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The new Fistula department at Arba Minch Hospital

Outreach work

The Ethiopia Fund’s collected donations go primarily to supporting the Fistula Department at the new Women’s ward at Arba Minch hospital and to ensuring that outreach work is performed in Arba Minch (population 80,000) and the surrounding rural area of Zigitti (population 50,000).

The Norwegian Lutheran Mission (NLM) makes this outreach work possible due to an ageing Toyota Land Cruiser that they kindly donated. However, this Land Cruiser was old and well used, and it required a maintenance overhaul in order to enter service. This work was financed by donations from The Ethiopia Fund. In addition to this car, we may soon also supply a motorbike due to the poor conditions of some of the roads in the area that make using a car difficult.

A decent car is needed on the poor roads in the area

Importance of education, delay in marriage, pregnancy and birth

Since birth injuries like fistula occur most often in young girls it is essential that parents are made aware of the importance of education and of delaying marriage and pregnancy until later in life when the pelvis is sufficiently mature. The availability of the hospital and surrounding health care centers must be advertised, and a mindset instilled into expectant mothers of using these centers and choosing professional medical help for antenatal care. These expectant mothers must be taught that attempting to give birth at home with an un-trained birth attendant that lacks the necessary skills needed for a safe delivery, especially if complications occur, is dangerous.

Maternity villages

An exciting new project we are starting is the construction of a new Maternity Village within the hospital area of Arba Minch. This Village will care for high risk women with twins, breech presentation, and pre-eclampsia, amongst others, who normally live out in the rural areas far away from medical access. These women can come to the Maternity Village and stay for the weeks leading up to delivery to ensure they are in a safe environment if complications should occur during the birth process. Our plan is also to build a new Maternity Village up in the mountains of a town called Konso (further south in Ethiopia) as soon as the new hospital being built here is up and running. This is one of the 10 health centers built in the rural areas managed by Arba Minch Hospital.

The well-run maternity village in Gidole, another small hospital in the rural area of south Ethiopia.

The main aim of the outreach work is to find the hidden shameful fistula women

The Fistula department’s main aim for the outreach work is to find the hidden shameful fistula women, give them information about all the free treatments available, including transportation to the hospital, the operation(s), post-operative care, physiotherapy, new clothes and the return journey back home.
The aim for 2012 was to treat at least 60 Fistula women over the course of the year, but in the first three months more than 30 women had been operated on. This is effectively a doubling of the planned number of operations for the year, and it is impressive considering there is only a single gynaecologist at Arba Minch hospital, Dr Amenu. Our plan is to hire a second gynecologist to come to Arba Minch one week a month or if possible employ one full time. Dr. Bernt Lindtjørn ( is at the moment working on this recruitment.

Pension schemes

The salary for the staff at the Fistula Department is currently very low. Thus, we would like to support pension schemes for employees of the department. In addition to this financial support we also want to supply new clothes for fistula women, as well as sanitary napkins, underwear, bed sheets, curtains for the ward and blankets to the women. We have also just supplied a kettle for making tea/coffee and a separate TV for the ward; due to the smell of urine and faeces suffered by the Fistula women they are not allowed by other patients to use the common rooms in the rest of the hospital.

A chair at the ward soaked in urine

The staff at the department. From left to right: health officer Tinsae, gynaecologist Amenu, nurse Katene, head nurse Efagegnehu, nursing aid Adanech, cleaning aid Martha, and nursing aid Ketona. The Ethiopia Fund’s Anne Berge Pedersen behind.

The 20-bed-fistula department at Arba Minch Hospital runs all the activity supported by The Ethiopia Fund and does not receive any support from other organisations. Without our help the fistula women in this area would not be able to get the necessary treatment.

The department’s personnel consist of one gynaecologist, one health officer (who performs caesareans), 2 nurses, 2 unskilled health workers (both having previously been fistula patients themselves), and a cleaning aid

From left to right: nursing aid Adanech, cleaning aid Martha, and nursing aid Ketona

The extraordinary empathy and care provided by this staff is inspiring, as well as the clean and almost odour-free environment they maintain.

Health officers
Because of economic hardship there has always been a shortage of physicians in Ethiopia. As soon as doctors qualify they leave for other countries where they salaries are higher. Because of this exodus, many African countries have introduced a separate education for health officers. Such officers do not become doctors, but instead are most often former midwives (or nurses) with an additional 2-year University education. This trains them mainly in performing Caesarean sections, which allows them to save countless lives of both mothers and children as well as reducing the incidence of serious birth injuries. The Norwegian Agency for Development Cooperation (NORAD) has supported the education of 35 such health officers that have been trained in Arba Minch and who have started their work in the 10 small hospitals/health stations built in the surrounding areas. The education of these health officers continues.

An very young, recently operated fistula woman at the Fistula department at Arba Minch Hospital. After her operation she met a new man, got married, became pregnant and came back to the clinic where she delivered by caesarean section. What a joy!

Left to right: Department nurse Efagegnehu, The Ethiopia Fund’s Anne Berge Pedersen, and Nurse Katene

Fistula Surgeons

Fistulas are graded from 1-3 depending on how complex they are. Dr Amenu is skilled at operating Fistulas graded 1 and sometimes 2, while more complex grade 2 and 3 fistula are, at the moment, referred to the better equipped Fistula Department in Yirgalem or the well known Hamlin Fistula hospital in Addis Ababa; surgeons here have access to more comprehensive methods and skills relating to complex fistula. It would therefore be great if we could hire a more experienced fistula surgeon to do the more complex fistulas without the need to transport the women and a nurse to a separate facility (journeys which typically take 8-10 hours).

Desta Mender

Unfortunately some Fistulas are not possible to repair (10%). The longer a fistula has gone untreated the more scarring and thus complicated the healing process becomes; in certain cases a recovery cannot be made. In these cases, the women are given the opportunity to move to Desta Mender (“village of joy”) run by the Catherine Hamlin foundation.

Desta Mender is a beautiful site just outside Addis Ababa dedicated to the rehabilitation, training, and reintegration of fistula sufferers. Fistula sufferers may endure ongoing problems of incontinence or may have a “Stoma” bag attached to collect urine/or faeces as a result of their non-functioning bladder/rectum systems. These women need training in literacy, basic health management, and general skills development to enable them to build confidence towards independent living for the future.

Bright smiles from women living at Desta Mender

At present Desta Mender is home to 35-50 women who are engaged in a range of training and income generation activities. The Ethiopia Fund has so far supported them with upgraded facilities associated with their chicken/egg production as well as buying new cows and improving the systems for managing insemination and breeding by training the women to improve their animal management.

Animals at Desta Mender

In addition to this we are in discussions to support the education of midwives both through the Hamlin Collage of Midwives in Addis Ababa and the University in Arba Minch (through a Master’s programme for midwifery teachers). Our aim is also to get cooperation from the teachers at The Hamlin Fistula Hospital and the teachers from Arba Minch University in the hope that the teaching methods and skills training can become as good as possible for the midwifery students in Arba Minch!

The higher the level of education of the midwives in Ethiopia the better their skills become and the more maternal/neonatal death can be prevented.

100% of all collections will be handed over directly to NLM (The Norwegian Lutheran Mission) in Addis Ababa and from there paid to the hospital in Arba Minch after receipt received on work performed. All expences are therefore taken care of by the board. NLM managed this hospital lead by Dr Bernt Lindtjørn until the summer of 2011 but it is now run by the Ethiopians themselves.

For details on how to donate to the project, please see the DONATE page (link at the top)

The Ethiopia Fund
Organisasjonsnummer: 997836529