(August 30-September 13, 2004)
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“ Fistula is the result of obstructed labor and obstructed transport”
Dr. Catherine Hamlin, Addis Ababa Fistula Hospital
A mission consisting of John Osika, Wendy Walker and Cheikh Sagna travelled to Ethiopia from August 29-September 13 to carry out preparation activities under a JSDF seed fund for a project which will address the role of transport in preventing obstetric fistulas in particular and providing emergency access to health services in general. They were joined in the field by local consultants, Dr. Eskinder Rashid, Mr. Mengistu Haile and Mr. Habtamu Demisse. The mission worked in collaboration at the Resident Mission with John Riverson, Negede Lewi,Yeshi Gizaw, Zelalem Dagnaw and Tizazu Kassa. The Ethiopian Roads Authority (ERA) under the leadership of Ato Bekele Negussie provided significant logistical support for the mission. The focus of the proposed project will be in the areas of: (i) facilitating access to health services through innovative intermediate means and management of transport (IMT’s, emergency access cards, small community labor-based civil works such as footbridge rehabilitation, etc.) ; (ii) increasing knowledge about fistula and reproductive health issues among communities, traditional birth attendants, NGOs, CBOs, and health care providers; and (iii) empowering communities and various levels of the healthcare system to identify and implement solutions aimed at improving access to healthcare and other basic social services. This project will be carried out in collaboration with a range of local stakeholders in the transport, health and social sectors. In the transport sector, the Ethiopian Roads Authority (ERA), the relevant Rural Road Authorities (RRA's) and Regional Transport Authorities, local transport service providers will be key stakeholders. In the health sector, the Fistula Hospital of Addis Ababa and its outreach centers in Yirgalem (in Southern region) and Bahr Dar (in Ahmara region), together with the Regional Health Bureaus, district and sub-district health care networks will be key stakeholders. In the social sector, civil society organizations and in particular NGO organizations such as the Red Cross, CBO's such as the women's association, the local chapter of IFRTD will be key stakeholders. This work will build on the activities currently being carried out under the Road Sector Development Program for Ethiopia and the Ethiopia Health Sector Development Program.
The link between obstetric fistula, poor transport access and increased vulnerability
One of the most preventable social and health problems experienced by childbearing women in Ethiopia is that of obstetric fistulas. It is the result of complications during childbirth that lead to defects in the birth canal which can cause a linkage of the birth canal with the urine bladder or rectum. This creates a continuous and uncontrollable stream of urine and/or faeces coming from the birth canal and a strong and socially embarrassing smell. The condition is preventable when professional healthcare is promptly received during childbirth. Affected women are mostly teenagers (in Ethiopia one hospital based study put their mean age at 17.8 years with many of them aged 13 or 14 years) and are 'living indicators of failed maternal health systems'. Recent statistics from the U.N. point to fistula as the most underrepresented maternal health problem in Africa with estimates of over one million women