Tag Archives: maternal health

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: Brave Women

They have been called some of the bravest women in the world.

When a woman suffers obstructed labor in rural Ethiopia, she often has no place to go. She labors for days, and fistula can develop due to excessive and prolonged pressure on internal organs. The Hamlin Fistula Hospital is devoted to the repair of fistula and the psychological healing of women who suffer this devastating condition. They also are dedicated to helping to prevent fistula from occurring at all.

In November 2010, Dr. Hamlin’s dream came true when the first Hamlin midwife graduates started working in the field, offering prenatal care and a referral service to pregnant women in the countryside. The midwives work alongside the Ethiopian government to help reduce instances of fistula by providing much needed care to these women who live so isolated from health centers.

Each Hamlin health outpost has an ambulance to assist with referrals to regional hospitals where C-sections can be performed in emergency situations. The midwives, all coming from various villages around Ethiopia, are selected via a rigorous interviewing and testing process. Once they complete three years of training at the Hamlin College of Midwives, they return to their villages to work for six years. During this time, they are also educating villagers on maternal healthcare initiatives as well as building trust with the village as a whole. Their days consist of prenatal care, assisting with difficult births, education, and referrals of extreme cases.

It is not an easy job, living so far away from their colleagues and a team of ready support and modern equipment. But they are well equipped for support when they need it. This does not mean that they do not face extremely difficult situations alone. Rural women still prefer to give birth at home, and often go to receive help after it is much too late.

The Hamlin midwife becomes a wise health official rapidly.

Ethiopia: Maternal Mortality

I took my first trip to Africa and Madagascar when my three children were in preschool. I set off to bring back images so they could see how children live in developing countries.

Fast forward fifteen years, and this time next week I will be working with the Hamlin Fistula Hospital in Ethiopia to document the work they do to heal and also prevent a devastating maternal condition that occurs due to prolonged labor.

Had I been born an Ethiopian woman living in a rural area, chances are strong that I would have died during the birth of my first child. Ben was too large to fit through my pelvis, and I had an emergency C-section to halt his distress and enable me to give birth to him.

When I look at my three grown children, Ben, Aaron and Brynn, the love I feel overflows into an insatiable desire to help these suffering mothers in Ethiopia.

Ethiopia: Hamlin College of Midwives

Join me as I travel to Addis Ababa, Ethiopia to meet some of the world’s bravest women as they support each other by reducing infant and maternal mortality and the occurrence of the physically and emotionally devastating condition of fistula.

It is a great honor to be asked to visit the Hamlin College of Midwives to capture the essence of their 2011 graduation ceremony. On October 15, 2011, the Hamlin Fistula College of Midwives will graduate a second class of trained midwives. After the ceremony, these newly trained women will return to their rural villages to care for new mothers and assist extremely difficult deliveries.

Every day, 1,000 women and 8,000 babies die due to complications from pregnancy or childbirth. And for each maternal death, at least 20 additional women suffer devastating injuries related to their simple desire to produce a family to help work the fields to sustain their food source.  These World Health Organization statistics are sobering, especially when contrasted with the kind of care that is received elsewhere in the world.

The Hamlin College of Midwives is responding to this crisis by training local rural women much needed midwifery skills and supporting them as they set up services in their rural home villages.

Come along as we celebrate these midwives and the mothers of Ethiopia!  I will be documenting this momentous occasion, as well as other aspects of the beautiful and innovative Ethiopian culture. I will also be writing guest blog entries on Phil Borges’ Stirring the Fire website.

We are hoping that a collective cheer from around the world will be heard as these Ethiopian women extend one of the most loving gestures to one another: helping a mother deliver the life that grew inside of her.

Each midwife has been able to be trained without having to pay fees, which they could never afford. Your help is critical in making this possible. Donations for the midwife college are being accepted now at the Hamlin Fistula USA website.

For Dr. Catherine Hamlin’s story, read about her book here.

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: Presentations and Discussions

Here is a list of upcoming lectures/slide show regarding our emergency obstetrics efforts in Ethiopia:

February 17, Portland, OR
Portland State University, 2:00pm classroom discussion. Call for details.

February 17, Lake Oswego, OR
Lake Oswego Reads, 7:00pm, Marylhurst College, 17600 Pacific Highway

April 19, Portland, OR
Medical Society of Metropolitan Portland, 7:30pm, Embassy Suites Hotel, 319 SW Pine St.

May 15, Portland, OR
The Development Salon meets in the Park View Room at the Mirabella in South Waterfront. 4:30pm Wine Reception, 5:30pm Discussion. Mirabella is located one block east of the OHSU aerial tram base at 3550 SW Bond Avenue. Call 503-688-6806 for further directions.

May 16, Bend, OR
Cascade Camera Club: Bend Senior Center, 1600 SE Reed Market Road. Doors open 6:30 pm; meeting begins at 7:00 pm.

Ethiopia: Degie’s Story – Part 3

I enter the room cautiously, not wanting to disturb the family. They motion for me to come all the way in, and when I do, I see beaming faces and hands outreached, scrambling to make contact. I am only the photographer, not a doctor, but their joy and appreciation are boundless: Degie has lived through an obstructed labor and childbirth, and the baby is thriving. I look at Degie, and her smile is wide, tears are in her eyes. I grab her outreached hands and shake them like a mad woman. I too am thrilled to see such a difference in her well-being. I can also detect concern regarding how she will comfortably make the long walk home.

She slowly uncovers the tiny baby boy next to her, her first-born child, and the cool air makes him stir. Lips plump, tiny fists pumping the air, he opens his eyes and makes a sucking sound that makes us all laugh. He is content. I motion outside for someone to come and translate for me, and I tell Degie that I think she will make a wonderful mother. I also tell her that I have never seen such devotion from an extended family, at least three members sitting at her bedside around the clock, waiting to see if she needs anything.

In rural hospitals, the family must provide basic care for the patient. They feed them, bathe them, and sometimes even administer simple nursing tasks. Degie’s sisters, brothers and grandparents have provided exceptional care for her. It is not always like this. At times, there is no family support. These perhaps are the most difficult situations to witness. When a person comes in great crisis, and they have no one to support them, most likely they have no means to pay for services and they reluctantly must turn away. It is heartbreaking to watch a very ill woman, laboring with a child, have to leave the hospital grounds based upon inability to pay the fees. Once again, our souls reach out to her and want to pay the fees, but the hospital administrator strictly advises us that this creates more problems than they can handle once we are gone.

What do they do? Where do they go?

This is simply a way a life here in rural Ethiopia. Our minds turn to how we could possibly make the payment of fees sustainable. An on-going fund for destitute patients? A plea to the government? We don’t know these answers.

But Degie is fortunate in that she has many brothers who sold cows to pay for her surgery, and have taken time from the fields to carry her home. They gently walk her to the makeshift stretcher, and tenderly move her down onto it, covering her with a gabi. A chaotic flurry of hands dip into injera and food is passed around. The men are fed quickly so that they have strength to make the arduous walk over rock strewn terrain back to their village. After a bit more clamoring as they decide who is in front and who is in back, they reach down and pull up on the stretcher, lifting Degie’s body high onto their shoulders. The sisters pack up the food and scurry behind, barefoot with gabbies flowing in the wind.

I watch them turn away from the hospital and walk together down the rocky road toward their village, their feet hitting the ground in rhythmic unison. And as they disappear into the horizon, I see the faint outline of a group of men carrying a woman toward the hospital.

 

Ethiopia: Degie’s Story – Part 2

By now, many family members are crowding the doors, becoming more desperate as time moves on. I try to ease their concern by saying “teru doctor” (good doctor) but they look past me. Crying turns to sobbing, as each family member finds a stoop to sit upon outside of the operating room that is maneuvered without running water.

By the time I have changed into scrubs, I see that the nurse anesthetist is already preparing Degie for her spinal block. I rush into the room, find a position that is far from the sterile field, and set up my camera. Within literally minutes, Dr. Philippa exclaims with excitement, “And…..WE HAVE A BABY!”. The room is filled with the glorious sound of the cries of a newborn baby.

Though extremely weak, Degie is now alert, and begins fervently looking about the room, her eyes tracking every move of where her baby is. I ask a midwife to bring the baby over to her so she can see it. He does so, and she stares deeply at the infant. I take a few photos of the baby, and exit the room. I can’t take my scrubs off fast enough to make my way outside. I show the family the photo of their newest addition and say ” konjo baby” (beautiful baby). The sisters and brothers press against each other to get a peek at the photo. The grandfather shouts for joy.

Degie’s parents are both dead, but she has a wide circle of support with her many brothers and sisters and grandparents. One young man looks particularly shy, and stands apart from the group. I move away from the crowd and show him the back of the camera. A slight smile starts at the corners of his mouth, and he looks intently into my eyes.

“Degie husband”, someone whispers. I turn to try to say something to him, but he has moved away. He now stands in front of the doorway, trying to get a glimpse of his wife.

Ethiopia: Degie’s Story – Part 1

Degie is curled on her bed, her body is still. Her breathing is shallow, and her eyes can’t seem to focus. Her tattered gabby cloth swirls around her body, and one bare foot is dangling over the side of the bed. I look at her for a long time, wishing I could help her. I hear a voice, and see that the woman in the bed over in the corner is also watching her.

“She sick. Very sick,” she says in broken English. I nod silently in agreement.

Degie is tiny. Her rail thin body is listless, and her mouth gapes open as she tries to take in each breath. I try to find a midwife to ask about her, and as I start to move away, Degie screams out in agony. A midwife rushes into the room, followed by our medical team. She has been in labor for a long time, no one knows for sure exactly how many days it has been. A few family members are sitting near her bed, and as the day progresses, more brothers and sisters trickle in, having heard how sick she is. Many are openly crying.

In rural Ethiopia, family members are expected to fill in as nurses and to provide other items of support such as food and bed sheets, but it is apparent that this family is here because they love her dearly and they are deeply frightened.

This is Degie’s first pregnancy, and she is near death due to this long labor.

The midwives administer Pitocin, and wait for her contractions to come more frequently. Once they do, they ask her older brothers to carry her into the labor room, and they comply in a stoic manner. It is not hard to see the concern on their faces. Degie continues to contort her body as each contraction comes, yet she is so weak she can hardly breathe, let alone scream during her pain. The midwives ask Degie to start pushing. They try everything to get the baby out, but it will not move.

Degie is suffering from obstructed labor, which often results in death for both the mother and baby.  If a woman does live through obstructed labor, she frequently develops a fistula, which has devastating physical, social and psychological effects.

After two hours of pushing and an attempt at delivering the baby with a vacuum, one midwife, Selam, asks for visiting obstetrician Dr. Philippa to return to the labor room. Once Dr. Philippa arrives, she agrees with Selam that Degie’s tiny pelvis will not accommodate the birth of this baby and the baby can only be delivered by cesarean section. When they ask for Degie’s consent, she shakes her head no. She is scared and is worried about the money: less than $100. The midwives tell her brother that both Degie and the baby will die if the baby does not come out soon. Degie’s brother assures Degie that they will sell precious cattle and do whatever it takes to find the money. He pleads with her to say yes.

Degie gives her permission, and is swiftly transported to the operating room where a team of midwives, a nurse anesthetist, Dr. Philippa and Physician’s Assistant Darlene have assembled. They are ready for her.

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