Map of life expectancy at birth from Global Education Project.

Tuesday, April 26, 2011

Guest Post

This is something I haven't done for a while, but I'll be happy to entertain guest posts in the future. Must be on topic, no commercial promotion, and in accord with our overall perspective and values and what not. Author Pat Walling also writes for the Medical Billing and Coding blog. As I told her I would mention, one of the major sources of waste in our current health care non-system that relies on a mess of different insurance plans is the need to spend absurd resources on billing and coding. With a single payer system, we'd do a lot less of it. But, that's the world we live in now, and somebody's got to do it. -- C

Illiterate Fistula Surgeon Brings Hope to Women

Mamitu Gashe is not an ordinary surgeon, at least not in the way most people think of a surgeon. She did not grow up with medical aspirations, but instead assumed the profession as a way to help women deal with a problem she once faced herself. Mamitu's journey started in a remote Ethiopian village when she was 15 years old. She married a local man, became pregnant and eventually lost the baby. Soon after, she discovered body fluids leaking from her vagina.

What Mamitu had was a condition known as an obstetric fistula. A fistula in general refers to any abnormal passageway or connection between vessels or organs in the body that do not normally connect. Fistulas may occur in the lungs, stomach, nose and other parts of the anatomy. Obstetric fistulas specifically refer to damage in tissues of the vagina that cause leaks from the bladder or bowels. This particular condition was a common occurrence in the United States in the 1800s, but improved medical treatments and procedures have made the condition almost non-existent in industrialized nations. Most of the cases today occur in underdeveloped nations, mostly located in Africa.

The young women who suffer from fistula in impoverished parts of the world often lead a lonely life in solitude until they die. They are forbidden from being near community drinking water for fear of contamination. Some of these women commit suicide due to their life of isolation and shame. Mamitu, who was illiterate at the time she was suffering from the condition, found relief thanks to a pair of Australian doctors. Australian obstetrician Catherine Hamlin and her late husband, Dr. Reginald Hamlin, started Addis Ababa Fistula Hospital, located in Ethiopia, in 1974. The couple originally planned on staying in the area for only a few years, but ended up dedicating their lives to helping women in this part of the world receive treatment for a condition that dramatically reduces their quality of life.

In order to make the trip that changed her life, Mamitu spent seven years begging for change at a local bus station to save up the money for the trip to Addis Ababa Fistula Hospital. Dr. Hamlin performed the surgery on Mamitu free of charge. Afterwards, Mamitu ended up working at the hospital changing beds. Eventually Dr. Reg Hamlin became confident enough in her abilities to ask Mamitu to help with removing the stitches of other patients. From then on Mamitu became more involved in the process of repairing fistulas. After observing the surgeries for a few years, Mamitu went to school and eventually became a surgeon and began performing the surgeries herself.

Mamitu is now considered an expert in obstetric fistula surgery. She continues to work side by side with Dr. Hamlin at Addis Ababa Fistula Hospital (nicknamed "puddle city" because of the condition treated there) to provide hope for women who once had no real alternative, except to live a life in isolation while quietly suffering from an embarrassing medical condition. In addition, she provides instruction to other surgeons who travel from around the world to learn the basics of this type of surgery. Mamitu has never forgotten how Dr. Hamlin, now 83, and her husband helped her achieve a productive, healthy life. Addis Ababa Fistula Hospital performs the reconstructive surgery on African girls free of charge. The surgery itself normally costs $300, but many who need it simply cannot afford it or have no way to get to a facility where the operation is preformed. As result, the hospital has helped an estimated 25,000 young women live a better life in the years since it started operations.

In order to help make obstetric fistulas a thing of the past, The United Nations is seeking $750 million to treat up to 3.5 million women who suffer from obstetric fistulas by 2015. Following a successful surgery, many of these women can be integrated back into their communities. Additionally, Mamitu (along with several others) is seeking increased funding to combat the condition. The funding would go to education efforts, as well as providing the surgery to those in need. Treatments for an obstetric fistula will vary based on the cause and extent of the condition, but typically include a combination of surgery and antibiotics. In cases involving younger patients, surgery is sometimes delayed with medications until a certain age is reached. However, it is estimated that upwards of 300,000 lives could be saved with education and medical efforts.

Mamitu has devoted her life to helping others receive treatment for this treatable condition. Her efforts today are focused on raising awareness and funds to help those in need lead a better life. Similarly, Dr. Hamlin appeared on Oprah in 2004 to tell the story of Mamitu and the hospital she operates in Ethiopia. While the appearance did help to raise awareness and bring in additional revenue, there is still much work that needs to be done. Efforts by Hamlin and others will continue until obstetric fistula is a thing of the past worldwide. The Fistula Foundation supports efforts at Addis Ababa Fistula Hospital, and has raised over $3 million to help keep the hospital in operation.

Dr. Hamlin and her colleagues in the field are often frustrated by the fact that a curable condition such as an obstetric fistula remains a big problem in certain parts of the world. The United Nations is assisting with efforts to raise funds to hopefully bring an end to the condition. According to the U.N., about two million women and girls may suffer from the condition. However, success stories like Mamitu’s, are providing inspiration to women around the world. "No woman should have to suffer what I suffered," Mamitu told reporters at a recent luncheon. Mamitu does not normally seek the spotlight, but she hopes that by telling her story other women with the same condition will get the help they need to lead full, healthy lives.

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