Why is there such a concentration of effort on Ethiopia?
It is true that women experience the suffering and degradation resulting from fistulas in many countries. Whenever women give birth at a distance from good medical facilities, there is a risk that obstructed labour may result in a still birth and a fistula. Where there is access to a hospital, a caesarean section can be carried out, the baby saved and the mother saved from dreadful injury.
In many poor countries in Africa and Asia fistula injuries are common, but there are several reasons why the problem is more severe in Ethiopia.
Ethiopia is a large country, more than twice the size of France and more than four times the size of New Zealand. Like New Zealand, it is very mountainous, but, unlike New Zealand, many of its people live in the mountainous areas. It now has a population of 70 million, many of whom live in villages without vehicular access. Many live several days’ walk from a main road.
The strong cultural tradition for girls to marry in their early teens adds to the risk of obstructed labour in their first pregnancy as their bodies are not fully developed. Malnutrition resulting from poverty also weighs against them.
It is the combination of factors outlined above that makes Ethiopia a special case. The country lacks the resources to build roads through hostile terrain or to provide hospitals in remote areas. Dr Hamlin’s answer is to train midwives who will work in rural villages providing ante-natal care and education, identifying women with potential complications, and assisting them to attend a regional hospital for the birth. See “Village Midwives”.
The Addis Ababa Fistula Hospital and some of the outreach centres also provide training for surgeons from other countries.