekelle University. For one week each summer, WFF Founder, Dr. Lewis Wall, and guest experts in Obstetrics and Gynecology, Urogynecology and additional specialties teach enhanced curriculum to benefit local medical professionals. Approximately 60-100 students, residents, faculty and visitors from other institutions attend each of the classes provided.

This program is a vital contributor to the OB-GYN residency program, which graduated its first five specialists in December 2016. All five graduates chose to stay on as Mekelle University faculty to increase the institution’s capacity to train future students and residents while providing patient care through the university’s Ayder Referral Hospital. The MMEC introduces numerous U.S. and International physicians to service in Ethiopia, some of whom remain engaged and make repeat trips. Guest lecturers in MMEC have included: WFF Board Members (Dr. Rahel Nardos, Dr. Theresa Spitznagle, Dr. Christopher Payne), Washington University in St. Louis faculty (Dr. Lewis Wall, Dr. Jerry Lowder, Dr. Christina Chu), University of Ghana faculty (Dr. Anyetei Lassey), and Internationally recognized experts (Dr. Jeannette M. Potts).

Urogynecology Fellowship Training Program

In 2015, WFF launched the program in partnership with Mekelle University, Hamlin Fistula Ethiopia and Footsteps to Healing at Oregon Health & Science University. This is the first program of its kind in Ethiopia and is accredited through Mekelle University. This program aims to provide Urogynecology sub-specialty education comparable to Western standards with the goal of enabling graduates 1) to establish clinical centers of excellence to treat women with all types of urogynecologic disorders (not limited to fistula) and 2) to develop additional training centers for sub-specialists in urogynecology.

Urogynecology, also known as Female Pelvic Medicine and Reconstructive Surgery, is a specialty focused on the care of women with pelvic floor dysfunction such as incontinence (urinary and fecal leakage), prolapse (bulging or falling of the vaginal tissues), and pelvic pain. As the world progresses toward eliminating the most dire effects of traumatic childbirth, obstetric fistula and maternal mortality, we still have an epidemic of women suffering chronic effects. Pelvic organ prolapse, a bulging of pelvic organs like the uterus, bladder and bowel is primarily a childbirth-related injury associated with obstructed labor. A preliminary ongoing survey of three regions in Ethiopia estimates that 5,000 to 6,000 women have obstetric fistulas, while over 250,000 suffer from pelvic organ prolapse.

With Ethiopia’s declining incidence of fistula, partnering with Hamlin Fistula Ethiopia facilitates both
in-country medical training for Africans and treatment of local women for injuries beyond fistula through Hamlin’s hospital in Addis Ababa plus five satellite medical centers. Our first four Urogynecology Fellows in training are skilled fistula surgeons with Hamlin Fistula Ethiopia. Fellows are mentored in conducting clinical research, and in addition to classroom instruction, they receive surgical instruction while performing healing prolapse repairs. Dr. Renate Roentgen, an expert in female urology from Germany, serves as the on-site fellowship director and urology instructor. Annually, Board Member Dr. Rahel Nardos leads a team from Oregon Health & Science University (OHSU) to provide our Fellows hands-on surgical instruction while performing prolapse surgeries. She also facilitates additional expert instructors from OHSU and other partner institutions traveling to Ethiopia throughout the year. Since the start of this fellowship training program, our Ethiopian fellows have performed close to 300 pelvic organ prolapse and incontinence surgeries.

Gestational Trophoblastic Disease (GTD) Center

In 2015, WFF launched development of the GTD Center at the Ayder Referral Hospital/Mekelle University. GTD is a group of conditions in which tumors grow inside a woman’s uterus (womb). Clinical data from Ayder Referral Hospital suggests that GTD is a relatively common problem in the surrounding Tigray region at 1 case per 110 deliveries — one of the highest rates in the world. In a recent worldwide survey, mortality for patients with GTD primarily treated at a GTD center — such as the Ayder Referral Hospital/Mekelle University GTD Center — was far lower than those who received treatment elsewhere. Patients’ mortality rates were 2.1% at a GTD center and 8% for those who received primary treatment elsewhere. The GTD Center in Ethiopia became fully operational in 2016, and the team was able to cure 65 of 66 women through their dedicated treatment at a GTD Center that first year. In year two, they anticipate treating 120 women with annual increases thereafter.