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Improving Women's Health in Ethiopia: Challenges, Solutions, and Community Support

Ethiopia's healthcare landscape faces significant challenges, with a per capita income of $1,312 and high infant mortality rates. The country struggles with a shortage of medical professionals, as 95% of doctors migrate post-graduation. Despite these obstacles, initiatives are underway to improve women's health, particularly in obstetrics and gynecology. Facilities are planned to increase surgical procedures and training for midwives prioritizes preventive care at community levels. Desta Mender exemplifies holistic support, empowering women through education and vocational training while providing vital healthcare.

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Improving Women's Health in Ethiopia: Challenges, Solutions, and Community Support

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  1. Ethiopia USA U.N. Human Development Index1604 Population 80m313m No. of children / women62.06 Per Capita income USD13122,365 Infant mortality / 10001226.06 Population / State Physician40,000400 Adult literacy (%)3799

  2. Medical Staffing in Ethiopia • 95% of doctors leave for USA on graduation • 155 gynaecologists • 501 specialists work for the State • 850 doctors work for NGO’s • Midwife training increased to 4 yrs • Health Officer training for pelvic surgery 3 yrs • Emphasis on prevention at village level

  3. Spectrum of Trauma Secondary to Obstructed Labour • Urological • Gynaecological • Gastroenterological • Musculoskeletal • Neurological • Dermatological • Foetal • Social / Psychiatric

  4. 1959-2011 Holistic care

  5. 5 New locations in Ethiopia Planned increase from 2500 procedures/year to >4000

  6. Mekele Centre

  7. Length of Stay > 52 days n = 15

  8. The Fistula Hospital • Biochemistry • Haematology • Bacteriology • Virology • Blood Transfusion • Radiology

  9. Ureterovaginal Fistula (122)

  10. Causative Procedure Stillborn 28 Alive • Caesarean Section: 86 • Uterine Rupture: 20 • Instrumental delivery: 6 • Hysterectomy for gynaecological causes: 10 2

  11. Number of Operations

  12. Annual Performance Report for 2010

  13. Additional Major Procedures • Stress procedures • Tears • Ileal conduits • Mainz II Pouches • Enterocystoplasty • Uretericreimplant • Stones • Colostomy

  14. VVF Patients: 2010 (n = 1,321) 93%Successful first repairs 4% Unsuccessful first repairs 2% Incurable 24% Successful repair BUT still incontinent • Overflow 16% • Pure Stress 6% • Mixed stress/ Detrusor over activity78%

  15. Training • Facilities • Local • International • Basic & Advanced • Doctors & Nurses • Hospital links

  16. Urodynamic Findings –Patients previously operated n = 176 Stress Incontinence & Detrusor Over activity 121 Overflow 29 Pure Stress Incontinence 18 Normal 6 Detrusor Over activity 2

  17. Treatment of Detrusor over activity / Stress incontinence Bladder training and Oxybutynin for 2 months (n = 164) Cured = 9 Improved = 65 (urgency, dry bed, some voiding) Dry with plug = 45 Still wet = 45

  18. Mixed Incontinence n = 45

  19. “Superbugs” and Fistula Patients

  20. Study 2 573 urine cultures • 140 sterile • 4 resistant to all antibiotics • 16 sensitive to only one antibiotic • 181 out of 433 (42%) of bacteria were sensitive to < 4 antibiotics

  21. Ileal Conduits • 156 patients • 127 Primiparous, 25 multiparous, 4 nulliparous • Mean age at operation: 26 yrs, • Range 14 – 65 years • Mean duration of incontinence: 5 yrs, 7 mths

  22. Ileal Conduits (155): Prior Surgery 112 - Attempted fistula closure, mean 2, range 1 – 7 15 - Stress incontinence procedure • 7 - Removal of urogenital calculus • 4 - Bladder augmentation • 2 - Mainz II Pouch

  23. Additional findings 74 – Renal obstruction 45 – Abnormal renal function 9 – Recurrent or severe urinary tract infection

  24. Desta Mender

  25. A Community of Affliction • The bag is the icon of their identity • Neglects enduring social networks and embeddeness of the women • Erects parallel structures of self care • Prolonged stay in a paradise of sorts • Lifetime dependence

  26. Programme at Desta Mender • Non-formal adult education • Literacy and numeracy skills • Building self-confidence • Communication skills • Skills for independent living • Vocational training • Dairy, Poultry, Horticulture • Catering • Tailoring

  27. Survival • Patients – 156 • Surviving – 144 • Range: 6 days – 22 years • Mean 5 yrs 9 months

  28. Deaths 12 patients died • 8 Renal failure, range: 6 days – 17 years • 1 Disseminated TB and CRF: 3 months • 3 Unknown cause • Median survival after surgery: 5yrs 7months

  29. Outcomes • 31 of 47 women with abnormal renal function improved • 48 of 76 women with obstructed kidneys improved • All women have improved quality of life, life expectancy and opportunities for work and living outside Desta Mender

  30. Costs • One piece appliance / year US$ 220 x35 = $7,700 • Two piece appliance / year US$ 7,700 x 117 = $81,900 • Total for appliances: $89,600 • Desta Mender Cost / year US$ 307,410 • Grand Total: US$ 397,010

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