Obstetric fistula is a debilitating condition in which women injured in childbirth uncontrollably leak a trail of urine or feces. While a delivery by caesarian section prevents obstetric fistula, in sub-Saharan Africa such medical procedures and prenatal care rarely exist. As many as three million women, many in Ethiopia, suffer the devastating effects of this injury, while being shunned by the patriarchal society of their clans and villages. The Bahar Dar Fistula Hospital is one of the few refuges for these suffering women.
Netsanet Feleke, 15, stands in a mud house in her village in Bure, Ethiopia. She has been leaking urine, and with no medical care available nearby, she must travel a few hours to the Bahar Dar Hamlin Fistula Center, in Bahar Dar, Ethiopia.
Poor women living in the patriarchal society of Ethiopia have very little control over their lives. Village elders demand that Netsanet Feleke leave her home near Bure, Ethiopia, and go to the fistula center.
Fistula sufferers are often shunned by their families and neighbors, who abhor the stench and filth of their condition. Under the watchful eyes of their neighbors in their village in Bure, Ethiopia, Netsanet (second from right), 15, and Ferehiwot (right), 20, prepare to leave for treatment at the fistula center.
Ahai, a fragile young woman of about 22, weeps, her heart heavy from the suffering she has endured since the death of her baby and trauma of living with a fistula.
The hallmark symptom of vaginal fistula is the persistent drip of urine that a woman is powerless to control, a trail of tears that affects thousands of the poorest women in Ethiopia.
Bireeh is carried into the Bahar Dar Hamlin Fistula Center in Bahar Dar, Ethiopia by her brothers after an obstructed birth left her with a dead child and a fistula that left her weak, incontinent and in constant pain.
The hallway at the Bahar Dar Hamlin Fistula Hospital is marked with urine footprints of one of the many suffering women who pass through its doors every day.
Young women from northern Ethiopia pass their recovery time by lounging outside the center and getting to know each other. They sit over drains to catch the urine they leak.
A patient walks through the 30-bed ward of the center.
Ahai, 22, cries on a gurney after having an examination of her injuries. Her fistula is so severe that she constantly leaks a stream of urine despite the catheter that tethers her to a plastic bucket. She has no intention of going back to her village.
With the help of a patient, left, nurse's aides, right, mop up after Bireeh at the fistula center. The women are former fistula patients themselves. They work as nurse's aides preparing patients for intimate surgery and cheerfully mopping up the unending puddles and trails of urine. Most are illiterate, but uniquely able to communicate with their fragile and frightened patients.
Fistula patients find a sisterhood at the Bahar Dar Hamlin Fistula Center and look after each other. Hirut aids nine year old patient Alem who cries out for a drink of water.
Fistula patients have enemas in preparation for their surgeries.
Nurses and Dr. Andrew Browning hold down Alem while she bravely gets a spinal block before her surgery. She is a beautiful and babbly 7-year-old who was raped by a family friend on her way to school.
A fistula patient goes through the 30-minute surgery under local anesthesia in the simple but clean operating theatre.
Dr. Andrew Browning talks to 7-year old rape victim Alem about her surgery. The damage was so severe that doctors had to repair anal and vaginal fistulas, fix her bladder and reconstruct soft tissue in the cervix. Dr. Browning says the child will probably not be incontinent but he cannot promise her a baby of her own.
Nurse aides, Etanate Andarge, Belaynshe Mengeste and Anguache Adbaru fold gauze for surgeries with the help of 7-year-old patient Alem. The women are former fistula patients themselves. They work as nurse's aides preparing patients for intimate surgery and cheerfully mopping up the unending puddles and trails of urine. Most are illiterate, but uniquely able to communicate with their fragile and frightened patients.
Young women nervously wait for pelvic exams to determine the success of their fistula surgeries.
Cured fistula patients happily "graduate" from the hospital. Women are presented with bus fare home and given new dresses because their old clothes reek of urine.
Women who make it to the fistula center are the lucky ones. No women suffering from fistula is ever turned away.