Notes from the field: Obstetric Fistula in Ethiopia
My name is Tsega. I am from Begi, in Western Ethiopia. It’s about 750 km from Addis Ababa. It’s on the border of Sudan. I am 39 years old.
My job is constructing, manufacturing, and installing micro hydro-powered turbines for rural areas. I work to help people in this way because hydro powered mills are much cheaper for them than diesel.
In our area, grinding meal is women’s work. Women carry heavy burdens and they travel long distances to get to a grinding mill. Sometimes they carry their babies on their backs and the grain on their heads and it is a very difficult thing. But we construct this mill around their village because we have rivers everywhere in West Wologa, especially around Begi, and it is really easy to help women around there. It is good to get a mill near their village.
Our mill can grind every kind of crop. Common grains in Ethiopia are Teff, barley, wheat, maize, and sorghum. One mill can help 800 households.
The problem of fistula is very wide in Wologa and in the whole of Ethiopia. Women affected by this problem face big challenges. Normally they cannot sit with others. They cannot live with their husbands or live with their friends. So they cannot feel free.
In my area the cause of fistula is early marriage. Also, women cannot get treatment when they give birth, during delivery. They cannot get to a clinic or hospital. Their labor can last 3, 4, 5 days and that can cause fistula. The baby gets stuck and they are in labor for a long time. If they could get treatment urgently it might not become difficult like this.
I read books that women around the world have written. But women especially around our area of Begi are really under a heavy burden. That’s why I want to help. That’s why I want to tell them that they have rights like men.
Men see what happens in their own area. If a man’s mother used to carry him and another thing or two around every day, doing heavy work around the field and house, he does whatever he saw. This is because of a shortage of education or information and not because he is crude. It’s because he doesn’t know.
God is important for me. I believe in God. I live because of His grace. Living in this world is not my choice; it’s because of God’s willingness. I am a Christian. The blood of Jesus Christ is not like sheep, like goats, like ox. God gave us his own son. His love is that much. That is why I want to be Christian, because of His love.
Because I am Christian I want to help others. Let me tell you about my turbines, the price that I give one complete turbine with its construction. The price I ask a church or a non-profit organization and the price I ask another is not the same. Really, I give turbines for a church for a very, very cheap price because a church will not exploit the people around it. They use this mill just to help people.
Helping a woman means helping the country because when someone helps a woman she helps her family and her child. We are all from women. The world is from women, not only from men. The future of our world depends on the strength of our women. Because of that, taking care of women is taking care of the world.
Some husbands help their wives before and after they have fistula. Not all, but some of them. Some men do not want to help and do not want to take care of their wives because some women cured from fistula cannot bear children and others cannot work or do heavy labor. In our area one man can marry about 4-5 women. He uses these women for heavy work, and if a woman cannot do heavy work or she cannot give birth, why should he help this woman? I think that is the problem.
In another way, there are some men that take care of their wives after they are affected by fistula and after they are cured. This is from his kindness. Maybe he loves his wife and he is kind. Naturally, some people are kind and others are business-minded. Because of this, some people are helping their wives.
Helping each other is the most important part of a relationship between men and women. They have to respect each other. A man has to think about his wife, about her health, about his duty. He has to think about her feelings. And the same is true for women. They have to do the same things. She has to understand him.
Especially men have to help their wives because women naturally need special support from their husbands. That does not mean that women are less than men but that they have to support each other. A man has to support his wife, and a woman has to support her husband. There is a saying “There is a strong woman behind a strong man.” So a man cannot be strong unless a woman is strong. They need each other.
Women around Begi marry around age 14-15. Sometimes they marry at 13, but this is not legal even though it happens. Typically the husband can be 24, 30, and even up to 40 years old.
If I had a daughter I would not allow her to be married before she is 20 years old. She has to have matured, not only by physical maturity but also she has to think in the right way and she has to be educated.
We transport women from Begi to Addis Ababa Fistula Hospital. Before we bring them there we collect women from their villages. There is a special house in our church for these fistula women patients. The room has special waterproof beds. Our church will give these women their food. They clean their clothes. They give them diapers. The women take showers and take rest and they can also have some advice and counseling. After they get this counseling we bring them to the Addis Ababa Fistula Hospital.
Transporting women is not my special work. My special work is helping women by manufacturing and installing water turbine mills. Turbine mills help all women: not only fistula patient women but all women. Sometimes I help by driving the car because it’s a very long journey and it’s difficult for one driver. Sometimes when they ask me to help them I help freely, without charge. But my main job is manufacturing turbines and installing them.
One turbine costs about 100,000 Birr ($6,250 USD) and can help about 800 households.
Recently I was in Begi installing a turbine around the area of Jimbila. While I was installing, people came and told me there was a woman trying to kill herself. And I said, “Why? Why is she trying to do this?”
I was told, “She is leaking. She is a fistula patient and she does not have anyone to help her. Her husband hits her and none of her friends want relations with her. Because of that she feels very badly and she does not want to live. So she tried to kill herself.”
I knew my church is helping women with fistula so I said, “Please help this woman. I will take her to my church. They will help her.” So immediately they brought the woman. I stopped my work and I took her into my car and I took her to Begi. I talked with the fistula project manager and she really felt sorry about this woman. After we treated her by giving food and clothing and diapers, and after a week, we brought her to Addis Ababa with two other patients. Her name is Ajayibe.
In our area we are surrounded by Muslims. Most people in Begi are Muslims. These Muslims are very kind, very sociable. We live together, we work together. Sometimes there is a wrong kind of teaching that comes from another area and that bring a disturbance between the Christians and Muslims. These problems can happen, but really Muslims and Christians around Begi are living in very peaceful conditions.
We are Christians, but we are helping Muslim women. Most all of our fistula patients are Muslim women. We are a serving church, but we say that our Lord Jesus Christ died for every human being: for Muslims and for Buddhists and for Hindus. For every person living in the world he died. That’s why we help every person.
Now we’ve brought Ajayibe from Begi. Hopefully she’ll be cured. After that we don’t know where she’ll go. She doesn’t have family. She does not have a husband. Really, I cannot say anything about Ajayibe after she is cured. I don’t know where she will go and I don’t know how she will live. This is very difficult. She is 22 years old.
I want to tell people that treating fistula patients is not enough. That’s not the only thing we have to do. The main thing is to help them before they become a patient. It is possible to help them if we just think about it. We need to help women from very far areas get help to give birth. If you can help do that we will not have to transport women to the Fistula Hospital. I think that’s the main point.
The problem is not the distance to a clinic. There is just no transportation. Because of that, women spend a long time in labor before ever reaching a hospital. There is no means of transportation. They cannot get a car. And women in such a condition cannot sit on horseback or donkey back. And it’s not easy to transport by human labor. It’s not easy to carry her like that. Of course the distance is not less than 20-30 km. Traveling 20 km is not easy without a vehicle. There is no means of transportation!
If a man wants to bring his wife from where he is living to where she can get treatment he would have to pay about 1,000 Birr (approximately $62.50 USD). Nobody has that. No one has this Birr around a rural area; they are poor. Of course if we could help by giving transport to them we could reduce this problem.
I will ask Ajayibe and I will ask my church about her condition and situation. If there is something that I can do for her, really, I want to do it.