March 21, 2016

Since 2010, OHSU has had a global collaboration in Ethiopia in a program called Footsteps to Healing. Teams of OHSU School of Medicine faculty members and trainees have provided more than 200 pelvic organ prolapse surgeries, helping to improve the quality of life for women in rural Ethiopia. The following article summarizes their most recent trip, in January 2016.

The last surgical day of our two week medical mission this January was bitter sweet. We worked side by side with our Ethiopian colleagues to provide 42 pelvic floor reconstructive surgeries for women with severe pelvic organ prolapse and incontinence at Hamlin Fistula and Ayder hospitals.

These women had come from very remote parts of the Tigray and surrounding regions. Some had lived with this condition for decades and others were experiencing a severe degree of loss of pelvic support at a very young age. They were all resigned to a socially and physically constrained life without access to care. In a heartwarming collaboration between our Mekelle University, Hamlin Fistula Hospital and Tigray Women's Association partners, the women were given the hope of cure for the first time in their lives.

Pelvic organ prolapse is not a problem limited to the developing world, but the severity of risk factors such as multiple vaginal deliveries, obstructed labor due to lack of timely obstetric care, poor nutrition and a lifetime of heavy lifting results in severe symptoms at a young age. This is worsened by the lack of properly trained health care providers to give clinical and surgical care.

One of the most heartwarming yet bittersweet moments for our surgical team was the last day of surgery. We realized that there were still three women we couldn't fit into our already packed surgery schedule. One of these women has had stage IV prolapse (the most severe stage) for over 20 years and had come from a remote village. She broke down in tears when she realized we couldn't do her surgery. Soon she was surrounded by many more pleading voices from the other patients. These women had bonded while waiting for their surgeries and they had taken deep comfort in each other, in our team and the care and advocacy from the hospital staff and the leaders of the Tigray Women's Association who had transported, housed and cared for them. In the past, not being able to provide this surgery meant that patients had to return home with no hope for cure. But this time it was different.

Launching Ethiopia's first formal urogynecology program

Our team was providing not only surgical care, but also clinical and surgical training to three skilled gynecologists and fistula surgeons who are the first formal urogynecology trainees in the country. This is the result of collaboration between Mekelle University, Hamlin Fistula Ethiopia, St. Paul Millennium Medical College, Worldwide Fistula Fund and our OHSU Footsteps to Healing team. These fellows will continue to provide care to women with pelvic floor conditions while receiving ongoing mentorship. As we can now refer them to our fellows, no woman with prolapse will be returning home this year without receiving care.

Read more in this Footsteps to Healing newsletter.

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Improving women's quality of life in Ethiopia

 

Pictured top, the Ethiopia‐OHSU urogynecology fellowship team (left to right): Dr. Renate (fellowship director), Dr. Fekadu (Hamlin fellow and medical director), Dr. Edwards (urogynecologist and co‐director of OHSU Center for Women's Health), Dr. Kenne (OHSU fellow), Dr. Dawit (St Paul fellow), Dr. Melaku (Ayder/Hamlin fellow and fistula surgeon), Dr. Nardos (urogynecologist OHSU/Kaiser, Founder of Footsteps to Healing, board member for Worldwide Fistula Fund)

Pictured below: Ethiopian women often clapped and danced after surgery to express their gratitude

Photo credit: Joni Kabana, Kabana Photography, LLC