Aira Hospital

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.

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?”

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.

Soon I will be leaving Nigeria and return home to Ethiopia. Contrary to the negative picture which is falsely spread around in the world I have only met very kind, exceptionally polite and incredible helpful people during my one month long visit here. Also living under Sharia was not at all that terrible experience which the establishment in the western world wants us to believe. I had a wonderful unrestricted and pleasant time without experiencing any inconvenience.

For a devoted Moslem the pilgrimage to Mecca is extremely important. Just as important it ought to be for any devoted fistula surgeon to make a pilgrimage to Katsina - headquarter of the national fistula project in Nigeria -  to be enlightened.  Dr Kees Waaldijk has not only repaired leaking women for a great part of his life, but continuously developed new and improved techniques for fistula repair based on never ending research and a painstaking detailed documentation of each and every surgical procedure performed over a period of more than 25 years. The source of truth concerning fistula surgery is found in Katsina.

The main fistula center in Katsina has 150 beds. However the patients and relatives spend the main part of the time outdoor under the shadow of a tree.

Plastic buckets for collecting urine under every bed

Going home after being cured and discharged

VIDEO ← click here for video

No need of rehabilitation or reintegration!

In three weeks I have been travelling with Dr Kees between four different fistula centers in 4 cities: Katsina – Kano – Zaira – Sokoto

We operate fistulas the whole day, we talk fistulas the whole evening and we dream fistulas the whole night. I have learned a lot, receiving the essence of Dr Kees’ lifelong and vast experience of fistula surgery all for free. I am extremely grateful for that.

The stereotypical picture of a fistula patient as a depressed, abandoned and socially outcast doesn’t fit with what we see here. In Aira 8-9 out of ten women with obstetric fistula come to the hospital with their husband as attendant. Those who are outcasts are usually unmarried women who end up in disgrace due to the fact that becoming pregnant as an unmarried woman is unaccepted in the society (as in the western world a little more than 50 years ago). It is the same picture what we see here. 60 % of the fistula patients are still living with their husbands, but that doesn’t mean that remaining 40 % are divorced. According to Hausa culture the first delivery has take place in the house of the woman’s parents, and if it is protracted and complicated with a fistula as end result she will remain with her parents until the problem is solved. However the husband will keep in contact and visit her regularly.

Not one of all the patients I have seen here is circumcised. That is because it is not in the culture of the Muslims who constitute more than 90 % of the population. That doesn’t surprises at all since we already know that circumcision does not contribute to the development of a fistula.

Many of the patients are very young since they marry at young age. But that doesn’t implicate that early marriage is causing obstructed labor and fistula. If the marriage were delayed some years the girls would only get their fistulas some years later. Just as in Ethiopia more than 50 % of the fistula patients are multipara (having delivered one or more times). Yesterday we operated a para 19 (a woman who delivered 19 times) who got her fistula at the 19’th delivery.

Always remember that a fistula is caused exclusively by lack of qualified obstetric service and nothing else!

What surprises me is that 70 % of all the fistula patients here have actually delivered in a hospital. That clearly implicates an obstetric service of unacceptable low quality. 

The advertisements which the big and very rich international NGO’s are financing and distributing are therefore not only useless, but even discriminating and insulting to the women.

African women are not stupid! If they knew that delivering in the hospital would be safe and result in a live baby, they wouldn’t hesitate to go there to deliver. But when the sad fact is that in the hospital they are neglected as much - or maybe even more - as at home, why bother to go to the hospital? The advertisement is an insult to the highly intelligent African women.

Instead of wasting money and energy on glossy advertisements and other useless preventive health activities it would be far better to support so-called “curative” health care which includes obstetric service. I say so-called “curative” because one and every performed cesarean is a preventive measure, just as many other inpatient surgical procedures.

Enough for this time. I will be back!