Tag Archives: Mota

Ethiopia: Our Eyes Together

She stands in the doorway, shoulders slumped, hair in tangles from not being washed in a week, shirt stained with blood, tears streaming down her cheeks. One hand is in her lab coat pocket, the other fumbles with the keys that mysteriously no longer work in the door to her sleeping room. Four women walked in with dead babies today alone, with several mothers struggling in other beds; it’s been a difficult day.

She longs to quiet her mind, to place the images of death in perspective with the job at hand. She signed up for this, with full knowledge of the difficulties. A diversion please. Shower? There is no water. Chocolate? Gone. Music? Too much of a reminder of home. A nice note of encouragement via our CDMA internet connection? It’s 3:10am back home, so no news. Like many Ethiopians who are hungry, worn or troubled, she reaches for sleep. But in this place, on this day, it does not come. Tossing and turning, stomach in knots, a fever arises and she whispers: “This is hard.”

Death is a part of the fabric of life here in Ethiopia. The people have come full terms with the likelihood of its occurrence. According to World Health Organization figures, 10,000 babies and 1600 mothers die from childbirth complications every day. Here at Mota Hospital, the director responds to the question regarding what is the most difficult aspect of midwife retention with the words: “We see death of our mothers and sisters every day, on our doorstep, and we have little supplies to help them.”

The problem is quite complex, as many intertwined issues exist in Africa. When a girl or woman labors at home, she may not even be aware that there is a health center nearby. Hospitals have a desperate need for doctors, which are first priority, and they rarely have money for outreach and education. Even if she does know about the hospital, often a woman will suffer in silence and not want to bother her husband, father, brother who toil in the fields all day. By the time she musters the courage to say she thinks she is in trouble, it is often at such a late stage that the baby and mother are well headed toward death.

If she is lucky, the husband, father, brother may then rally several men to carry her over the rock strewn and rugged terrain to get her to the hospital, walking for hours, sometimes days to get her here. And then, once here, they see the costs that are associated with care (most often less than $100) and they quickly realize that they will have to sell all of their cows in order to pay the bill. The pivotal decision must be made: get the care their loved one needs and become destitute, or turn away and go back home. At times, treatment will be started only to have the family run out of money and leave mid-treatment. And perhaps the worse situation is when a woman is carried to the hospital only to find that it is not staffed.

We often long to pay for services when we see that they could save a life. We are told that this is not sustainable for the hospital, as many problems arise when the hospital cannot pay for other villagers after we have gone. Money is best donated toward equipment and occasional free services where they deem it to be appropriate. So, we assimilate to this way of life, and now, here in this tiny village, the problems of Ethiopia become our problems. No longer are we a simple bystander. We feel the loss. We see the complexity. We are saddened by the pain these women and their families suffer.

And, we hold hope, just as the doctors do.

A new road is being built that will connect Addis Ababa to Bahir Dar. Mota will become a stop mid-way, and many believe that this road will create a demand for better services in Mota, such as desperately needed water flow. This will enable the old rusted truck ambulance be to retrieve patients from outposts. It will bring better telecommunications services. The doctors tell us that they have seen immense progress already in the few years that they have been here. I ask them what support they have to mentally keep going when they see so much suffering and death every day. Their answer is said with quiet and passionate devotion: “These are our mothers and our sisters. Of course we will work for them.”

I have often reflected on the eye contact that is present in Ethiopians. I have traveled to many countries, witnessed many rituals and interactions, and never have I seen such an intense and long-holding gaze as here in Ethiopia. A few weeks ago, an Ethiopian man said something to me when I asked about courtship here that plays out in my mind today. His words: “Everything starts and ends with the eyes. It’s all within our eyes. Words are never needed.”

Ethiopians are creative, full of wonder, and tender. They know and experience many things that most of us will never endure, let alone fathom that these situations even exist. When I look into their eyes, I see more than the current situation at hand. I see belief, hope and an almost father-like twinkle that tells me they see me as a child: innocent, comfortable and maybe even if I am lucky, endearing to them. They see through me, because my life, my world, is transparent and thin compared to theirs. Their heart beats hard every day, while mine has long periods of rest, boredom even.

I look at Dr. Philippa as she finally finds sleep, and I admire her dedication to enter this world and exchange information with the midwives, and to also bring us all into the equation of moving toward the goal of creating healing environments for anyone who suffers here.

It is now morning, and Dr. Philippa rises with vigor and purpose. She picks up her stained lab coat, grabs a piece of bread, and pushes the door open to go round on the patients. Before she leaves, she hesitates, looks over at me and starts to say something. She searches my eyes, and then without words, closes the door behind her.

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.

Ethiopia: Home Sweet Home

Here are a few photos of our home here in Mota, Ethiopia.


Our living space.


Our kitchen. Sink leaks badly. But hey! We have a refrigerator!


Our bathroom: water comes a few times a week if we are lucky. Toilet does not flush, but we can pour water into it.


Our trusty Mr. Bleach. Food is soaked in it, kitchen is cleaned with it. I love Mr. Bleach.


The outside of our home.


Wash day!

Ethiopia: Off To Mota

We said goodbye to Dr. P and Darlene, and off to Mota they went. We were excited to know there was cell reception in Mota when we got our first call from them. The news was equally as exciting. In less than 24 hours, they had been harassed significantly in BahirDar, found themselves in the middle of a religious celebratory mob scene in Mota, learned that there is no internet in Mota, found out that we would have water only three days per week, and that no cook existed for us.

The good news: sheets are pretty clean, the hospital staff is warm and inviting, and the air is cool without too much threat of malaria carrying mosquitoes. And the rooms are in the hospital compound so we can be locked in at night.

From all accounts, they are navigating the obstacles the best they can. This does not come without a bit of sleeplessness and anxiety….and lots of “what ifs”.

What if a women dies while we are there? How will Dr. P and Darlene feel about removing a dead fetus? What if a woman is hurt? What if a referral needs to be made, knowing there is no place to refer in the vicinity? What if the village gets angry? Will they accept a female doctor?

Most of these questions seem less of a concern during the daytime. But when the head hits the pillow, we all lie awake churning the scenarios over and over.

This is the hard part. And we signed up for it.

Dr. P and Darlene get ready to take off on their plane to Mota, while Jay and I turn toward Arba Minch

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 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.

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