Fistula Archives - Joni Kabana PhotographyJoni Kabana Photography

Darkroom Gallery: Multiples Exhibit

One of my photos created while on assignment with Hamlin Fistula Hospital was selected by juror William Albert Allard to be in Darkroom Gallery’s “Multiples” show. The exhibit opens September 14 in Essex Junction, Vermont.

These women each had been treated for fistula and were living in Hamlin’s rehabilitation center, Desta Mender, where they learned new skills such as reading, writing and math after their surgeries were completed.

Many women are ostracized by their villages when they develop a fistula, and often they must find new ways of supporting themselves. Undaunted by their struggles, they form a bond while residing at the hospital and help each other heal emotionally. New confidence is found, and together they help each other find new paths to walk, unbridled by the injury they suffered.

Fistulas can develop many ways, but most often it occurs due to obstructed labor. Dr. Catherine Hamlin saw the great need for prevention efforts and developed a midwifery college where young village girls are trained in midwifery and other maternal health care actions in Addis Ababa after which they return to their villages to provide much needed care in their remote home areas.

It has been an honor to stand in front of these brave women, the fistula survivors and the new midwives, and realize how devoted they are to their own healing and to the healing of others.

Desta Mender graduates 2015

Terra Magazine: Uganda Goat Milk Soap-Making

The recent issue of Oregon State University’s Terra Magazine features a story about our goat milk soap-making project in Uganda. What an honor it has been to work with so many Oregon constituents in making this project come to life, all initiated by one gesture of gift giving from a soap maker in Fossil, Oregon to fistula survivors in Soroti, Uganda.

Altered Views: Lessons From Africa

For the past several months, I had the honor of traveling to Africa to document various projects for some really outstanding organizations that are performing tireless and devoted work in Ethiopia, Tanzania and Uganda. I welcomed these assignments as an offering to alter my lifestyle and challenge my perspectives, but more importantly, I wanted to set aside all other commitments to create imagery that might make a difference to people who are struggling.

Now back home as I reflect upon the past several months, I realize that I am going through reverse cultural shock. What once brought joy to me is altered. I still love meals from Portland’s creative restaurant scene and the idea of wearing a pair of sassy boots, but this trip has made me reach ever so fervently for how we touch the earth…and each other.

My days in Africa were spent in heated debate, exchanging innovative ideas, feeling the shock of human peril, learning about living a truly nomadic lifestyle. and dancing until I collapsed. My heart was so full at times that I had to shut down, fold up, and sit alone in a room to come down from this life high. And sometimes I needed a rest from the effects of my own physical and mental curiosity.

Africa is where we began. Lessons abound from the moment a person steps onto the Motherland. I have many stories to tell, but I will start by highlighting a few of the assignments that sparked a renewal of my mindset.

SABAHAR, Addis Ababa, Ethiopia

I started my journey by working on a fashion shoot for Sabahar, a collective of some of the finest weavers in Ethiopia. Their scarves are woven with super soft traditional Ethiopian cotton and silk spun by silkworms raised on their property. Most importantly, they are devoted to fair employment practices. Their Ethiopian staff are paid a great wage while working in a beautiful and supportive environment. Happy faces were seen throughout the garden-filled compound.

TERREWODE, Soroti, Uganda

Returning to Uganda seared my soul. Seeing friends I had met earlier in the year and getting to work more closely with TERREWODE (a reintergration center for fistula survivors) was an educating and heart-touching experience. A team volunteered services to teach goat milk soap-making to villagers and TERREWODE staff, advise on the development of packaging, develop a video about the soap-making process and document the way music, dance and drama are used to educate others about fistula.

OREGON HEALTH & SCIENCES UNIVERSITY, Portland, Oregon, USA and Mekele, Ethiopia

Some people say that a “silent epidemic” of prolapse conditions are occurring across the globe. Many women suffer from this debilitating healthcare concern while continuing to perform their physically demanding work despite the constant severe pain they experience. Medical staff from Portland joined their expert hands to repair prolapses in many women in the northern Tigray area of Ethiopia. In addition, they trained other Ethiopian medical staff how to perform this life-altering operation.

DIGNITY PERIOD, Mekele, Ethiopia

Who would have thought that lack of education and support for menstruating girls and women would have such a dire effect on so many aspects of a female’s life? Lack of menstrual supplies and running water, coupled with little education about the natural occurrence and importance of menstrual cycles, has a direct correlation with how a girl can stay in school and the effects of self esteem for all women. Freweini Mebrahtu responded to this need and created a factory called Mariam Seba (named after her daughter) that makes reusable sanitary napkins and employs women. Dignity Period provides access to sanitary pads and educates students about a female body’s natural process. They also are in the process of researching latrine and water sources for schools to enable hygienic practices. In addition, they are researching the impact of this intervention on the lives of young school girls.

Watch a short video that uses my still images and video I captured while in Mekele, Ethiopia here.

THE MEKELE BLIND SCHOOL, Mekele, Ethiopia

I am haunted in a very good and profound way from the way the students and other staff got to know me while I visited The Mekele Blind School. I was petted, nibbled, pinched and truly moved by the students, and learned many new ways of emphasizing one sense over the other. It was astonishing to see the children running freely and holding each other so closely when they were together. If only we all could experience each other more so in this manner. This school is in dire need of many improvements but they march on inspiring within each student the confidence that they can do anything they wish.

TIGRAY ASSOCIATION ON INTELLECTUAL DISABILITIES, Mekele, Ethiopia

Every so often something will shake my foundation and enrage my soul. On this trip, I found out that girls/women with mental illness are often targeted for rape because some men believe these females are unwanted and therefore free from HIV or other diseases. The afflicted female needs to have 24/7 watch over her in fear she might exit the home compound without someone accompanying her. The Tigray Association on Intellectual Disabilities, founded by a sister of an intellectually challenged girl, helps to nurture and provide activities for both women and men, as well as keep them safe.

HOPE ENTERPRISES SCHOOL, Addis Ababa, Ethiopia

Imagine living in the most desolate of situations at a poverty level that is at the lowest shanty structure level. Someone knocks on your door, and they ask many questions about your children that are living there. After a lengthy interview process, your family has been selected to be a part of the Hope Enterprise School in Addis Ababa, Ethiopia. Your child will be supported from the time they enter school through high school graduation and they will be assisted until they are placed in a job. This is just one of the many remarkable projects that are funded by Hope Enterprises.

STREET CHILDREN’S BREAKFAST, Addis Ababa, Ethiopia

I rarely feel the devastation of having great pangs of hunger. I can grab a cracker and know that a meal will be had soon. When I am very hungry, my senses get mixed up and I get irritable. For a young boy faced with living on the streets of Addis Ababa, Ethiopia, a breakfast in the morning can mean he can live a day of staving off hunger and not having to hustle or steal for food. Hope Enterprises feeds street boys bread, banana and milk each morning.

MATERNITY AFRICA, Arusha, Tanzania

Fistula is a devastating condition that affects thousands of women and the families they nurture and support. Dr. Andrew Browning is one of the best fistula surgeons in the world and after working for many years with the Hamlin Fistula Hospital, Andrew now is based in Arusha, Tanzania where he practices and teaches on a global level. Maternity Africa supports his efforts and is in the process of building a new hospital which will ensure that best practices are in place. They also are firmly devoted to fistula prevention by working with midwives to educate villagers about the dire consequences of obstructed labor.

A Rally For Maternal Care in Uganda

He stands tall, towering over the ladies, yet his gestures are gentle. His smile comes quickly as he expresses his love for these women. We are here to listen to his song, hear his words and see dancers hop, shake and spin to the music he makes, all in the name of educating others about the devastating effects of fistula.

The women file into the room, their colorful dresses accentuating their inherent cheerful spirits. They are all fistula survivors, and they are here to help spread joy and encouragement to those who are still suffering from this condition. They have been here before, and they know the isolating despair they felt when they were leaking urine and feces down their own legs.

But today is a new day. They have been healed by the hand of a skillful surgeon and they are now participating in reintegration skill training at Terrewode, their programming funded by the Worldwide Fistula Fund, in the beautiful Soroti region of Uganda. Sewing, jewelry and basket making, bread baking: the products of all of these activities can be sold in markets and and is a way for these women to get back on their feet and feel productive once again. They are here to learn these skills, and also participate in a performance for us.

The African man suffers a generalized stigma that portrays him as typically uncaring, a tyrant who dominates women, marries them at an early age, and abandons them when when they become ill. While these things do happen across our globe, there is another side to this portrayal; concern for women by males in African countries also can be seen readily if one spends any time in villages.

Stephen Otim uses music to attract others to the joyful sounds heard in the distance. In various villages, people gather to see the colorfully clothed dancers and to watch the drama unfold before them. The message in the lyrics and in the dialog all centers around educating others to look for signs of obstructed labor and also to refer a loved one for care should she develop a fistula. Through music and drama, this group is removing the shameful stigma associated with fistula, and in its place they are helping men and women rally around the condition.

One by one, more men ask to become a part of the festive ensemble. They not only understand the issues surrounding maternal care, they feel a sense of responsibility and a surge of motivation to spread maternal health education further. Young men, old retired men, boys: they all want to be a part of this collective concern for their wives, sisters, mothers and daughters.

Each day, approximately 16,000 women die or suffer serious complications from causes related to pregnancy or childbirth. Every six seconds a mother-to-be experiences a life-threatening complication.

I think we all have some work to do.

Music heals, beckons and is a universal language that has no boundaries. Stephen picks up his thumb drum, smiles at my young Moroccan male assistant who has been busy setting up equipment, and says slyly “Would you like to learn how to play?”

(Update: I will be returning to Uganda in November 2015 to work on documenting the music and dance troop’s performances and to assist with an Oregon-Uganda goat milk soap making project. Donations for this work are greatly appreciated. Send us an email if you would like to hear more about these two projects. You can make a donation here. Specify “Soap Project” or “Music Project”)

View a video of the musicians and dancers in their village here.

Ethiopia: Selflessness

Addiss talks with each woman, giving swift advice and health care diagnosis as she recognizes issues. One by one, the women come in to the makeshift clinic, exposing their vulnerabilities and asking many questions.

Every woman has the right to deliver a healthy baby.

The husbands wait nearby, eager to hear of any news, with their hands reaching out to their wives. Waiting, waiting.

I watch Addiss care for one patient, two patients,…..six patients. Their eyes tell me of their desperation to be seen by a knowledgeable health care worker. Addiss simply moves through her day, ego in check. After all, this is what she sought: to help all rural women in this area give birth to their children without devastating results.

I ask Addiss if she has time for herself, and this question is met with curiosity. She can’t even comprehend what I am asking. After searching my face for a sign of understanding, she simply relays: I am dedicated to the mothers of Ethiopia.

Ethiopia: Meet Addiss, A Hamlin Midwife

Her name is Addiss and she is 21 years old.

She lives in a small village, Wotetabay, just outside of BahirDar, Ethiopia and she has dedicated the next six years of her life to helping rural Ethiopian women give birth to healthy babies. A recent graduate of Hamlin College of Midwives, she also knows the signs of fistula and will refer at-risk women to health centers and hospitals where they can receive the care they need to prevent this devastating condition.

She lives alone in a small thatch roof hut, after completing her three years of study at the Hamlin College of Midwives, and her dedication is unlike anything I have ever seen.

She sees patients as they arrive daily, helping them through miscarriages and difficult births and general health care issues. Five times a month she walks, sometimes for seven hours each day, to outreach health centers where she educates the community on women’s health issues.

My heart reaches for her.

I watch her as she helps a women who has just had a miscarriage. She educates the women about hygiene and proper care, and she tends to the husband, answering each of his questions.

She thinks nothing of my words as I say I honor her and will work hard on her behalf. This is simply her calling in life: to dedicate her time to the Hamlin philosophy of ensuring maternal health for all Ethiopian women. She looks intently, directly, into my eyes. She has seen far more than I have.

I follow her to her outpost, walking through corn fields and forests and open fields. She asks for water, and I give her my bottle. It is the least I can do for this girl, my hero. Confidently and with grace, she proceeds to traverse over harsh landscape, focused on arriving before too much time has passed.

The bush clears, and I see a large group of Ethiopians, celebrating church services. Addiss takes her place in the middle of the village people crowd, and when the priest gives her a signal, she begins speaking, educating those around her about maternal health. Clapping, cheering, declarations of promises break out, and the energy is so fervent, I cry. Look at her!

I hear that the village is building a new church, and I give a donation of 400 birr ($24) and the crowd cheers with heartfelt passion. A $24 donation really goes a long way for this village. They proceed to show me the base infrastructure that is in place, and as much as would like to stay and look at every element, and I see Addiss in the distance beckoning me to come. She is late now, and I need to move on.

We walk further, in terrain more difficult to navigate. Finally, I see a break in the landscape ahead and there, nestled in a small field, is a cluster of small mud walled structures. The health outpost at last.

Women are lined up, having waited hours for Addiss to arrive. Pregnant women, mothers with babies, older women. They count on Addiss’ dedication to them.

Ethiopia: Fistula At All Ages

Not all fistula patients are teenagers and women. Some of them are children, such as Aynababa, age four. Although child marriage is illegal in Ethiopia, many ancient cultural practices support this tradition, which is one situation that can result in fistula due to the young girl’s body not being fully developed to be able to handle childbirth. Other situations, such as rape, does occur, however it is infrequent due to the gentle nature of most Ethiopians.

Educating the rural community about fistula is vitally important to the Hamlin Fistula Hospital organization. Each midwife is trained to perform education outreach to the most remote areas of Ethiopia.

Although Aynababa suffers from fistula, one can see how the Ethiopian spirit cannot be easily broken. Each person she meets is greeted with an infectious smile and a degree of expressed happiness I rarely see in my own country.

I fall in love with the Ethiopian spirit again and again and again.

Ethiopia: Educating Countryside Women

Women in the rural countryside of Ethiopia are smart, resourceful and highly creative, yet they rarely get a chance to be educated. Their days are spent fetching water, gathering firewood and tending to the home fires while the men work in the fields. Simply getting food on the table for the family requires incredible stamina and devotion to keeping family nurturing as first priority.

When a woman comes to the Hamlin Fistula Hospital and as her body is healing, she has the opportunity to learn many things: the visual alphabet, reading and writing, simple arithmetic and even nursing procedures. Some women are even hired as nurse aids after completing their education. What better person is there to care for a new patient than a former patient?

Educating a woman from the rural areas builds confidence psychologically for her eventual return to her village. The last time she was there, she was weak and lacked any kind of function whatsoever. She also most likely was ostracized and shunned.

Can you imagine how it must feel when she arrives home months later as not only a physically healed woman, but she can also read and write and alert other women to the signs and devastating effects of obstructed labor?

She may never completely eliminate the stigma of once having fistula, but she is well prepared to deal with this adversity with much more confidence. She also has become a crucial resource in educating other village women when they must seek outside care, rather than remaining at home during difficult labor.

Ethiopia: Strong Bodies, Strong Spirits

When Asnaku arrived at the Hamlin Fistula Hospital, she was extremely weak. Women who suffer from fistula cease eating and drinking, so that their body does not produce waste, thus contaminating their villages. The shame they feel is enormous, and they try to minimize the effects they have on their surroundings and loved ones.

Often, they arrive emaciated and dehydrated. Before they can have surgery, their body must be strengthened by nutrition and physical therapy. Each day, they are required to eat one egg and one piece of bread, and drink plenty of water. Nurses aides, former patients themselves, help them perform exercises so their muscles begin to strengthen.

Foot massages are given daily to increase circulation. This is a most intimate time, when a nurse aid gives a patient her massage, looking deeply into her eyes and ensuring that the patient feels loved and supported.

Asnaku also continues with her exercises after surgery until she is strong enough to return to her village. From the very beginning when Dr. Hamlin developed the program for the hospital, she and her husband Reg knew that whole body wellness was of vital importance.

As Asnaku becomes stronger, she also becomes part of the support circle for newly arriving patients, helping them to become stronger physically and spiritually.

Ethiopia: Grace + Empowerment

We have all suffered to varying degrees. A lost relationship, death of a loved one, a missed chance. This summer has been especially difficult for several of my friends and also within our family due to various losses, to the point where I adopted a much practiced mantra: our happiness is in direct relation to how well we can grieve.

Grief comes in many forms, and I marvel at how often we try to push it aside and “get over it”, whatever the loss is. Lately, there has been so much of it in my life, I decided to try a different twist and embrace it. Learn from it. And I found that I am not very good at keeping that philosophy front and center.

I arrived at the Hamlin Fistula Hospital yesterday and within seconds was surrounded by women who suffer perhaps the most heinous condition a human being can endure. Fistula is not only physically debilitating, the effects are psychologically and socially devastating as well. And even if a woman finds her way to this miraculous hospital by the river, she still faces her return to her village where she often finds additional difficulties, and even a recurrence of fistula if she does not follow what she has learned while being cared for.

Yet all I see here on these grounds are beautiful women, with easy smiles, loving temperaments and deeply moving eye contact. They have felt the depths of pain that is unfathomable, only to reflect outward a generosity of spirit that is rarely encountered. It is as if their ability to suffer silently has instilled within them an ethereal aptitude to connect to humanity, instantly, at our most vulnerable level.

I am honored to be in their presence.

And as each women engages with profoundly perceptive eyes, I feel like a child, inexperienced, fumbling, uninitiated. They seem to know this, accepting this ferenji who lives such an easy life, and they take me into their graces with a tender hand, as if they know how easily I can break. These women are strong beyond imagination.

The Hamlin Fistula Hospital’s focus is not only to repair fistula, but they have built a comprehensive program that helps these women become empowered through prevention education and outreach, psychological counseling and community building. I spent the day with the patients, and followed one young woman as she showed me her daily activities. I will share Asnaku’s experiences in the upcoming blog posts.

For now, here are some of the women who helped me deepen my understanding of grace.

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