Sally Carter: Films, fistula, and an illiterate surgeon

One of the world’s most experienced fistula surgeons is illiterate. I found that out when I went to a screening of a short film called Fistula Hospital: Healing and Hope at the Frontline Club in Paddington. Her name is Mamitu Gashe, and she was a patient at the Addis Ababa Fistula hospital. After her operation she worked at the hospital, eventually assisting in operations. Over the years she has continued to learn and operate, now giving master classes to gynaecologists from all over the world.  

The documentary that was shown is in the Al Jazeera “Birthrights” series on maternal health around the world. The film’s maker, Lara Akeju, was at the event to introduce it, and to take questions. This film, and two others, are about the work of the Addis Ababa Fistula Hospital in Ethiopia, which was set up by a husband and wife team in 1974. Staff there treat around 2500 women a year for free, and the hospital looks after about 50 long term patients.

Obstetric fistula is virtually unheard of in the Western countries, but the United Nations estimates that at least two million girls and women live with fistula, most of them in Africa.

Their stories often go like this: a young woman or girl tries to deliver her first baby. The labour is prolonged, obstructed, and the baby is stillborn. Blood supply to the vagina, bladder, and sometimes the rectum is compromised. The tissues die and a hole forms through which urine or faeces leak uncontrollably. The woman is usually abandoned by her husband and shunned by her community. In Ethiopia, some of these women manage to get to the fistula hospital.

Although the reasons patients arrive at the hospital are universally tragic, from there on it seems common sense, good humour, and hard graft take over to improve these women’s lives. Using interviews with the patients, doctors, nurses, and psychologists at the hospital, the film shows how difficult and inspirational life there is, and it’s not all about operations.

The hospital has a traditional Ethiopian tukul where the staff and patients regularly meet to drink coffee. One of the psychiatric nurses talks about its importance.  “Coffee is not only a drink. It has so many meanings … It brings us together, nurses, nurse aids, and patients. That is why we love coffee.”

During the talk after the film, one member of the audience asked how the staff and patients reacted to the presence of the film crew in their hospital. Ms Akeju said everyone at the hospital seemed positive and they were happy to tell their stories. Women who have obstetric fistula are often young and usually ostracised – in other words, voiceless. This film, and I’m sure the others in the series, allow these women to be heard, and it was a pleasure to watch and listen to them.

Sally Carter is a technical editor, BMJ