ADDIS ABABA FISTULA HOSPITAL

Hamlin Fistula UK
Quarterly Report April 2009
formerly Hamlin Churchill Childbirth Injuries
Fund)
Registered UK Chrity No: 25
We had a visit in December 2008 from the wife of the Danish Prime Minister, who came with a
Exclusively supporting the Addis Ababa Fistula
delegation from the Danish Embassy. Dr Hamlin welcomed the guests and also took them for
Hospital
lunch to Desta Mender and to visit the Midwifery College. The women trained in catering
supplied a wonderful lunch for our guests, using the skills they are developing as we plan to
open the new “café” at Desta Mender.

Annette Bennett and Dr Hamlin with guests

Message from the CEO – Mark Bennett

The last few months have been a busy period for us as we continue to treat patients and to
work on prevention initiatives. We have had a visit from Dr Kees Waaldijk, a Dutch national
and the most experienced fistula surgeon internationally after the Hamlin’s. We were very
happy for him to demonstrate his techniques to us here.

There are people still living on land granted to us for our Midwifery College and we are excited
to report that the Municipality has finally granted land so that these people can move. We will
partner with both the Municipality and “Habitat for Humanity” in the building of new homes for
them. This will commence soon.

This year is 50 years since the Hamlins first came to Ethiopia to begin working to improve
maternal health. We are now finalizing our plans for celebrations in May and early June. We
would love to make this a special event, not only to recognize the commitment of the Hamlin’s,
but also to further highlight the need for improved maternal health. Our plans to upgrade the
Maternal Health Unit in Bahir Dar, so that more women have access to emergency obstetric
care have met with continued delays. This has been extremely frustrating. The plans have
been in place for 12 months and we hope that within a few weeks a contractor will be selected
to commence this work . We are also finalizing plans to upgrade a rural health centre in the
Amhara region (Dangla), in co-operation with another NGO so that women in that area will
have access to emergency obstetric care. We are providing equipment and supervision for this.
There is not space here to give you a full update on all our activities, but here are some other
highlights of recent months:

Construction commenced on our Metu Building, Ato Kassahun was appointed as our project
officer and is making great progress.

We also appointed a Senior Finance Executive, Ato Asfaw, who has now commenced his work.

We began work on a project with the World Bank/ Roads Authority and appointed a project
leader.

We visited the Harar Fistula Centre and were encouraged at the work being done and also at
the number of patients already treated. New generators have arrived and will be installed in
our regional Centres.

Dr Hamlin travelled to the UK for Christmas with Richard and Diana and her health tests were
all positive.

Prof Gordon Williams with Ethiopian doctors

Medical News

Prof. Gordon Williams, a long time friend of the hospital resigned from his role at the new
Medical School in Addis Ababa and has been appointed as the interim Medical Director while
we search for a long term candidate. Dr Andrew Browning has been in Australia for the last
part of 2008 attending a course on plastic reconstructive surgery and taking some leave.
Medical Audit meetings have been commenced at the hospital on a regular basis, evaluating
our performance and difficult case issues. New Doctors appointed, Dr Fekade and Dr Bitew
both commenced their training and they are willing to work in our regional centres as needed.
In the last part of the year many long term cases were reviewed and managed with 11 urethral
implantations and 9 ileal conduit patients operated and revised. The number of cases treated
in the last quarter was over 540.

Sr Azeb our physiotherapist also completed further training in the UK with the assistance of our
good friend Physiotherapist Lesley Cochrane.
Desta Mender

The activities to generate income at Desta Mender are showing real potential. The dairy, egg
production and market gardening are generating significant returns to cover all expenses. This
contributes to the living expenses of the women and also provides them with a significant
income. It is exciting to see the women grow in confidence as they realize that they have the
potential to support themselves in real business ventures.

The next step will be to assist the women to move out from living on site in our
accommodation and to live independently in the community. For some of them, this will be a
big step, since they have lived at Desta Mender for a few years. Giving the women confidence
to live normally in the community is our aim, it is a long road to full rehabilitation after the
injuries that they faced.

Ephrem Akilu

The other exciting development is that the women trained in catering skills will soon have a
new facility to demonstrate their expertise. A new building is almost complete, with funds
donated through Soroptomists International. We will have a small kitchen, an outdoor café and
toilets. This facility will be used together with the Meeting Room by the pond and we will
welcome visitors to use them for meetings or just enjoying the peaceful and beautiful
environment at Desta Mender. The women will use their new skills at baking pies and serving
meals to the customers that we hope to attract to the site. We give special thanks to Mrs. Ray
Newman from Australia, for her work in assisting us to develop skills and to set up the kitchen
and the “Juniper Café”. We hope to open in late Spring 2009.

We also give thanks to our Dutch partners who have shown continued interest in assisting us
to develop a curriculum for training women at Desta Mender. We are now moving closer to a
comprehensive curriculum that will include literacy linked to skills to equip the women to
manage their income generating activities.

Harar Outreach Centre

Harar Fistula Centre started receiving patients on the 1st of October 2008, and by the end of
the first quarter 38 patients had been treated by our team. Most patients had come from West
Harerge area. The patients were referred through doctors working in hospitals and private
clinics and also patients who had received treatment went back and talked about our new
centre. Habtam has had fistula for many years, she heard from a cured fistula patient about
our new centre, so she came along for treatment. Another patient got in touch with her cousin
and they both managed to get to the centre where they were able to receive treatment. Our
public health officer Ato Negash visited six Woredas to raise awareness of the fistula centre
and to investigate the number of patients around those areas. He went to Garmuleta,
Kurfachele, Bedeno, Girawa, Emegn and Goloda. These areas are mostly where the patients
admitted came from.

Dr Yifru with two sisters

The Health Professionals in these areas did not know about our Harar Hamlin Centre, some of
them did not even know about fistula. We have also developed a network with other NGO’s
which are assisting with transport costs of patients to our centre here. We will hold a workshop
with potential partners who are working on projects in the rural areas around Harar and West
Harerge, to inform them about Obstetric Fistula and the services that we offer. We want to
learn how our activities can be co-ordinated with the work of others.

Mekelle Outreach Centre.

Dr Melaku and Ato Solomon working in Mekelle, have presented their plan for reaching the
Tigray region to raise awareness about fistula and to search for patients to increase the case
load at our centre. This new plan calls for a male nurse to be hired and also an incentive
scheme to enlist the assistance of rural health workers in identifying patients to refer to our
facility.
 Bethel with patients

The final details of this plan are being prepared but we hope in the next 12 months to visit all
46 zones of the region and to evaluate the possible extent of obstetric fistula in the Tigray
region. We will then work on extending our contact with neighbouring regions in North East
Amhara and the Afar to the East. These are remote areas with harsh conditions and we will
need to decide the best means by which to reach communities in these areas.

Story of a Patient

Somia, (not her real name,) a patient admitted to our Harar Hamlin Fistula Centre, has suffered
with obstetric fistula for 50 years, since her first pregnancy. She knew about doctors able to
perform surgery in Addis Ababa but she could not afford to make the journey and had no-one
to support her.

Somia’s first pregnancy resulted in a stillborn child and soon afterwards her husband left her
and married someone else. No one wanted to be near her due to her offensive smell. She was
lucky to have a sister who cared for her even though she was not allowed to live in the same
house. A small shack was built for her which became “her place” for 50 years. Somia
explained, “After being in that room for so long, I can hardly believe that I am in this hospital
where I can see others who have been cured. They will be able to have children and live their
life again. I am still lucky for if I am cured I will give thanks to God and be able to pray.” Somia
told the staff, “Please try your best to cure me, it is not a matter of having children for I have
given up on that a long time ago but if you cure me I will be clean again. As an old woman I will
have the opportunity to thank my God and I will have respect and honour and be able to go to
the mosque”

The Hamlin’s have been in Ethiopia curing patients for 50 years this year, Somia has lived with
this problem for the same length of time. Building a centre in Harar has brought her long
overdue relief and there are sure to be many others around the country who need access to
treatment to restore their dignity.

Physiotherapy

Work has commenced on our new Physiotherapy and Patient Education Centre. We hope that
by mid 2009 it will be complete and will enhance significantly the work we are able to do. Sr
Azeb our head physiotherapist was able to attend training in the UK, organized by our good
friend Lesley Cochrane. We are looking forward to extending the care that we are able to offer
patients in our new facility.

In November we received a patient, Yetanite (not her real name), from the Amhara region, a
young woman about 20 years of age who had suffered with her injury for about 5 years. When
she arrived to us she weighed only 22 kg (less than 4 stones).

She had been lying curled up on a mat for many years, hidden, due to her shame. Her muscles
and tendons were badly contracted, she could not walk. Yetanite is now on our main ward since
she needs regular massage and attention. She has daily physiotherapy and is beginning to get
movement back in her legs. She is on a high nutrition diet to build her strength so it will be
some months before she is strong enough for an operation. Already she is looking much
stronger, her eyes are bright and she is happy because of the care and attention she receives.

Midwifery College

The Hamlin Midwifery College is almost half-way through its second year and the new intake of
students are a wonderful group of young women. They have been extremely enthusiastic and
forth-coming when discussing areas such as gender issues, harmful traditional practices and
the socio-economic factors in Ethiopia which contribute to a high maternal mortality rate. The
students have also studied anatomy, physiology and IT, key concepts in midwifery and basic
caring skills, such as patient care, keeping records, physical assessment, vital signs and
medication administration. The second year students have continued to practice their
midwifery skills at a nearby health centre one day a week during the academic semester and
are now on long clinical placements, studying neonatal, pediatrics and general medicine.

Beverley Stewart with Annette Bennett and a member of staff

Recently after assisting a local woman during her labour and delivery our students were
praised by the woman for being cared for so well. She told her family how God had blessed her
because she delivered her baby while they were on duty. She asked how she could contact
them in case she had any more questions about caring for her first child.

Story about a member of our staff.

Sister Tenadem is our head Theatre nurse responsible for all of the activities of the operating
theatre. She is also our most senior nurse, reporting to Sr. Ejigayehu, our Matron.
Tenadem Bekele, is married to Solomon and they have two boys, Yonatan aged 12 and
Dagmawi aged 9.

Sister Ejigayehu and Sister Tenadem

She came to work at our hospital in July 1989 and has worked as an important member of the
staff for almost 20 years, joining the theatre when Dr Reg. Hamlin led the surgical team. In that
time there has been a lot of change but Tenadem has been pleased to be a part of the work of
the Fistula Hospital. She explained, “This is a place where I found a role model in Dr Catherine
Hamlin. Through her I have learned how to serve the poor neglected mothers of this country. It
gives me great satisfaction to be a part of this organization, I know it is the right place for me.”
She has recently completed her studies in management and is now continuing to convert her
Nursing Diploma into a degree.

Serkalem from our kitchen serving meals on the main ward

The hospital provides a full range of care for the patients. The kitchen staff and laundry
workers are a critical part of the team, ensuring that the health and dignity of these women is
restored. Each person has a part to play to ensure that God’s love and compassion are
demonstrated in how we treat each precious woman.

Latest news of two of our UK Trustees

In mid January, one of our trustee’s, Beverley Stewart, left England for a six months sabbatical
to the Fistula Hospital, as we reported in our last Newsletter. The College is pleased to have in
their midst a midwife with her level of experience and management, so she will be a great
asset in helping to teach the students. We are in regular contact with her and she is working
well in her new environment.

Dr Catherine Hamlin with Beverley Stewart and Dr Brian Hancock from the UK Trust

Her first few weeks were spent helping Sr. Annette Bennett with administration before
beginning the new midwifery module with the students. The 1st year students have recently
been faced with a variety of exams and the 2nd year students have been on clinical
placement. Beverley reported on two patients who had delivered a few days earlier in a nearby
hospital. They are at the Fistula Hospital resting before going home. She said they were both
so happy to have delivered safely.

Dr Brian Hancock, has made one of his frequent trips to Ethiopia and has been at Yirga Alem
undertaking surgery with Dr Einar Lande, the local surgeon at that hospital. A Norwegian
urologist was visiting at the same time and the three doctors said how much they were able to
learn from each other. Dr Hancock said the Yirga Alem Centre is a very happy place and he
reported on the excellent qualities of Dr Lande. Dr Hancock spent two weeks at the Fistula
Hospital in Addis Ababa, performing many difficult operations and helping in a teaching
capacity. Also visiting was Dr Tom Rassen, a doctor recently retired from the Flying Doctor
Service and who now lives in Nairobi.
Dr Einar Lande at Yirga Alem with Dr Brian Hancock