Ethiopia: Abebech, A Young Victim

Abebech, age 8, rests on the operating table, her eyes following the nurses’ every move. She appears relaxed, even though she has not been given any drugs.  Trust is apparent, and a smile creeps across her face as Dr. Andrew Browning enters the room.

On the other side of the room, another woman is being prepped for her fistula repair.  Two surgeries can occur at the same time in the pristine clean operating room.  The woman and Abebech exchange smiles, knowing that relief will soon come to them.

Abebech was brutally sodomized, with a resulting rectal fistula.  Rape was only recently deemed illegal here in Ethiopia, so the culture has not caught up with the new law.  Most women will not admit that rape occurs.  In Abebech’s case, she says that it was “an accident”.  Dr. Andrew knows that the injuries indicate rape.  I ask Andrew if this is the youngest rape victim he has seen.  He shakes his head no, and relays that the youngest was four years old.

My heart yearns to hold her, to take away the reality that she most likely will go home to her perpetrator.  I don’t want to think about how she might suffer this injury again.

Dr. Andrew whispers something to her, and she smiles again.

Ethiopia: Psychological Support

Sometimes a woman needs urgent care while Dr. Andrew Browning is in surgery at the Fistula Hospital in Barhirdar.  The nurses do their best to help until he can tend to the woman in need.  Often, their needs rest in the psychological aspect of their experiences.  Healing does not end after their surgery.  After being released from the hospital, women return to their daily lives of back-breaking wood collection, water fetching, navigating numerous disappointments and bracing against fear of repeated painful bodily injury.

A psychologist is unheard of in rural Ethiopia, and women are accustomed to bearing their own problems.  They live for their children, and will repeatedly return to a man who causes great physical pain, just to live out their desire for motherhood.

At times I get asked why I do so much international work when there are so many needs in the United States.  I have pondered this a lot during this trip.  I think part of the reason is that I am in awe of seeing women with such an unwavering commitment to raising their families and keeping the cycle of life going, despite such dire hardships.  The explosive joy when they see their first baby, a tender touch on the cheeks of their pleading children, a knowing smile they give to one another, the giggles when they carry a heavy load of wood on their hunched backs when they see me, a firenje, the fierce support they lend to one another.  All of this is so magnified to me, living in a society where my life is so easy yet insular.

These women remind me of the power of grace, and the depths to which a loving hand can heal.  I watch them interact with one another, and am humbled by their devotion to life.

How can I not extend a reciprocal hand?

Ethiopia: A Devotion To Women In Need

Dr. Andrew Browning is tired. He spends his days and nights performing surgery on women who find their way to the Fistula Hospital in Barhirdar, working with the staff to ensure that the hospital runs smoothly and is free from the spread of disease, and tending to his own family.  Some women walk days to get to see him and he has to make hard decisions on who gets treated and who gets turned away.

In addition to all of this, he also works on his goal of establishing a C-section program at an outer clinic hospital in Mota to prevent fistula and prolapse cases form the bush rural areas.  Most often, if a women can walk to a hospital within days of continued labor instead of weeks, a C-section will prevent the horrific fistula from occurring and/or death of the baby and mother. Reality hits Andrew hard when a woman shows up after walking for weeks, carrying a dead baby in her womb.  Worse, is when he hears of a lay “doctor” or husband who tries to extract the baby without anesthesia or sterile tools.

Andrew needs many things himself.

He needs more doctors to come to Ethiopia and help him. He needs reliable water at the hospital in Mota.  He needs more sources of support for the work he is performing.

And he could use a bit of cheer in the form of a rare bite of aged cheese, an ice cold beer or a laugh or two.

Weary, with his face lined from processing all that he sees, he is a tender man with extraordinary devotion to these women.  I can only imagine how he feels when his head rests on his pillow at night and darkness tries relentlessly to still his mind.

Ethiopia: A Man’s Involvement

The various health issues that arise in a society that marries off their girls at age 12 and expects a male to start his family before age 18 are abundant.  Rape is illegal here, but it happens often.  And even if the marriage is based upon love, a girl’s body can’t handle childbirth at that young age.

In Ethiopia, divorce or abandonment is not seen as a cultural taboo.  It is very common for a male to move on to another family, and for the woman to be left behind with a large brood of children to care for.  Most often, the women band together and help each other survive on very little.  They continue their jobs of gathering wood, fetching water and preparing food.

But on the occasion where we see continued involvement by the men who are concerned about the health of their wives, there is a focused desperation.  It is almost like they are fighting two battles: to obtain medical care for their loved one, and to push through the cultural norm of indifference.

Ethiopia: Amognesh Finds her Way

After spending the day in Mota, we decide to visit another medical clinic on the way back to Bahirdar.  This small clinic serves patients in a rural area outside of Bahirdar for those who cannot make it into the city.

We see a small, frail girl sitting on a chair, with blood streaming from her.  She is so weak she can no longer walk.  Her mother and father carried her for several days to reach this clinic.  Amognesh is her name, and she has a serious fistula.  She had labored for many weeks.  Her baby died in her womb, and had to be extracted, in pieces, all without anesthesia.

Amognesh wants to walk again.  She wants to live.  She is lucky that her parents have brought her to the clinic.  Andrew decides that she must come to Bahirdar, and he will operate on her.  I offer to give up my space in the van, and then quickly was told that we could not transport her.  Someone will come to get her in a few days.  Andrew also says that he cannot operate on her until she eats, and has more strength.  Because waste spills out constantly, many fistula patients avoid eating.

Rahel holds her hand and tells her that there is a solution.  Amognesh’s mother cries out, and then reaches out to Rahel and presses her lips to Rahel’s hand, sucking the back of it.  Loving joy pours from her.

We all hope the transport and feeding prep can happen in time.

Ethiopia: A Labor Of Love

After trying to outwit the mosquitoes, I decide to just get up and start the day at 3:20am.  I shower (tepid, not cold, water in this one – hurray!) and go out on the balcony where I can better hear the cacophony of day break sounds: priests singing, birds chirping, monkeys screeching, an occasional pair of shuffling feet from down below, and security sirens.  The sirens remind me that I am in a place that will soon have an election, a typically deadly time.  According to those here who are familiar with the elections, there is high hope that this one will be relatively tame compared to past elections.

Today we go to see Mota, a rural bush area of Ethiopia where Dr. Andrew Browning, medical director of Bahirdar’s Fistula Center (a branch of the Addis Ababa Fistula Hospital), is trying to coordinate preventative surgical care of pregnant women who are laboring long hours or have other complications. Andrew arrives at our hotel with Dr. Rahel Nardos, the Ethiopian OB/GYN and resident Urogynecologist Fellow from Oregon Health and Sciences University (OHSU).  They have worked together at the Bahirdar and Mota hospitals in the past, and while Rahel now works in Portland, Oregon, Andrew, by the grace of his own personal fundraising, works in Bahirdar and Mota.

They tell me that when a woman heavy labors for many days or weeks, several problems can arise.  If the woman is lucky, she will eventually deliver a baby.  Death is another common outcome. And there is yet another situation that is far less talked about: developing a fistula, where a hole is torn inside of the woman and her waste then comes out of her vagina. She constantly leaks urine and feces, and is most often shunned by her husband, family and village.  She hides in a tiny corner and is embarrassed to emerge.  She smells horribly, and her clothes are badly stained. She eats at night so that others do not see her.

Fistula repair surgery exists in several developing countries, but most families will not admit to the problem, nor can they easily walk hundreds of miles to the closest hospital, let alone transport the affected woman who often is very weak and cannot walk.  If they do take on the exhausting trip to the hospital, they have no funds to pay for the repair surgeries.

Andrew, a spirited and kind Australian, nurtures a deep devotion to helping these women.  He repairs fistulas at the Fistula Center, but he also sees the vital benefits of establishing surgical centers out in the rural areas so that Cesarean Sections can be performed and fistulas are prevented.  The hospital at Mota has been constructed, the surgical rooms are ready, donated supplies are sitting in boxes.  Yet there is one halting issue: getting doctors to be willing to work there.  We walk along the corridors of the hospital and a sadness prevails as other Ethiopian doctors perform outpatient duties, passing the empty yet ready surgical rooms all day.  Even sadder is when a woman shows up after laboring for weeks and there is nothing they can do for her.

Andrew relentlessly follows his course, and little by little, he makes progress.  This June, several doctors from Holland will be arriving as a team to perform surgeries.  Yet, when we face the hospital administrator at his desk and Andrew announces their commitment to coming, joy does not come easily.  The administrator has heard this before, hopes have risen, and then doctors back out of the commitment to coming.

This time, Andrew believes the surgical team will follow through. The conversation then turns to preparation needs, such as establishing a steady supply of clean water and painting the guest houses.  We ask how the Ethiopian people will trust that doctors will treat them if they come, and Andrew assures us that the bush communication is strong, and word will circulate quickly through the villages.

As we turn to leave, I hear moaning from behind a door.  They let me go inside, and Rahel explains to a woman on a gurney that I am there to make images that might possibly help the hospital.  We find out that she has been in heavy labor for three days.  She nods her head yes – anything to help the needs of her sisters.

Ethiopia: Fearless Curiosity

Day Three and sleep still evades me.

As my mind and body ache for a hint of rest, I can think of a myriad of reasons why, instead of sleeping, I have my laptop propped up in bed acting as a magnet for aggressive mosquitoes that find their way under the bed net. Repetitive music hypnotically blares outside the window as people yell back and forth to each other late into the night.  Frequent footsteps outside of my sleep room door beckon for attention and my 18 year old daughter Brynn sleeps peacefully next to me, her breathing almost syncing perfectly with the music.

I look at my daughter.

These past few days were not as I expected, which is true about any other time I have spent in Africa.  I have come to plan for the occasional lost luggage, flight cancellations, missed communication and long confusing waits. But this time I suppose I do have fantasies of mother-daughter bonding occurring as we tenderly experience a new part of the world together. Instead, we are bickering like cats after our long flights and spending the night staring at the ceiling in the Nairobi airport “dungeon” (as it is affectionately called by ex-pats).  Anything I advise her is fodder for heated debate, and when I allow my frustration to escalate, it only catapults the tension.  I realize it is only Day Three, and experience informs me not to get hyped up about anything that happens during the sleep deprived and cultural shift transition period.

But this angst about Brynn is not what is keeping me awake, nor are the sounds coming from the bathroom that eerily sound like a gigantic  fang-toothed rodent coming up from the sewer.

It is that girl in the museum.

I saw her from the corner of my eye as we looked at artifacts in the National Museum in Addis Ababa this afternoon.  She stood there, right in the center of the room, and stared at us, as though we were from another life time.  Left arm crossing her body to clutch her other arm, she looked braced and strong.  Her arms were hidden by dozens of gold bracelets pressed tightly into her skin.  But it was the glee in her eyes that caught my attention.  She looked giddy as she unflinchingly stared at Brynn’s blond hair.  When my eyes caught hers, instead of becoming shy and looking away, she seemed to lock in harder with her gaze, and with this, she looked like she was from another galaxy.  Or that she knew something very sacred that we did not know, living in our Western haughty ways.

I could not refrain myself from staring, and this did not seem to bother her in the least. She stood tall, muscles rippling down her arms and legs from hard work of some kind.  Her head was shaven, and tiny scars lined her skull in a swirling pattern.  Her ear lobes were dangling long, with wide open circles where her gauges once were.

She was one of the most mesmerizing persons I have ever seen.  She somehow seemed to exist outside of her body. A spirit in the flesh.

Her curiosity about Brynn was fearless, and as we made our way from room to room, we could feel the magnetic force that was in the room.  Our friend and guide Seyoum identified her as most likely being from Southern Ethiopia villages, and as he started to tell me more about this part of the culture, I found myself not able to hear him even though I wanted to know everything about her tribe. The visual of her was overwhelming any other sense.  I turned my eyes toward Brynn, and could see the same level of wonderment coming from her. As the girl stood firm, I slowly walked over to her and said hello as best as I could without words, reaching my hand out to her and holding eye contact way longer than is comfortable for my cultural influence.  I heard a catch in her voice as she tried to bridge the gap between our languages, her words barely audible.  I motioned for Brynn to come over and I silently watched as they shook hands, giggling nervously.

Mankind began here in Ethiopia and this girl seemed to wear that distinction in her every gesture.  Yet here she was, enchanted with Brynn’s exoticism.  This haunts me at this late hour for some reason, and I wonder:  what could she possibly see in us that we don’t see?  With her grace and level of ability to engage, I felt that we were far less interesting, and coming from our expedited Western culture, that we could not see humanity such as she could from the vantage point of the heart. I felt humbled by her, and a tinge of longing crept in as I knew we couldn’t follow her and learn more from her.

As Brynn lies curled up next to me now, I think about her and our mother-daughter complexity that mirrors us together and propels us apart as she begins to lead her own life without my constant oversight.  Through the Ethiopian girl’s gestures and honor toward toward Brynn, I realize something.  I think I can see my daughter more closely from afar.

Ethiopia: Pre-Organization

A significant amount of prep work is occurring during these final days before we leave for Ethiopia,  Everyone wants the operating schedule to flow smoothly, so there is much dialog circling about the organization of the flow of patients.  Scott, the person who is in charge of the Gimbie Hospital operating room, sent this email today:

The OB/GYN surgeons at Gimbie will be Dr. Tekle (Ethiopian, Maternity World Wide) and Dr. Leonie ( UK , Maternity World Wide).   I do want to assure you that our surgeons will make all efforts to appropriately follow up on each patient.

Our operating room is set up with two operating theatres.  Most general surgeries and C/S are performed in OR 1.  We will use OR 2 for the UVP surgeries, since it has the only OR table where a patient can be placed in a lithotomic position.  I apologize that this table is very old and not the most convenient, but it is all we have.  Portable lighting is the only available lighting in OR 2, and is not the most desirable.

I appreciate that your team is bringing instruments, drapes, and gowns, since all of these items are at a premium here.  Our instruments are old, and our drapes and gowns are still laundered by hand. We are also having a difficult time obtaining the necessary sutures in Ethiopia at this time.  I was glad to hear that you would be able to bring those supplies, as well.  If any mesh material is needed in the surgeries, it also must be brought from the States, since this too is difficult to find.

At this time, we have three Ethiopian nurses that assist, and four other personnel that can circulate, and two nurse anesthetists.  Since charting is minimal, the room turn over is quite fast.  We have extra personnel to clean and ready the room in about 15 minutes post surgery.  Our limiting factors are making sure the patient is admitted and is NPO the night before.  It is also difficult to perform elective surgeries between the sacred Ethiopian lunchtime that ranges from 12 to 2pm every day.  Currently, our whole OR team is new and still training, so that must also be added to the equation.  But I must say they are all enjoyable to work with and willing to learn.

Ethiopia: Daughter Brynn

How do I aptly prepare my 18 year old daughter for her first trip to a developing nation?  And this trip will be especially intense due to the various heart wrenching medical conditions we will see.  Our home will be the hospital, not a hotel, for most of the time we are there.  Brynn will have a variety of assignments, including scrubbing in during surgeries on occasion if she is needed.

We talk about general safety, how to interact graciously with the culture, how to avoid problems, what to wear and not wear, and the fact that there will be many frustrations, joys, hazards and times when we will feel drunken by the culture.  But where do I start with telling her that she won’t return home the same person?  That pulsating Africa, with all of its terrors and catapulting strains, will get into her blood and grip her in the heart like little else can affect in the same manner?

I choose to remain silent, and not put words on something I can’t even come to terms with myself.  I will listen closely to her while we are there, and I will watch for that hesitant flicker in her eyes, when it is obvious the world has shaken.

(Photo: Joni Kabana)

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