Tag Archives: Fistula

ASMP Best Of 2011

My work documenting emergency obstetrics in rural Ethiopia was chosen to be in the American Society of Media Photographers “Best of 2011” project list.  I am hoping that this will bring about increased understanding of the difficulties surrounding maternal health that are present in rural settings.  The Ethiopian government is actively developing solutions to address these problems as quickly as they can, with minimal resources.

Here is an interview that details this project and others that I am working on, plus some of my philosophies and business practices.

Ethiopia: The Hamlin Fistula Hospital

During this past year, I have kept in contact with the communications director of the Hamlin Fistula Hospitals. I promised to bring her several bags of KEEN shoes that were graciously donated so that patients could walk home more comfortably, even though the weight of these shoes would add a bit of complexity to our travel. Getting the shoes through customs can be difficult, which often means having to be held back for questioning.

Sure enough, we were stopped by the customs officer, with his incredulous question: “These shoes! Are they all yours?” (Really now, do Americans give the impression they would travel with 40 pairs of shoes?) I put on my most confident stance, and picked up the heavy bags, explained that they were donations, and turning on my heel to take off, did not give him time to ask me anything else.

We arrived at the Hamlin Fistula Hospital the next morning, and were instantly astonished at the site of this hospital. Lush gardens were the dominant feature, overshadowing the buildings. It felt as though we were in a fairy tale. We talked with Feven about many things, but one topic was of utmost importance: which direction we should take with our documentation and film.

Feven explained that young girls are often married off young to avoid abduction and rape. When the girl becomes pregnant at an early age, her pelvis is too small to give birth to her baby and she labors for many days and sometimes weeks. The constant pressure of the baby creates many problems.

When the young girl who lives in the rural countryside realizes that her baby is not able to be delivered, she usually has little choice but to wait for the baby to die in her womb. Even after the dead baby shrinks and is able to be delivered or extracted by a family member, she is often left with a fistula condition, where a hole is formed between the bladder and/or rectum and the vagina, and waste continuously flows, resulting in ostracizing from her village and abandonment by her husband.

A girl with a fistula usually will live on the outskirts of the village, afraid to walk for fear of contaminating her surroundings. She sits in a makeshift nest, and waits out her days, sometimes having to fight off hyenas due to her constant smell.

Sadly, this can all be prevented if there was better access to health care in the rural countryside. The Ethiopian government is building hospitals and clinics all over the country to address this. However, most of the clinics stand idle, in desperate need of doctors.

Our time here will be spent in a tiny hospital, which has no running water, in Mota. Dr. Philippa Ribbink will be training Ethiopian Health Officers how to perform emergency obstetrics. We know that this work will have a profound impact on all of us, but sitting here and listening to Feven, we are energized to do this work.

Feven asks us to focus on the inaccessibility that a young pregnant girl faces. Sometimes this means lack of access to hospitals, sometimes it means that while a hospital may exist, no doctors are present. Often it means that the young girl cannot get to the hospital. Foot bridges are washed away, the terrain is too rugged to walk during the 4th or 5th day of laboring, or family men cannot leave their farming work to be able to carry her on a makeshift stretcher. We also hear that more donkey carts are desperately needed to help facilitate her ability to get to a hospital during prolonged labor.

A few weeks earlier, I had made a request to meet Dr. Hamlin. Nothing was promised, as many people ask to meet her and her time is extremely limited. I watch as Feven picks up the phone and dials a number. It is a apparent that she has called Dr. Hamlin, and she asks if she has time to meet us. After a bit of dialoging, we make a plan to come back at 3pm, with our cameras. We have been granted an interview and approval to film her.


A young patient sits on the grounds of the Hamlin Fistula Hospital, in Addis Ababa.


Dr. Hamlin and Feven Haddis are delighted by by the donation of KEEN shoes

Return To Ethiopia

It looks like we will be going back to Ethiopia in early 2011 to stay a month.  I will travel with a team of doctors and nurses to a very remote area, where we will focus on obstructive childbirth issues.  I will also be documenting the lifestyle of a rural Ethiopian woman, in an in-depth manner.

Global Soul International, a 501c3 organization, will help us with fund-raising for this effort.  Donations are also accepted online here under the Projects section.

Ethiopia: Overwhelming Needs

More often than not, women are abandoned by their husbands after their prolonged labor results in a fistula.  They reek from fecal odor, and they walk around with blood and body fluid stained clothing. Most women resign themselves to a corner of their hut, and will not emerge during day hours for fear of being humiliated and chastised.

It is rare that a male will show concern or support, and when we do see tender gestures coming from them, our hearts break from watching their helplessness.  It is comforting to know that Dr. Andrew is able to fix the fistula, but the need is so overwhelming that he can’t get to all of the patients.  The fortunate women who find their way to the hospital have to wait weeks before their surgery can take place.  While they wait, they sit in the garden outside of the hospital.  The sun beats down, and an eerie silence ensues.

Everyone knows that time is of essence.

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: 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.

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