Aira Hospital

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

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.

The rain has started and we have water in the taps again. What a luxury to take a shower for the first time since a month. The hospital has always priority so in there we have had little water all the time except some few days.

Rainy season means fewer patients. People are again too busy in the fields to come to the hospital, but still we are in the unusual situation that we have a 2-3 days waiting list for surgery. We never seem to catch up.

We learned from Ethiopian Airlines to overbook systematically since there are always some “no show” passengers. However we have emergencies which the airlines do not have to bother about. The already overcrowded operation programs are more often than not disturbed by urgent life saving procedures, in particular complicated deliveries.

To make things more efficient we have tried to reserve one full day a week for minor cases. The first such day was a great success. Together with the eye surgeon we did 42 surgical procedures in one day. Not enough for Guinness Record Book, but anyway.

These four fistula patients after successful repair are not for the record book either

A specialized fistula center will do 4-5 cases a day. We do not have that many patients due to the fact that several “women’s projects” run by different organizations in the surroundings perseverate in collecting women with fistulas and shuffle them all the way to Addis Abeba bypassing Aira Hospital – “crossing the river to fetch water”. Not only because some of these different organizations are unaware that Aira Hospital offer free surgery for fistula patients, but more often due to selfish economical profits. As I have written before a network of parasitical activities multiplies around the poor fistula women, who are exploited by individuals and organizations for their own benefit.

Anyway our four ladies are all smiling happily….

….. and why not? Thanks to our poor fund they have been successfully repaired for free.

The two elder of them have suffered for more than 20 years with urine leakage day and night, not being able to keep themselves clean and dry for all these years.

One of the elder ladies has 5 childen, the others have no live children.

One of the younger ones is pregnant in 3’d months and will have a good chance to get a live baby if only she comes in time for a cesarean section

You may wonder how it is possible to repair a fistula in a pregnant woman, but actually the hormonal environment caused by the pregnancy promotes healing and acts beneficial to the repair.

You may also wonder how she could become pregnant with a leaking fistula.

Well, Dr Kees Waaldijk, the fistula expert in Nigeria, seriously claims that the smell of urine acts as an aphrodisiac for many men.

I really don’t know that. What I do know however is that the sexual instinct is difficult to control – by legislation as well as by man himself.

That I clearly understood when standing in front of the monkey house while visiting the London Zoo. The monkeys copulated wildly and uncontrolled. One gentleman found it inappropriate since many women and children in the public were watching the activity. He approached the keeper and asked him to do something to stop the monkeys doing the “naughty things”. The keeper asked the gentleman “How could I possible make them stop?” The man reflected a while and suggested “Couldn’t you give them some cakes?” to which the keeper replayed “Would you stop for a cake, Sir?”

A nearby mission hospital relies very much on short term expatriates staff. Some of these “ferenjis” describe vividly their experiences on the web – just like me. Reading the most often very pathetic descriptions of their experiences you understand that many years presence in this country has made me a bit hardened, being used to the prevailing extreme poverty and harsh conditions. Some patients however can still break your heart.

Look at this 50 years old lady who came with a urinary fistula (obstetric fistula). She delivered her only child – a stillborn – more than 20 years ago and got a fistula. She has been leaking urine uncontrollable day and night since then, not aware that her condition could be treated. Only recently she heard an announcement in the local church that women with obstetric fistulas can be cured in our hospital – and for free!

Now for the first time in over 20 years she woke up in a dry bed after a successful surgical procedure. No wonder that her face is shining with a big smile.

Her husband is still married to her. He didn’t abandon her in spite of the endless smell of urine  in their home.

For the attending husbands who look after their admitted wives it can be boring with time. So why not give a helping hand with preparing the gauze compresses?

After patiently waiting for an extended time it happened!

Mobile network started working in Aira this week. We have been looking forward to that for a long time, were told that it will come on Monday – but not which Monday. Now it came on a Friday.

It will change our world just as much as when the stationary telephones were introduced some years back. If the network is stable – and why shouldn’t it be? – we can get wireless broadband which allow us to surf unlimited for only 400 birr a month. Be prepared to see a change on this blog then!

In the hospital we will gradually replace the Walkie-Talkies which have been a good service during the last years. Mobile phones will reach further and are more reliable.

The picture of Ethiopia as a chronic backward country with starvation and no progress is completely wrong. Since we came here in Aira 6 years ago we have seen the coming of electricity, telephone -first fixed and now mobile - and reconstruction of the main road from Addis with asphalt almost all the way to Aira.

What we need now is only water! We have been without water for more than two weeks. Not due to failing pumps or other technical problems, but simply due to the fact that now in the end of the dry season the rivers have dried out and no rain has come yet.

People around are wondering if this is a consequence of global climate changes?

I had a professional very exciting and pleasant stay in Nigeria, but it is anyhow good to be back home in Ethiopia.

What did I learn from my visit in Nigeria?

Fistula surgeons in general concentrate on closing the fistula opening by suturing the bladder wall. Dr Kees has a different approach. The fistula is to be considered as part of a major traumatic tissue lost of important structures – muscles and fascia – in the pelvic floor. In short he is focusing on reconstruction of the tissue (fascial) defect, and during that process the fistula is closed as well - just as the continence mechanism is restored.

I watched and learned his operation for restoring continence in women with severe stress incontinence (inability to hold the urine) after successfully closure of a fistula. Step by step the urethra was shown with repeated measurements to lengthen before your eyes, and from flowing uncontrollable the urine gradually was controlled completely. An original and beautiful procedure which could help innumerable women not only in the third world but in the first world as well.

The unfortunate thing is that it is extremely difficult for people over there to accept that something can be learned from the third world.

I even learned something new about surgery for prolapse – a very simple way of restraining a uterine prolapse and a better way to do a cystocele repair.

All this I hope to demonstrate with pictures on my pages here on the blog after a while.

Being in the business for some time nothing surprises anymore. That the Fistula Project which Dr Kees is running – the largest in the world – has insufficient financial support to that extent that he from time to time has to pay from his own pocket is however a scandal.

As I have stated repeatedly the vast majority of the NGOs are considering curative healthcare (hospital inpatient care) as not worthy of financial support. Support to preventive health exclusively is considered politically correct.

Why is it so difficult to understand that the only way to cure a fistula is by surgery and the only way to prevent a fistula is by surgery – that is a cesarian in due time.

If there is no functional obstetric service which offers a cesarean in about four hours after a delivery gets obstructed all other means are useless. What is the use of identifying risk mothers at antenatal clinics or complications during delivery if there is no hospital where the delivering mother can be referred and get a cesarean in due time? What does empowering women and enlightening them about their right to good health care help if there is no good health care around?  

All that money which are poured out on different “fistula projects” – billions of dollars – are wasted as long as there is no functional hospitals with professional and efficient obstetric service including surgical relief of an obstructed labor.

What did the recent meeting in Addis Abeba where all the “big shots” and “experts” from all over the world discussed maternal health care in the developing world cost? Millions of dollars for business class flights, 5 star hotels and 5 stars restaurants – and maybe whiskey and women? (who know? I wouldn’t be surprised). And what came out of it? Nothing but empty words, a promise to reduce maternal death by 75% in 5 years! Wonderful - if only talking could do it. Unfortunately however I haven’t seen any documentation until now that talking saved a single mother’s life or closed a single fistula.