By: Habiba Cooper Diallo
I recently travelled to Ethiopia where I spent one month between December and January. After nearly 48 hours in transit between Canada and Germany, my family and I arrived at Bole airport on December 14th.
Finally, the trip I had been long awaiting came to fruition.
I quickly fell in love with Addis Ababa, particularly the Azmari betochh (traditional music houses) that are all over the city. Ethiopia has a very old troubadour tradition similar to what can be found in many other parts of Africa like the Djelu/griots in Mali. An Azmari bet, many of which take the form of restaurants or cafes, is where traditional poets, bards, entertain audiences through their impromptu lyrics accompanied by enticing masenqo or krar rhythms. Azmaris sing about topics ranging from epic historical events to the mundane: love, family, society etc. Celebrated Ethiopian Azmaris include the late Asnaketch Worku.
A few days after arriving, I decided it was time to visit Addis Ababa Fistula Hospital—one of my main reasons for travelling to Ethiopia. We hopped into one of the blue taxicabs that was left from the Soviet era, and our driver, Ashabir, got us through the vibrant city centre to the hospital, which is about 20 minutes outside Addis.
Walking through the hospital gates was one of the most poignant moments of my life. Since that summer of 2008 when I learned about Anafghat, the study of and awareness around obstetric fistula has become such an integral part of my life. Walking through the gates, and eventually meeting with patients, I felt that my work on fistula was made personal.
On day one at the hospital, Andenet Gezahegn, the then public relations officer, gave us a tour of the various wards such as surgery, physiotherapy, and post-operative.
At fistula hospitals or clinics, it is necessary to have physiotherapy or rehabilitation services for the reason that many fistula patients live with the illness for years during which time they remain immobile, sedentary, in a very restricted position (ex. with their knees pressed against their chest) in an attempt to stop the flow of urine and feces which constantly leaks from their bodies. As a result, many patients develop stiff joints, and are barely able to walk on their feet. Some have to practise walking anew with a walker until their feet become accustomed again. Andenet told us that although 98% of fistula surgeries are successful, there are a few fistulas that are so severe, or that the affected woman has been living with for so long that her pelvis muscles become so weak, that surgery is sometimes unsuccessful. They will require a colostomy bag for life to collect the waste products dripping from their organs. In these cases, patients are offered a place to live at Desta Mender. Desta Mender, which means, Joy Village, is a community of fistula patients whose surgeries were unsuccessful. If they decide not to return home to their own families, they can live at the house with other women and access the resources they need for their condition.
We then returned to the main office where Feven, the Deputy CEO and Global Communications Manager, with the help of a baby doll and a model pelvis explained how fistula occurs from an obstructed labour. As the baby’s head pushes against the mother’s pelvis, it causes the bladder/rectum to rupture which results in an obstetric fistula for the mother. The baby is usually still born.
After our educational discussion with Feven, we prepared to leave.
The next morning when we returned to the hospital, we were treated by the reception staff to freshly baked ambasha bread. Ambasha is sweet and soft and makes the perfect addition to a warm cup of tea. This was the day that I would get to interview two of the patients.
I met with two lovely young women named Emewedat and Asris. Andenet translated between English and Amharic.
The following is an excerpt from the interviews I conducted with the patients. They are meant to provide a contextual understanding of fistula from the perspective of fistula patients themselves. It is critical to remember that those who suffer from fistula are living, sentient women themselves and as such we must make an effort to assess the condition through their humanity as opposed to solely their pathology.
Habiba: Hi what’s your name and age?
Asris: Asris. I’m 18 years old.
Habiba: What was the happiest moment in your life?
Asris: The Ethiopian Millennium in 2000.
Habiba: Please tell me a little bit about your life before the fistula hospital?
Asris: I am from Mender in Wellega, Oromia. I have two brothers and two sisters. I played volleyball in school and I loved sports. I also enjoyed studying, and was at the top of my class.
Habiba: Would you like to tell me about obstetric fistula and how you developed it?
Asris: I was experiencing a 4-day labor. There were no clinics nearby, nor doctors. After labor, I developed a fistula. I went to Aira clinic where I had my fistula stitched together. Though, after one month the stitches broke loose and my urine was unquelled. My boss from my part-time job realized my problem and eventually brought me here to the Addis Ababa Fistula Hospital.
Habiba: What are your future plans?
Asris: My goal is to be in good health and get a good education.
Habiba: Hi. What’s your name and age?
Emewedat: Emewedat. I’m 15 years old.
Habiba: When were you most happy in your life?
Emewedat: I was always happy before getting fistula.
Habiba: Could you please tell me something about your home?
Emewedat: I am from Dehana. I have an older brother. At home, I attended to the sheep and goats, in addition to going to school. There are many mountains in Dehana, the tallest of them is Terara Kulamba.
Habiba: Did your baby survive upon giving birth?
Emewedat: No. My baby died inside me.
Habiba: How did you arrive the Addis Ababa Fistula Hospital?
Emewedat: There was a health worker in my area who accompanied me to the Mekelle Fistula Hospital in Tigray Region, but when I got there they said my fistula would need to be treated in Addis, so I was sent here.
Habiba: How do you feel about yourself now?
Emewedat: I’m not happy because I’m not cured yet. When I’m cured I’ll be happy.
I was aware that for them to share their stories of fistula with me was very sensitive and private, and so I made an effort to not dwell so much on the pathology (fistula) itself. I wanted to get to know them through their humanity. I am 15-years-old—the same age as Emewedat, and 3 years younger than Asris—so evidently, I share some of the same dreams and aspirations they have as any young person would. Given that they were courageous and willing to share their stories with me, I asked them if they had any questions for me and let them know that if at any time they wanted to know anything about my life, that they should not hesitate to ask.
In spite of Ethiopia’s majestic beauty, obstetric fistula is a silent menace, a silent epidemic that denies too many women their humanity. Womanhood and mothering should be a time for joy and celebration, yet fistula patients are shamed for neither “fulfilling” their womanhood through labour or being able to mother a child. They fail at being a woman and a mother.
Habiba Cooper Diallo
I am a Canadian fistula advocate and blogger, and the founder of the Women’s Health Organization International, WHOI. I have been doing fistula awareness-building in Canada for the past 10 years. My work on fistula has led me to Ghana, Senegal, Guinea, Ethiopia, and Sierra Leone. I have been featured in Forbes, the HuffPost, and UNFPA