A Walk to Beautiful

A Walk to Beautiful

PBS Airdate: May 13, 2008

AYEHU'S MOTHER: I, her mother, made her live out back.

AYEHU (Fistula Patient): I was very upset at having to deal with people's disgust and disdain for me, so I decided to go and make a shelter and wait for certain death.

AYEHU'S MOTHER: If she were not sick, I would not have her separate from me.

AYEHU: The labor lasted for a week. The baby died in my womb. After the doctor took it out, I felt something leaking.

I was living with my husband when I got this problem. He told me to leave, and he married someone else. So I took my daughter and came to live here in this condition.

AYEHU'S MOTHER: It's very difficult to let her stay in the house, because people come to visit.

AYEHU: I have no married life. I don't have a job, I don't mix with people. I live here hidden away from others. This is not life. Death would be better than this.

FIKRE: (Former Fistula Patient): The baby had died in my womb. The doctor took out the body piece by piece.

I started sleeping on the ground, because I was wetting my bed. For 10 years I lived like this.

Good morning. How are you?

AYEHU: I am fine.

FIKRE: Are you feeling better?

AYEHU: I'm okay.

FIKRE: I remember when everybody used to shun me, especially on the bus, where people covered their noses because of the stench. I would get so hurt and ashamed. After the surgery, I have become a normal person, wearing new clothes and mixing with friends.

AYEHU: You were opened up?

FIKRE: Yes.

AYEHU: You didn't feel anything?

FIKRE: They know what they're doing.

AYEHU: How can they bring you back to life?

FIKRE: They know how. Will you go to the hospital now, in Addis Ababa?

AYEHU'S MOTHER: Here, have this.

AYEHU: What are you untying? Why do I need this?

AYEHU'S MOTHER: Keep the money safe in your dress. Don't cry.

AYEHU: I am not going to cry.

AYEHU'S MOTHER: May God bring you home safely. Focus your heart. Don't cry. Just go.

AYEHU: I thought about drinking poison. But my family told me not to, because my soul would burn in hell. They said this to scare me. If I die that way my soul will not rest.

DR. CATHERINE HAMLIN (Co-Founder, Addis Ababa Fistula Hospital): These women are not welcome in a general hospital. They can't often get in because of the tremendous pressure on the hospitals for other more urgent things. Also they are not welcome because they're smelling, and they are poor, and they are often turned away by the guard at the gate. This is really why we built the hospital.

GETU: Come over here. Where do you come from?

AYEHU: Gojam.

GETU: What happened to you?

AYEHU: I'm sick.

GETU: Have a seat here.

RUTH KENNEDY (Hospital Liaison Officer): This is a foreign child. Say "hi" to him. Say "hi" to him.

This is like your bone. And the baby comes out like this. But in your case it was not coming out. And then it died.

CATHERINE HAMLIN: Some help is needed when the baby can't be born in the usual 12 hours that takes to have a baby. Usually it is due to a small pelvis or a mal-position of the baby inside the mother's uterus. It occurs all of over the world. In five percent of all labors help is needed.

DR. WORKINEH GETANEH (Resident): What happened to you?

AYEHU: I leak.

WORKINEH GETANEH: Are you incontinent of feces?

AYEHU: No.

WORKINEH GETANEH: You leak only urine? Does it leak constantly?

AYEHU: (Nods)

WORKINEH GETANEH: When did it start?

AYEHU: Some six years ago.

WORKINEH GETANEH: How long were you in labor?

AYEHU: For a week.

WORKINEH GETANEH: For a week?

AYEHU: (Nods)

WORKINEH GETANEH: Was the child alive?

AYEHU: No, it was not.

WORKINEH GETANEH: Did you have a pelvic delivery or a Cesarean section?

AYEHU: They pulled it out.

WORKINEH GETANEH: Now I need to perform a pelvic examination.

CATHERINE HAMLIN: She starts labor and she expects to be perhaps delivered by the evening, if it's the morning, early morning, but the day goes by and she hasn't had the baby.

NURSE: Ayehu, we just need to see where the leak is coming from.

CATHERINE HAMLIN: The village women encourage her. The second day goes by and even the third and fourth. Up to 10 days I have had a woman in labor. By that time, the little girl is exhausted, dehydrated, and she finally pushes out a dead baby. But she wakes up to a worse horror.

WORKINEH GETANEH: Ayehu, there is a hole between your birth passage and bladder. Okay?

AYEHU: (Nods)

WORKINEH GETANEH: Like through ripped cloth, that is where the urine flows. It will be sewn up.

So the size of the fistula is two by three centimeters. Now you will be given a bed.

CATHERINE HAMLIN: Every time a uterus contracts it pushes the baby's head against the bone of the pelvis. The blood supply of that area is cut off. So that lump of tissue that's being squashed will die and it just drops out. So this means that she's lost some of her bladder or some of her rectal wall.

DR. AMBAYE WOLDEMICHAEL (Fistula Surgeon): The fistula patients, it's not only physical trauma that they are suffering of. It's social and then the psychological. In the countryside, being a woman is being able to be a wife, bear a child, too, and have a family. But when they fail to do that, they consider themselves that they are not like any woman.

CATHERINE HAMLIN: The husband, he said "You go back to your family." And he'll just send her off with a bundle on her back. They run out to welcome her, thinking that she coming home with a baby, and they find her in this state. Her life is ruined. So they will build her a little hut outside, and there she will stay 'til death, unless she hears that she can be cured.

AYEHU: It was a makeshift home, made from sticks and straw against the house. It was just to protect me from being eaten by hyenas. My brothers and sisters, they even hated me for staying there.

There on the floor, I would lay out the wood and sleep. I spent the night sitting.

I am very surprised. I never expected there to be a lot of people like this. Everybody is sick. I thought it was only me.

CATHERINE HAMLIN: Most peasant women in the developing world have to do all the hard work. They have to do the cooking, the grinding of the corn, the collecting of the water from the well, carrying sticks from the forest. So, all her energy has gone into work instead of into growth. She hasn't had enough nourishment.

RUTH KENNEDY: If we take someone like this little girl, what has happened is at the age of two she started carrying a jar of water. By the age of eight, she's carrying something that I can't lift. But all those years she's been eating a good diet, but not enough calories. What happens is she grows short. Now if I stand, you'll just see how short she is, and I'm an average height, I'm five-foot-three.

AMBAYE WOLDEMICHAEL: A girl, especially a girl in the countryside, they are too small for their age. So if she gets pregnant at the age of 14, definitely, the baby would be too big for her, for this to pass through during delivery. So she will end up in obstructed labor.

WUBETE (Fistula Patient): It was so painful, I passed out. On the fifth day, I got to the hospital and delivered. They said it was a stillbirth, but I didn't see it. I was told to vacate the bed because they had more patients than beds. I got up to change my clothes, and I wet myself. I went home, but I didn't get better.

Six months after delivery, I came here. From my home to the bus, it was a six hour walk. Once I got on, I wore trousers and used cloth as padding. The bus got hot and the cloth started to smell. I felt so terrible but I had to make my way here somehow.

It's beautiful here, everything from the clothes to the beds. I've started making friends. People aren't revolted by me here.

AMBAYE WOLDEMICHAEL: They usually think that they are the only person in the world who leaks urine. So being at Fistula Hospital is a part of psychotherapy. They discuss their problem with other women. They start to understand that there are other women with the same kind of problem.

CATHERINE HAMLIN: So this is very important to nurse them together. And they have a social life together. We see them talking, and they feel at home. They feel they are not being ostracized from their society. And they're loved, and they feel welcome. So this is where the healing process starts, of the mind, and this is very important.

AYEHU: Half of me is afraid; the other half, I don't know. Fikre told me a lot. She told me not to be afraid and said, "You won't be left sick while I am cured."

ANESTHESIOLOGIST: You will feel some cold.

DR. ABEBAW: You will be injected now.

ANESTHESIOLOGIST: You are brave.

NURSE: Enough, enough. Hold her. Hold the bed firm.

ANESTHESIOLOGIST: Relax your legs. Are you okay? You are brave.

CATHERINE HAMLIN: We've got this girl with her whole life ahead, and if she is not cured it is going to be a misery and a horror to her forever.

AMBAYE WOLDEMICHAEL: The fistula is not very big, well-mobilized now, and I am going to close it.

CATHERINE HAMLIN: This is the fascination of fistula surgery. To make a new life for a young girl that suffered more than any women should be called on to endure.

AMBAYE WOLDEMICHAEL: We just finished closing the fistula now, and then we are going to do a dye test to make sure that the suture line is watertight. So we put the dye, if there's any hole, the dye comes through the hole. Now there is nothing coming through the wall. This means that the hole is closed completely.

CATHERINE HAMLIN: We leave her with a catheter draining for 12 or 14 days. And we hope that she is going to be able to pass urine normally.

EJIGAYEHU WOLDE (Head Nurse): Choose.

The new clothes, it's a symbol for us. They're cured. They are going to start a new life.

WUBETE: Because they are going home, they are being given clothes. It's lovely. I feel happy that it'll be me soon. I hope to get better like them.

I stayed here for a month and got treatment, but the leaking didn't stop, so I went back home. I came back and got treated again, but there was still no change. They gave me a third appointment, and now I have come back for that. When others say they are cured after their second or third visits, I begin to think I will be too.

DR. BIRUCK TAFESSE (Gynecologist): Wubete?

WUBETE: Yes.

BIRUCK TAFESSE: You are Wubete, yes? A fistula? She was operated on but now has stress incontinence, urodynamics. We'll take her today.

The fistula, that is the hole in the bladder, is closed. And now the bladder function is not restored. So we're going to do certain examinations, run certain tests and see where the problem actually is.

This is a urodynamic examination. This is a machine which measures the interabdominal pressure, and it also measures, at the same time, the pressure inside the bladder. And then the machine will give us the bladder capacity, how much the bladder can hold.

The problem is when you were in labor your bladder was ruined. Most of it was destroyed.

According to the results, she has reduced bladder capacity. It is reduced by half as compared to a normal person. But the good thing is that there is some regeneration capacity of the bladder that we hope, with time, her bladder capacity will increase to some extent.

Now, while you are here you will stay with us for a little bit. There are some exercises that we will need to do. Sister Azeb will show you, okay?

WUBETE: I don't want to go back to my village.

BIRUCK TAFESSE: Wubete, dear.

WUBETE: Yes?

BIRUCK TAFESSE: Wait outside now, okay?

WUBETE: I didn't want to get married. They would find a husband, throw a party and send me away. I ran away many times. I refused to go back, but my father kept beating me. I was about 10 or 11 years old. I kept running away until I finally stayed with the fourth one because I got pregnant. I told my father, "You beat me and kept sending me back and look what has become of me." If my mother were alive, she wouldn't have let this happen. I won't go home without being cured because no one will accept me. My other choice is to kill myself.

ALMAZ (Fistula Patient): I was married at 15. My husband abducted me while I was going to a market. There were many of them. I was overwhelmed. They separated me from the other girls and took me. He kept me somewhere for 14 days and then brought me to his home. After that, I gave birth to a baby in less than a year. That's all I had, and it died. For three years, the injury of my body affected my life badly. I could not work or be productive. My life fell apart.

If I get cured and go back home, I would like to dress up like my friends, walk like my friends, live a normal life like my friends.

DR. HAILE AYTENFISHU (Fistula Surgeon): Almaz, she was found to have a double fistula. Double fistula means a hole communicating between the rectum and the vagina and bladder and vagina.

You don't have to be a woman to understand a woman's problem. If someone's incontinent and cannot control her feces and urine, it's simple to predict what is going to happen to her in the community and the family. So to relieve such a problem is a very, very...I mean, good, good job.

ANESTHESIOLOGIST: Relax, you are fine.

HAILE AYTENFISHU: I've repaired the bladder, and now I'm doing the rectal fistula repair.

NURSE: Done, okay?

ALMAZ: May God bless you all.

CATHERINE HAMLIN: We are able to close the fistula in about 93 percent of cases. We are able to operate on 30 women a week, and so we hope this year that we'll be able to do 1,500 operations. But we estimate that there are over a hundred thousand waiting, in the countryside, in Ethiopia.

My husband and I came to Ethiopia in 1959. The previous gynecologist that we replaced said to my husband, "The fistula patients will break your hearts." And that's really what they did.

We didn't plan to stay, but as we began to cure them, of course, more and more came to us, so we stayed on. I have been here ever since. My husband would still be here if he was alive.

AZEB (Nurse): Dr. Biruk saw you yesterday, and what did he say to you?

WUBETE: He said I might get better and to come see you for a follow-up.

AZEB: Being in labor for five days strained your muscles.

WUBETE: Yes.

AZEB: Now, I will show you the exercise that will help change your life. Do you remember learning this exercise the last time you were treated?

Wubete, we're all here to help you.

WUBETE: I did what I was told for the last six months, and there was no change. They told me to do the same type of squeezing exercises. I didn't see any changes.

AZEB: Your bladder is very small. It needs time. You're very young. You are only 17, so give it time. Wubete, do you understand?

WUBETE: Fine, but I don't have a mother and no one to look after me. Back home, the work is very hard. I have no one, nothing. They were repulsed by me while I was there.

AZEB: It takes time, and you must not give up. You can't think of all these things now. Please don't cry, Wubete. Don't be so heartbroken. Have faith, tomorrow is another day. There will be change. Okay, my dear?

AMBAYE WOLDEMICHAEL: Fistula, it's a hidden epidemic; it's a silent epidemic. Nobody talks about it, because it's a problem of the poor woman; it's a problem of woman. But it's 100 percent preventable. Lack of good obstetric service, this is the main cause of fistula.

CATHERINE HAMLIN: For a population of 77 million people now in Ethiopia, we've only got 146 gynecologists and obstetricians. And most of these are in the cities, so the countrywomen are just completely neglected. This is a tragedy.

AMBAYE WOLDEMICHAEL: Ayehu, the catheter will be removed, and if the bed is dry, then you will be able to leave.

EJIGAYEHU WOLDING: Okay, my dear, good morning. Did you sleep well?

If there is not any leakage on the bed, that means they are dry. Up to now she is dry, and we hope that she will be okay.

AYEHU: I never thought I would ever get cured. I just assumed I would die.

It's great, it's wonderful. All is well now.

AYEHU'S MOTHER: Welcome back home. This is wonderful. Mimi, your mother is here. Come and kiss her.

AYEHU: Come in.

Back when I was still beautiful, I was married off. I was eight or nine, I think, very young. For my daughter I want her to choose, to grow up and decide for herself. I do not plan on getting her married anytime soon, just school.

I built all of this out of necessity. I am not going back there. We'll tear it down. I won't be living there anymore.

HAILE AYTENFISHU: How are you? Almaz are you okay? Is the bed dry? It looks fine.

ALMAZ: Okay.

HAILE AYTENFISHU: You will be fine and cured. They are helping you, right?

ALMAZ: Yes.

HAILE AYTENFISHU: She is on the eighth post-operative day, and until now, she is okay. So she will be here for another week. So after that we will check whether the bladder is healed or not and the rectum is healed or not. If it is okay she will go home.

There is no problem. We will give you money for transportation. All of you who come here, you, her and her, will all go home.

PATIENT: May the Lord give you long life.

HAILE AYTENFISHU: You are going to get better. That's for sure.

ALMAZ: A blessed man.

AZEB: We are trying a new thing today. It goes into your bladder and act as a plug. When you go to the bathroom you'll need to open it. You'll do it yourself.

WUBETE: Yes.

DR. ANDREW BROWNING (Fistula Surgeon): And then, when she feels her bladder full, she will pull this out and then...and then the urine comes away.

AZEB: When you go to the bathroom, you pull this out.

WUBETE: This part right here?

AZEB: This part inserts it. After that you can pull it out.

WUBETE: That piece?

AZEB: Yes, the rest stays inside. For some women it works, for some it doesn't. Are you willing to let us try it with you?

WUBETE: Sure.

ANDREW BROWNING: Usually, it's very difficult for these girls to learn how to put these plugs into their urethra. It's a very small spot to try and aim for, but she got it at first go. First time I've ever seen anyone get it at the first go. So I'm sure she'll be able to manage it very well.

WUBETE: I don't want to go back home. Is there is any possibility of work here?

EJIGAYEHU WOLDE: We will discuss all that with the doctors, okay?

WUBETE: Okay.

I am not going back home. I have no one there, so I'm not going back. I guess I will have to find a place to live, then look for work as a nanny. If that doesn't work I'll need to keep searching or begging, even.

HAILE AYTENFISHU: How are you now?

ALMAZ: I am cured.

HAILE AYTENFISHU: You're so brave. Are you happy?

ALMAZ: Yes.

HAILE AYTENFISHU: She is happy. I can't explain it. I have no words. I mean, I am happy, very much happy. I mean, to make a lady who has been incontinent for both urine and feces, to make her continent, I mean her happiness is the prize that I am getting now. Okay.

CATHERINE HAMLIN: As soon as they are cured, we talk to them about their future. We tell each patient they must get to the hospital for the next baby. We give every patient a card with a description of the operation, with all the findings. So we say, "When you feel the baby walking in your stomach, you start walking towards the hospital."

ALMAZ: Oh, in the name of Jesus, what does the house look like?

Why didn't he clean the house and sprinkle water on the dust?

WOMAN: He was lost and didn't know what to do.

MAN: Should we go find your husband?

ALMAZ: Yes. Let's go now.

The house was such a mess. In the name of the Lord, what is wrong with you?

My father has come. Come here. Father how are you? How have you been? I have come home cured. Share my joy.

ALMAZ'S FATHER: Are you completely cured?

ALMAZ: Yes, definitely.

WUBETE: At the hospital I was upset that I had nowhere to go. Then Sister Ruth told me I could come here. She told me that a friend of her works with children and that I could come here. I said, "Of course I will go." I stayed there for a while and then came here. Now I am very happy here. I am just remembering the situation.

There is a big difference with the plug. I have to go to the bathroom a lot, but it's fine.

KARIN VAN DEN BOSCH (Founder of Grace Village): The children are orphans because their parent died of H.I.V. We've given Wubete four children to take responsibility for, and we told the children, "This is going to be your Mom."

Already, in the little ones, you can see that they love her, so the bonding is starting.

WUBETE: I love them. Iyassu, he pouts!

KARIN VAN DEN BOSCH: I think just to have some future to look forward to has made her grown up, and now she has work to do. And she is learning. It makes people grow, giving them responsibility. It helps them enormously.

WUBETE: I grew up too fast and then was made small and helpless. And now I have become an adult again.