Everywhere you turn is green. The air is pure. The mountains are majestic. The land is generous. Welcome to Jimma, 350 km South-West from Addis Ababa, Ethiopia. Now a dormant city, Jimma was once the capital of the ancient kingdom of Kaffa – the land of coffee and honey.
Last week, I followed Dr. Ambaye Wolde Michael, one of the most experienced fistula surgeons in the world, to WAHA International’s Fistula Unit within the University Teaching Hospital of Jimma.
The University Teaching Hospital of Jimma, the only Teaching and Referral Hospital in all of south-western Ethiopia, is one of the oldest public hospitals in the country. Spreading over several kilometres within Jimma, the institution is unarguably the heart of the city. The hospital was established 77 years ago by Italian conquerors. Ever since their withdrawal, it has been running as a public hospital. WAHA International established a 16-bed fistula unit within the gynecology wing of the Hospital in 2010.
Gynecology Wing at the University Teaching Hospital in Jimma
As soon as we land in Jimma, we head straight to the Fistula Unit. Dr. Ambaye is very eager to see her patients.
“I have a gift and I can use it to change the lives of these women. Women with fistula are the most fragile segment of the society. A fistula victim is a poor, illiterate woman. She got married and started having children at a tender age. She does back-breaking work at home and in the fields. All the decisions are made by her husband and the other male figures in her life. In most cases, she contracts obstetric fistula because she is forced to give birth at home or because she cannot access a health facility on time. If she has a prolonged labor and contracts a fistula, her life takes a sudden downturn. She starts leaking urine, is rejected by her family, divorced by her husband, marginalized by her community. I cannot begin to describe the psychological trauma she suffers... Knowing that I can help a woman become continent again, knowing that I can deliver her from the ache gnawing at her heart: that’s what gives me drive in life”. Dr. Ambaye explains.
Fistula Patients in the Fistula Unit
The patients awaiting treatment in the unit are equally eager to see Dr. Ambaye. Laying in bed, Tangut, Kalissa, Fatouma, and the other patients smile at her shyly. She will operate them and restore their dignity... and they know it.
Hesitantly, the first patient enters the examination room. Her eyes are full of expectations. Once on the examination bed, she keeps eyes tightly closed while Dr. Ambaye runs tests. Nessira is 21 years old. She became incontinent after giving birth to her first baby five months ago. She developed obstetric fistula after an obstructed labor. Here baby's head was too large to pass through her pelvis. 97% of women who contract obstetric fistula lose their babies in the process. But Nessira’s baby is alive... She is one the luckiest ones...
“Doctor, my heart has been throbbing with torment and grief for the past five months”, says Nessira. “I have not been able to enjoy my first steps as a mother because I have been leaking urine day and night. But now, my heart is throbbing with anticipation because you are here and I know you can heal me”.
As she is still lactating, Dr. Ambaye tells her she will be operated on first thing in the morning, tomorrow. “Go get some rest. Tomorrow is a big day”, she tells her reassuringly.
After Dr. Ambaye finishes examining the other patients, we head back to the hotel. “Before WAHA opened this fistula unit, most women had to go through an incredibly tiresome journey to seek treatment in a different part of the country. Most would spend years and even decades living with fistula” Dr. Ambaye tells me. “But now, thanks to our services, they can access treatment on time, like Nessira will tomorrow”.
Dr. Ambaye preps for surgery
The next day, Dr. Ambaye arrives at the Hospital early in the morning. Four operations are scheduled, including Nessira’s. The operation theatre is full of activity: the anaesthetists, the scrub nurses, and the residents are all busy preparing for the first operation.
As Nessira is being prepared for surgery, she looks both frightened and excited.
With the help of the residents, Dr. Ambaye positions her on the operation table and comforts her: “it will be over before you know it” she says.
And it begins.
Like a true maestro, Dr. Ambaye cuts, dissects, stitches... The concentration on her face matches the weight she is carrying on her shoulders. Nessira has put all her hopes in her hands, and she wants to do her very best to free her from this terrible burden.
This of course is an invaluable learning opportunity and all the residents gather around Dr. Ambaye to assist and learn from her. I hear them whispering: “look at the stitches, she is a fantastic surgeon”.
Residents assisting Dr. Ambaye
After an hour-long operation, the fistula has been successfully closed. After proper follow-up, Nessira will become continent again.
Dr. Ambaye comes by Nessira’s side and tells her that the operation has been successful: “your nightmare is over” she says to her. Immediately, Nessira’s eyes swell up with tears. She reaches out and shyly touches Dr. Ambaye’s arm.
Nessira, thanking Dr. Ambaye
She doesn’t speak but her eyes say “thank you”. She looks like she wants to say something but she remains silent. Looking at her, Aeschylus’s words in Promotheus come to my mind: “To speak of this is painful for me: to keep silence is no less pain. On every side is suffering”.
In this emotion-loaded moment, she is silently telling Dr. Ambaye about how her life had taken a sudden downturn when she had started leaking urine, how deep she had sunk into the abyss, how she had chosen to brave it out for the sake of her baby, but how relieved and happy she was right now.
Before we leave Jimma, the energetic and never-tiring Dr.Ambaye will go on to do seven more life-changing operations.
On the last day, Dr. Ambaye does one last round to check on her patients. And this is when we witness a very touching scene: beaming with joy, we see Nessira breastfeeding her baby girl, Ayat.
There could not have been a more beautiful image to conclude our journey in Jimma.
“I have dedicated my life to treating women suffering from fistula”, Dr. Ambaye tells me. “To me, being a fistula surgeon is more than a profession: it’s my vocation”.
Ethiopia, a country dominated by men, has a long line of incredible women who have been influential in their compatriots’ lives: Queen of Sheba, Empress Taytu, Etege Menen etc.
Undoubtedly, Dr. Ambaye is one of them.
(Cover photo: Nessira with her mother and daughter)