Giving hope to rural women with obstetric fistula in Ethiopia.

News Q: What is an obstetric fistula? A: This is a condition which occurs when a woman is in labour for four or five days. The bony head of the baby presses on the pelvis for so long that a hole develops between the vagina and the bladder or between the vagina and the rectum, resulting in urinary or faecal incontinence. It's possible to prevent this injury by delivering the baby by caesar-ean section. But in Ethiopia there are not enough doctors in the countryside able to do this operation. Women with this condition are completely ostracized from society, their husbands leave them, they have no friends, because of the smell of urine or faecal matter that leaks. Women who live with this for months, even years, often have suicidal thoughts. Repairing this childbirth injury gives them new hope and new life. Q: When you first arrived in Ethiopia, you had never seen a case of obstetric fistula in your life. How did you learn to perform surgery that had become obsolete in the developed world? A: There were things written about obstetric fistulas. We knew several doctors who had been repairing them. We had a great friend in England who used to go to India to operate and we got in touch with him. We also had manuals, drawings of the actual operation from a wonderful Cairo-based professor Pasha Naguib Marfouz, he was a great help to us. We used to talk to him, we didn't get to meet him, but we learned from his textbooks. We are gynaecologists, so we are used to operating for other things, such as stress incontinence, so we were quite familiar with the anatomy, and we soon learnt. We started with small fistulas which any gynaecologist can fix without much training, and gradually tackled more difficult ones. Q: What was it like to be a fistula surgeon in Ethiopia in the 1960s? What were the challenges in finding qualified staff and adequate medical supplies? A: We were in a hospital that was very similar to the ones in Australia. We did not find it primitive in any way. The Princess Tsehai Memorial hospital had good doctors. These doctors were trained at the American University in Beirut, and we didn't have medical training at the university in Addis Ababa until 1966. We had a good nursing school with tutors from overseas, so we were …