Aira Hospital

It has been completely impossible to get connected to internet for a lomg time now. It takes too much energy and patience to even try when you come home tired after a busy day in OR. After trying to call and connect some 50 – 100 times or more without success you tend to give up.

Although we are temporary short of staff in the operating theater with 4 persons away for workshop and training we still managed to perform 35 surgeries in one day. High surgical activity benefits the patients and raise money for the hospital. That is what I consider true “income raising activity”.

Otherwise the popular idea of “income raising activity” always means something else for other people. Several years ago the hospital was evaluated by “experts” who in their report suggested that the hospital should start growing vegetables as “income raising activity”.

Think of a shoe factory which needs “income raising activity”. Would one consider growing vegetables or opening a cafeteria to generate money in that case? I think not. Then why is that seriously considered appropriate for a hospital?

Some years ago the hospital applied for a grant to build a much needed eye clinic. The donor advised the hospital to include some “income raising activity” as that would make the chance of receiving a positive response much higher. Therefore the hospital came up with the idea of building a cafeteria as well as an eye clinic. The simple fact that an eye clinic in itself would be income generating no one thought about.

Since more than two years the cafeteria building has been standing empty, which clearly proves that it is not needed and nobody has the knowledge/interest to start it up.

Have you ever seen a “white elephant”? Here is one – the cafeteria:

On the other hand we badly need more operating theaters. Since more than one year the number of eye surgeries has increased tremendously and the only limiting factor is lack of operating facilities. With more space the production and income will increase substantially. 

The hospital administration calculates very optimistic and unrealistic that the cafeteria could make an income of 5-7 000 birr a month (if it ever opens that is). In the operating theater we already take in 5 -7 000 birr a day. With an additional operating theater that could reach the double.

My only hope is that the hospital will not employ staff to run the cafeteria because that will definitely turn it to an “income loosing activity”. Better to let a private business rent the building, but I doubt that anybody is willing.

When electricity came to town more than 3 years ago some business people from Addis Abeba opened the first Mana Kaki (café) in town with bonbolinos and macchiato (doughnuts and latte). It closed after some months. There was obviously no market for such extravagancies. That should have been a lesson for the hospital administration.

As always I have excellent ideas. Since the construction of the building started I suggested using it as a new operating theater after some modifications. As always I am shouting in the desert!

Most donors, individuals as well as organizations, have their own agenda. Most often the help which is offered is not our highest priority or even not wanted.

Most of what is needed for keeping the hospital running and improving service - medical/technical equipment and materials or human resources - is available in the country. What the hospital need is money to buy it.

One of the few exceptions to the general rule is the international NGO based in US, the Fistula Foundation, who listened to our needs for helping women with obstetric fistulas - financial support so that the hospital can guarantee these patients free surgery and other necessary treatment for free – and we got that. From now on the hospital receives a generous fee from the Fistula Foundation for every performed fistula surgery.

This will make the common poor fund accessible to patients whom we previously had to turn down because of the limited volume of the fund.

When it becomes known widely through the congregations that every woman with an obstetric fistula is treated for free we will definitely see more patients coming for help and hopefully the individual NGOs who are active in Wollega will also divert their patients to Aira.

Have no doubt that fistula surgery is needed. Here are two recent patients who were operated in Aira Hospital. Both had previously delivered a stillborn by cesarean (could also be a laparotomy for ruptured uterus) in another hospital.

One is only 18 years old. She came after a few months with an ugly scar and had her fistula repaired.

Fortunately no one bothers about the esthetic look, not the husband, neither the woman.

I was actually once told by a staff member that the women might appreciate a big ugly scar that they can show to their husband and get some rest and empathy (?).

Hopefully she will be able to conceive again so that she can get a live baby by cesarean. The statistics tells us that the chance is only about 25%.

The other patient came after 4 years. She had paid 1 500 birr – a lot of money – for an operation which resulted in a dead baby and a fistula. She didn’t come to us before due to lack of money. The previous hospital treatment consumed all the savings of the family. She was overjoyed when she realized that she was cured and didn’t have to pay.

A contribution to the Fistula Foundation on www.fistulafoundation.org makes free treatment for women with fistula possible at Aira Hospital

To lose a leg is catastrophic. There is no supply of prosthesis around and without a leg you cannot do the farming which is the only way to survive for 95% of the rural population.

It is an old dream of mine to be able to supply our amputees with an artificial leg. Readymade prosthesis in different sizes left and right are available and can be purchased from abroad if only we had the money. Made of out of plastic they need only some heating to be adjusted to an amputation stump. No need of high tech equipment or trained staff - only money is needed.

Recently during the Swedish election campaign the country’s infamous Marxist-feminist nr 1 burned 100 000 Swedish crowns in public to get the attention of the media. She got it with the same success as when she urinated on the red carpet among dignitaries during a gala in Stockholm. This time however she was sober.

In the same election campaign various car companies pay 8 million crowns for free champagne to everyone.

One of our patients made an artificial leg for himself. A bit clumsy, but it works.

Others do not have that capacity and therefore we always do our outmost to save a limb.

This unfortunate man was as drunk as the Swedish Marxist-feminist NR 1 when she urinated on the red carpet. He fell asleep outside his hut and woke up in the middle of the night as a hyena was having a good meal on his leg.

In the operating theater all dead muscles and other soft tissues were cut away and the wound cleaned thoroughly (wound debridement and revision).

Not much was left. However the anterior muscles kept the foot in (dorsal) extension so there is a substantial chance of getting the patient walking on two feet

After some days the large defect was covered with skin graft.

It looked promising on the latest picture.

The patients disappeared although he was told to return for follow up.

Maybe a lucky hyena got a full and undisturbed meal later?

100 000 Swedish Crowns would pay for 500 cesareans saving 1000 human lives.

The free champagne could keep Aira Hospital going for 100 years.

Priorities are indeed different in this world.

About 2-3 years ago I was approached by a NGO representative was looking into the fistula business searching for a fistula project to support with the surplus of money which as I was told by their representative had been donated after the Tsunami catastrophe. Being a layman that person unfortunately had the same popular - but never the less wrong - ideas about fistulas as the ignorant majority and would only consider financial support for “rehabilitation” and “reintegration” - whatever was meant by that - and more unfortunate was not willing to take advice from a medical professional (read the post “THE FISTULA PROJECT”  - Thursday September 24′th 2009)

The regular reader of this blog knows by now that a woman leaking urine from a fistula is rehabilitated by a successful repair that makes her dry, and the only kind of reintegration is to have a live baby by cesarean if the patient manages to get pregnant again. That happens in about 25 % of successfully repaired fistula patients and there is not much you can do to change that.

I thought that the above mentioned project had been buried long time ago, but lately I learned to my big surprise that it is still on the table. It is a typical office desk product made by layman without any knowledge or practical experience in obstetric fistulas with all the classical misconceptions included.

Laymen as I have come to understand firmly believe that the basic content of a fistula project is a waiting area, a car and money for the women to “start a new life”. Even so with the mentioned project proposal.

The proposed costs for administration including salaries surpass 1/3 of the project money.

There is money for this and that, but not a single cent for surgical repair of fistulas.

One post called “Subsidy complicated deliveries Addis Abeba Fistula Hospital” is puzzling. We are dealing with all kinds of complicated deliveries at Aira Hospital. There is absolutely no need of referring any complicated delivery anywhere – definitely not to Addis Abeba. Mother and child would die on the road and the Fistula Hospital does not deal with deliveries anyway.

Another confusing post is “Anti natal surgeon training”?! “Anti” means against and “natal” something with nativity. Does it implicate that a surgeon has to be trained in surgery against nativity - tubal ligation, a procedure which is performed by our operating theatre staff on a regular base?   

I do not want to bore you with more details. You can read for yourself. But as I mentioned there is not a single cent for surgical repair of fistulas. Imagine a restaurant with beautiful interior, nice decorations, live music, excellent service, clean rest rooms and cocktail bar - but no kitchen!

It is tragic for the fistula patients who are in dire need of support. Who cares? Obviously not NGO white collar employees idling on a useless project proposal for years living their comfortable lives far away on a steady income.  

I rather confident that the hospital administration is clever enough not to get involved in this mess.

Aira Hospital has a long tradition of repairing obstetric fistulas dating back some 30 years or more. We used to have a regular flow of fistulas, but the later years it has decreased. Either because there are fewer fistulas around – which I doubt – or rather because there are several so-called women’s or fistula projects run by individual NGOs which collect women with obstetric fistulas and bring them all the way to Addis Abeba for repair bypassing Aira Hospital. Passing the river to fetch water so to say.

That is done for three different reasons:

1)      Lack of awareness

2)      Arrogance

3)      Greed

1) Lack of awareness that repair of obstetric fistulas is done at Aira Hospital. It is widespread and very firm believed that fistula repair can only be done at the famous Fistula Hospital in Addis Abeba

2) Many missionaries and other laymen think they know best and consider the treatment in Addis Abeba superior to everything else. The argument that the women are treated with dignity at the Fistula Hospital is used often. I do not have the slightest doubt about that, but although we do not teach our patients the alphabet or some handicrafts, and although we do not provide the repaired women with a new dress when discharged it doesn’t mean that we do not treat our fistula patients with the same dignity as we treat all our other patients.

3) Many individuals take the opportunity to make money from the different “fistula projects” by shuffling fistula patients long distances by road to Addis Abeba and cash generous daily allowances and mileage for that.

At the same time the Addis Abeba Fistula Hospital which is overburdened with patients tries their best to have fistula repairs done in the countryside at satellite centers.

Look at this map. Fistula patients are collected from places as far as Begi and taken by car all the way to Addis Abeba – 20 hours on the road.

The catholic sisters around Dembi Dollo came to know about our service only lately. Last week they referred 10 fistula patients for repair. 5 of the women were from Lalo Kile, 40 km south of Aira. They had originally been brought to Dembi Dollo to be transported to Addis Abeba later.

They arrived in Aira Wednesday and were all 10 repaired successfully by Friday as we have no waiting list. They will be discharged hopefully no later than after 14 days if no complications show up.

It is our sincere hope that this could be the beginning of the end to the fistula circus in our area.