Field Update: Q&A with Dr Ambaye
9 May 2022
Your questions about fistula - answered! Tune in to a Q&A with Ethiopian fistula surgeon, Dr Ambaye.
Ethiopiaid Australia CEO Sharon Elliott holds a virtual Q&A with one of Ethiopia's leading fistula surgeons, Dr Ambaye. Dr Ambaye trained under Dr Catherine Hamlin (who pioneered fistula surgery in Ethiopia) and recently founded her own organisation called Hope of Light which operates three fistula hospitals in Ethiopia. Find out why she founded her organisation, what made her decide to specialise in fistula surgery and what progress she has seen in the fight to end fistula in Ethiopia.
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Video transcript
Sharon:
Okay well I am delighted to be here today with Dr Ambaye. She is a leading fistula surgeon in Ethiopia and you trained under Dr Catherine Hamlin who was of course the pioneer of fistula surgery in Ethiopia and I know her name resonates with a lot of supporters out there. So they are very excited - we are very excited to be coming on board with you in the continuation of that work.
And of course your work being that two years ago now you founded your own organisation which is very exciting under the name of Hope of Light. Which I have to say I think is a particularly beautiful name and I think really reflects the kind of work you do.
You are now running three fistula hospitals across Ethiopia. So thank you so much for coming to this meeting today. And look this is a really exciting meeting because so many of our supporters in Australia that are really particularly passionate about fistula and the work that happens there. And we have actually got questions that have come from them that they asked me to put to you. So if you're ready to go...?
Dr Ambaye:
Yes, I'm ready Sharon.
Sharon:
Wonderful. So Dr Ambaye, can you tell us a little bit about your organisation, Hope of Light? What was it that made you decide to found the organisation? And obviously you do a broad span of work but maybe just sort of the highlights or the headlines of the work that you do?
Dr Ambaye:
Okay, thank you Sharon. The reason why to found Hope of Light, you know, before the establishment of Hope of Light I used to work for an international organisation called Women & Health Alliance International. And this international organisation phased out or stopped working in Ethiopia in February 2020.
So I'm a fistula surgeon - I'm a full-time fistula surgeon. I am dedicated for such kind of service. So when this organisation closed, I just - I felt empty. I mean, I have been working about fistula for more than two decades. I feel that I have a lot of experience. So much I have touched with these people. And then I am very happy to give the service to these woman.
When I know that this project, this organisation is going to be closed, then I say "What are we going to do?" Our work always should be sustainable. If we are going to - we have three centres established, working very well, treat more than 500 patients every year at the three centres. And then I decided I have to continue this work because the service is going to be sustainable.
And then I discuss - I wrote this to Ethiopiaid UK, Australia and Canada and Ethiopia Fund in Norway. So these three organisations were very much interested to help me and encouraged me to continue this work. And then I said, why not I establish a local NGO if you are willing to help me, I am really happy to teach the doctors and continue what has been started by WAHA International. And then I got a green light from this four organisations, donors, and then I establish a local NGO in July 2020. Then I started to do the work. That's how I started - how Hope of Light established.
And then what it's doing now is we have three major activities - in fact, it's four major activities what Hope of Light is doing. The first thing is to treat fistula patients. Fistula patients and other patients with pelvic floor disorder and they are incontinent. So this treatment is the main focus of our activity.
The second one is training of health professionals - training. Why we do the training? If we train the doctors, midwives, clinical nurses, health officers, while they are doing their training as university students we have a good chance to get in contact with such kind of health professionals, future health professionals. And then when they finish their training, they go to remote area and then they can apply - and at least they can prevent the occurrence of obstetric fistula. That's why we are very much interested in training. So the second most important activity is training.
The third is - you know fistula usually occurs in the very rural area, where the victims are illiterate, they don't have enough money, they are poor, they don't have access to the medical care. So they give birth at home and when there are complications they travel to the health facilities. So to avoid such kind of complications I feel that it's much better to bring awareness amongst the communities that all women should give birth at the health facility. Health Extension Workers teach them that fistula is preventable; you can prevent it if you deliver in the health facilities. This is the main important thing that we teach the community. And at the same time we identify fistula patients. Fistula patients they are always outcast and they are long isolated. They don't talk about their problem with the community members so they hide their symptoms behind the door. So our Health Extension Workers with former fistula patient they visit them house-to-house - they do house-to-house visits - and they tell them, Yes, see fistula is treatable; it's not your fault that you developed obstetric fistula. So these are the kind of activities. We teach community to prevent and at the same time we identify already victimed fistula patients so that they can go to the hospital for treatment.
And the fourth and most important thing is reintegration program. We are very happy that we are able to treat patients; 85% of our woman they are cured! But the rest, 14%, 15%, we are able to cure the fistula but they are still leaking a little bit when they cough, when they sneeze or when they lift objects. But with time they can - you know, we give it time and then most of them they get better.
There are a few per cent of our patients like 2-3%... there's nothing we can do for them. Some of them have repeated surgery; we are always able to close the fistula but we cannot fix the incontinence. And the reintegration program usually focussed on income generating activity. So, so far this year in 2022, we started in one of our sites, our fistula centre, to collect those patients who are not cured and are not able to support for themselves - we train them to do soap, you know liquid soap and bath soap - and then we train them so that they go back to their village and sell this product. They are able to produce this and then sell it to the community so that they can get some income generating - some money for them to support themselves. So these are the main activity of what Hope of Light is doing since its establishment.
Sharon:
Wonderful. Well, thank you for that. And I think for a couple of me - sorry, for me there's a couple of bits that it's so good to hear that it's big picture. You know, you're not just going in and treating the fistula but you're putting in place work to make sure that it changes the woman's whole life, but it's also taking it back into the community and it's making changes that are going to, you know, change what's happening for the next generation as well. And it's hearing things like that that is so very exciting.
Which kind of leads on but goes backwards almost to my next question - What made you decide to do this? What made you train as a fistula surgeon? It's not exactly a common thing to be doing. So, why?
Dr Ambaye:
You know it's - the first time I went to the fistula hospital is while I was doing my residency. In my residency program we have compulsory two months attachment to the Hamlin Fistula Hospital. So I went to the Hamlin Fistula Hospital to do my attachments during my residency.
And then I was very much impressed with the Hamlins in fact and their dedication to the fistula and it's made me [think], What do I do for these women? You know, these people are doing a lot - they're changing the life of the woman. If you see cured fistula patient, it's like reborn for them. It's their life is completely - changing completely. So I said, What do I do? What is my contribution? This is the feeling I have while doing my attachment, my residency program. I started to work with Hamlin.
I am very much impressed and then Dr Hamlin became my role model. I have learnt two major things in my life from Hamlin. The first thing is her dedication to her work. They were very much dedicated for what we are doing. And the second one is the love and care to the patient. It's, you know, it's not something that you get from the textbook. It's - I got it from working with her. That's what I know and that's what I learned from Dr Hamlin. So this are the kind of things that I am very much interested to be dedicated and continue my work with the fistula patients.
Sharon:
So obviously you've been doing you work for a while now and you must be seeing change come through Ethiopia. I know times have been challenging lately but on the whole, what sort of changes have you seen in Ethiopia in terms of maternal health and the prevalence of fistula?
Dr Ambaye:
So, there is a great change. Now it's my third decade working on fistula - it's a lot of years! So from the beginning, in the first 13 years I was working as a staff at a fistula hospital, the number of patients coming to the hospital, it's unbelievable. It's about 20 patients a week - it's a lot! And gradually it's going down. Now, still, there is a great improvement with the number of patients that we see at our centres. There is a change.
Then, how did we get this change? The first thing is that a lot of health facilities constructed - even though it's not enough and it's not well supplied - there are a lot of constructions. There are a lot of constructions of health facilities. And the road - there is an improvement in road construction. This has also contributed lots. And a lot of training, especially midwives. The number of midwives trained and assigned in the countryside. I can see the improvement in the training of health professionals, construction of roads, construction of health facilities, contribute a lot for the improvement of maternal health in other ways to reduce the number of obstetric fistula.
Sharon:
And I think that's a lovely difference to hear - that you really are seeing a difference and that there's less patients but for the right reasons, not, not for the wrong reasons.
So there's still challenges out there and still things that's going on and I know that life is particularly challenging at the moment. You've been through the effects of COVID which luckily were pretty short lived in Ethiopia really. But of course you still have the conflict that's been playing out across Tigray and I know has got far too close for comfort to the hospital in Gondar for sure. And it's having other negative effects on your work. Can you tell us a little bit about any lingering effects from COVID but also effects from the conflict at the moment and what impact that's having on you?
Dr Ambaye:
Yeah, in the last uh - until the end of June... Aug... September 2021 the impact of COVID was very much especially in our outreach activity because we can't gather people for outreach activity. We were trying but we were not able to do [it] in our maximum capacity. It affects a lot, COVID. But these days it's okay - we don't have that problem.
What we have as a main problem is the conflict, especially in Gondar in the northern part of the country. This conflict in Ethiopia now is national-wide. It affects every people, emotionally, physically, socially. It is a really a problem. It affects the living cost completely. When the country [is] in war, in conflict, there is always a shortage of food, transportation because everything is for the front [lines]. So the production, the force - the man workforce - they are going to the war.
It affects very much, not only in the northern part of the country but it affects people and activity in Jimma, it affects activity in Assela, it affects the activity in Gondar very much. For example, when we do the outreach program in Gondar, we used to collect all the women, you know, and then teach them. Now there is nothing! There is no health facility. It's all destroyed. It's unbelievable! Unbelievable. Every health centre. It's amazing.
Once I went to the outreach program in Gondar and there I was told I would have 8 patients, because diagnosed were 8 patients. But when I went there, I found 23 patients! And then I was wondering - and then I see the list of fistula patients coming to the fistula [centre], to Gondar, is increasing! Why? Because the health facilities are destroyed and home delivery is getting higher and all these health professionals - the midwives, doctors - are not working because there is no infrastructure to work there and there's no one to help them [pregnant women].
The conflict affects very much, not only in our service, it destroys the whole facilities; facilities for the delivery, facilities for the care of the patient. I am sure the number of fistula patients this year, next year will be higher. Now it's limited because there are no transportation services. The movement is still limited because we're still under the taskforce. It's not an easy place to move or for patients to come to the service. So all this will be reflected in the coming one or two years - the number of fistula [cases] I'm sure it will increase. This is how it affects. It affects the northern part of the country highly. It's unbelievable. It will take, you know, all that I told you of the construction of the health facilities, improvement in roads, all the trained health professionals, all that we were able to decrease... It all comes to zero now. We don't have anything. So it's going to take years to rebuild this infrastructure again. Until then, we'll see many more women end up in complication during their labour.
Sharon:
Yeah, I can imagine. It would be very, very challenging. Very challenging indeed. I won't keep you too much longer but I would like to ask if there is any one particular patient that always stays with you as a special case? It doesn't have to be because it was complicated but is there one patient that really stands out as someone close to your heart?
Dr Ambaye:
You know, I've been working with fistula patients almost... for so many years. This is my third decade! You know once I was working at the OPD [outpatient department] and then I saw one patient came from - not very far from Addis; just about a five hour drive from Addis.
And then I could see that she had a fistula for 7 years and then I say, You know why didn't you come all these years? She said, I didn't have money; I was waiting to get some money for all these years. And then I asked her, Now you came to the hospital and then how did you come? Who gave to you the money? She said, No, nobody gave me the money. When I was separated from my husband, I got a calf. You know, she got a young calf. And then I was feeding and looking after this cow and then for 7 years now I saved that calf and got the money to come to the hospital.
Then, without knowing it, I started to cry. You see, as a gynaecologist I say, What do I do for these people? I started to realise that every day this lady was looking after this calf, this ox, to get big and then waiting to get some more money and then come [to the hospital].
It's always hurting me when I think - not only I think of that patient - I think always there are so many women in the countryside who are not able to come to us because they don't have money. In fact, when they come we refund them. But to begin with they don't come - nobody's going to lend them because these women are, you know, isolated, they are rejected. And always I remember her because it reminds of other fistula patients who are suffering in the countryside because they don't have money to come to the fistula hospital.
Sharon:
That's beautiful, absolutely beautiful story. We often talk to our donors, or we'll ask them if they can make a gift that will help transport women to the hospital. You know, what better example is there than a woman that it's taken her 7 years of looking after her calf to get her there. Beautiful beautiful story.
Well, I am going to just about finish up there because you've shared some beautiful stuff with us - a combination of both incredibly useful, very informative but also it's just lovely to finish on that really happy note. I think that's a really good place to finish.
Except that I have got a very important message from one of our supporters - Graham, who lives out in Middle Camberwell, in my local - well, not my local area, but in my part of Australia in Victoria. He specifically asked me to pass on his congratulations to you on the work that you do and to send his well wishes to you. He thinks that the work that you do is amazing. It's my pleasure to pass that on.
And, of course, just a huge thank you from me and my team and also from all the supporters for taking the time to talk to us.
Dr Ambaye:
Thank you, thank you Sharon. And I want to take this opportunity to pass a message on to Ethiopiaid Australia. Through you, for your Board, for your own donors, please say thank you for all the work they are doing for the victims of obstetric fistula. Thank you Sharon.
Sharon:
Absolutely, and as I said, it is our absolute pleasure to be part of your amazing work.
