Ending Obstetric Fistula through Education in Ethiopia

3 Million Women

5 children/woman

1 physician/10,000 people

1 OB/GYN / 350,000 people

1,000 Midwives for

90 million people

85% Live in Rural Areas

95% Give Birth Unattended

Maternal Mortality Rate:

1 in 40

HOPE!

Addis Ababa Fistula Hospital

1,200 Women Treated

92% Success Rate

Associates Degree

Locations:

• At-risk communities
• Far from Hospitals and Urban Centers

Women:

• Prominent, trusted
• Most educated

Training:

• Management of normal delivery
• Timely detection and referral of women with obstetric complications

Practice:

Women recruited from surrounding areas

• SOURCES:
• "UN Millennium Project | Goals, Targets & Indicators." UN Millennium Project. United Nations, n.d. Web. 12 July 2013.
• Fistula. (n.d.) Gale Encyclopedia of Medicine. (2008). Retrieved July 10 2013 from http://medical-dictionary.thefreedictionary.com/fistula
• Obstetric fistula. (n.d.) Farlex Partner Medical Dictionary. (2012). Retrieved July 10 2013 from http://medical-dictionary.thefreedictionary.com/Obstetric+fistula
• Source: “Types of Obstetric Fistula." Operation Obstetric Fistula RSS. N.p., n.d. Web. 20 July 2013.
• Hancock, Brian, MD FRCS. "An Introduction to Obstetric Fistula." Lecture. The Global Library of Women's Medicine. Web. 25 June 2013.
• "National Borama Fistula Hospital Foundation | Facebook." Facebook. N.p., n.d. Web. 23 July 2013.
• "Alexia Foundation : Melanie Blanding." Alexia Foundation : Melanie Blanding. N.p., 2003. Web. 23 July 2013.
• Hancock, Brian, MD FRCS, and Andrew Bowning, MBBS MRCOG. "Practical Obstetric Fistula Surgery." The Royal Society of Medicine Press Limited (2009). The Global Library of Women's Medicine. Web. 25 June 2013.
• Hancock, Brian, MD FRCS. First Steps in Vesico-Vaginal Fistula Repair. The Royal Society of Medicine Press Limited (2005). The Global Library of Women's Medicine. Web. 25 June 2013.
• "The Controversial Founder of Women’s Hospital." Ephemeral New York. N.p., n.d. Web. 23 July 2013. Cron, Julia, MD. "Lessons From the Developing World: Obstructed Labor and the Vesico-Vaginal Fistula." Medscape News. Medscape General Medicine, 2003. Web. 12 July 2013.
• "WCI Addresses Obstetric Fistula in Ethiopia." Women's International Campaign. WCI, 13 Apr. 2009. Web. 28 July 2013.
• Hamlin, Catherine, and John Little. The Hospital by the River: A Story of Hope. Oxford, UK: Monarch, 2001. Print.
• "Addis Ababa Fistula Hospital." Ethiopia Adoption. N.p., n.d. Web. 23 July 2013.
• Addis Ababa Fistula Hospital. Digital image. Wikimedia Commons. Flickr 159817756.jpg, 25 Mar. 2005. Web. 28 July 2013.
• "AU and EU Commissioners Visit Addis Ababa Fistula Hospital « Ethiopian News." Ethiopian Review. N.p., 6 Apr. 2009wor. Web. 28 July 2013.
• Inbaraj, Sonny. "Married as Children, Women With Obstetric Fistulas Have No Future." Population Reference Bureau. N.p., Mar. 2004. Web. 12 July 2013.
• Ogundipe, Sola. “Nigeria: Child Marriage- We Must Stop Getting Our Young Girls Pregnant.” allAfrica. Vanguard. 26 July 2013. Web. 28 July 2013.
• Hancock, Brian, MD FRCS. "An Introduction to Obstetric Fistula." Lecture. The Global Library of Women's Medicine. Web. 25 June 2013.
• Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. Lancet 2006; 368: 1201-1209.
• "Substantial Geographic Disparities in Maternal Mortality." Childinfo.org: Statistics by Area - Maternal Mortality - Overview. UNICEF, 2010. Web. 23 July 2013.
• "Global Distribution of Physicians per 10,000 Population." ChartsBin. N.p., 2010. Web. 23 July 2013.
• Samba, Ali, and Joseph Rumingo. Obstetric Fistula: A Needs Assessment in Ghana and Rwanda. Rep. Ed. Charlotte Bacon. Comp. Deogratias Mboninyibuka, Moses Mukasa, Alphonse Munyakazi, and Mary Nell Wegner. EngenderHealth, n.d. Web. 12 July 2013.
• "Ethiopia." The World Factbook. The Central Intelligence Agency, n.d. Web. 12 July 2013.
• Biadgilign, Sibhatu, Kebede Deribe, Ayalu A. Reda, and Yihunie Lakew. "A Population Based Survey in Ethiopia Using Questionnaire as Proxy to Estimate Obstetric Fistula Prevalence: Results from Demographic and Health Survey." Reproductive Health. Reproductive Health Journal, n.d. Web. 12 July 2013.
• "Help Give a Woman a New Life." The Fistula Foundation. N.p., n.d. Web. 12 July 2013.
• Programmatic and Policy Recommendations for Addressing Obstetric Fistula and Uterine Prolapse. Perf. Kate Grant, Gillian Slingler, Dr. Luc De Bernis, Dr. Lauri Romanzi, Celia Pett. Woodrow Wilson Center: Global Health Initiative. Environment Change and Security Program and Global Sustainability and Resilience Program, n.d. Web. 26 June 2013.
• Miller, Suellen, Felicia Lester, Monique Webster, and Beth Cowan. "Obstetric Fistula: A Preventable Tragedy." Medscape News Today. Journal of Midwifery: Women’s Health, 2005. Web. 23 July 2013.
• "PINCC." Prevention International: No Cervical Cancer. N.p., n.d. Web. 26 June 2013. <http://www.pincc.org/>.
• "Midwifery School ~ Hamlin College of Midwives." Addis Ababa Fistula Hospital. N.p., n.d. Web. 12 July 2013.
• Biadgilign, Sibhatu, Kebede Deribe, Ayalu A. Reda, and Yihunie Lakew. "A Population Based Survey in Ethiopia Using Questionnaire as Proxy to Estimate Obstetric Fistula Prevalence: Results from Demographic and Health Survey." Reproductive Health. Reproductive Health Journal, n.d. Web. 12 July 2013.
• "Rugged Trauma-Medical Bag." Everything Birth | From Midwifery to Birth Supplies. Everything Birth, Inc., 2013. Web. 28 July 2013.
• Agarwal, Koki. “Why We Need Men to Save Lives.” Global Health. Issue 09. Winter 2011. Global Health Council. Print. pp. 22-23.
• "Ethiopia." The Fistula Foundation. N.p., n.d. Web. 12 July 2013.
• Stanton, Mary Ellen. "Interview." Personal interview. 24 June 2013.
• Campaign to End Fistula. UNFPA, n.d. Web. 26 June 2013.
• Midwives for Haiti. N.p., n.d. Web. 26 June 2013. < http://www.midwivesforhaiti.org/>.
• "Huru." Huru International. N.p., n.d. Web. 26 June 2013. <http://www.huruinternational.org/>.
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Ending Obstetric Fistula in Ethiopia Through Education

By: Shannon Theobald

SeraphimGLOBAL Fellow

Fistula ~ An Abnormal Hole

International and Celebrity Attention

Reproductive

System

Digestive System

Circulatory System

Urinary System

Lymphatic System

Types of Reproductive Fistula

Obstetric

Types:

Traumatic

Historical Timeline of Obstetric Fistula

1975

1163

1849

2050 BC

Dr. Sims (“Father of American Gynecology”) published “The Treatment of Vesico-Vaginal Fistula"

First book of operative gynecology by Roonhuyse

Hamlins opened the Addis Ababa Fistula Hospital in Ethiopia in connection to the Hamlin College of Midwives

Evidence of Obstructed Labor in Egyptian Queen

Current Data/Situation

1855

1838

11th Century AD

Avicenna noticed and recorded the connection between obstructed labor and VVF

TODAY

Dr. Mettauer confirmed relationship between obstructed labor and VVF and closed an obstetric fistula

Ethiopia

Dr. Sims opened the first fistula hospital in New York

Additional Educational Needs

Surgical Solutions

Causes of

Obstetric Fistula:

Effects of Obstetric Fistula

Women's Health Education

Educational Models for Disease Prevention and Safe Motherhood

Girl's Education

Education of Men

Hamlin College of Midwives' Mobile Training Program

Hamlin College of Midwives' Satellite Campuses

Satellite Campus Locations

48 Week Abbreviated Course

Prevalence of Obstetric Fistula

Prevalence of Untreated Obstetric Fistula

Prevalence of Obstetric Fistula in Household

Community

Education

Graduation:

• Revisit every 6 months
• Medical bag

Last 24 Weeks

First 12 Weeks

Second 12 Weeks

• Anatomy and Physiology
• Infection Prevention
• General Medicine Skills
• Medical Administration
• IT Skills

Practical and Experiential Training in Out-Patient Clinics for Pre-natal, Partum, and Post-natal Care.

• Theory & Practice of Labor & Delivery
• Ante- and Post-Natal Care
• Family Planning
• HIV/AIDS Prevention
• Pediatrics

Tigray

Southern Oromia near Somali

Southern Nations, Nationalities, and Peoples.

Psychological

Physical

Social

Economic

Cultural

Program Resources

Educational Materials

Training Tools

Referral

Systems

Radio

Communication

Transportation services

Program Success!