Assessing maternal health in Ethiopia

StudentSpeak is pleased to share this guest post from Elena Phoutrides, MS2, a student in the joint M.D./M.P.H. program. Elena is working abroad this summer in Tigray, Ethiopia thanks in part to the R. Bradley Sack International Scholarship and the OHSU Global Health Center.

It’s mid-morning: somewhat watery sunlight lighting up the bougainvillea, the appealing smell of fresh-roasted coffee in the air. Just about time for a coffee break here in Mekelle town in Tigray, Ethiopia.

I am fortunate to be working this summer with Healing Hands of Joy (HHOJ), a non-profit, nongovernmental organization based in Mekelle. HHOJ works with women who have experienced obstetric fistula; this condition occurs during prolonged obstructed labor, which creates a hole between the uterus and the bladder, the rectum, or both. The direct result of this injury is urinary or fecal incontinence. Indirectly, many women who experience fistula are traumatized and socially isolated as a result of the smell that accompanies obstetric fistula.

Ethiopia is one country where obstetric fistula remains relatively prevalent, due to a lack of easily accessible emergency obstetric care. The good news is that women who experience fistula can be surgically repaired at one of the six branches of the Hamlin Fistula Hospital, which works almost exclusively in fistula repair. However, the social issues that accompany fistula can’t be managed in an operating room, and despite successful closure of their fistula, many women continue to suffer from social isolation within their communities.

In this context, HHOJ trains women who have experienced fistula as Safe Motherhood Ambassadors, who work in their home communities to educate women about safe pregnancy, labor, and delivery. Ideally, their programs will impact both the experience of women with fistula as well as the community at large. HHOJ has done an excellent job of prioritizing monitoring and evaluation as a part of their program management, especially with regards to their program’s impact on fistula survivors.

My work this summer will help assess how HHOJ’s programs are affecting community-level maternal health knowledge and practices. This is a basic evaluation; untangling the question of how, exactly, a program can change how a community thinks about the health of mothers is a complex question.  However, I am excited to be a part of HHOJ’s work and the challenge of evaluation. I’ll be spending most of the next two weeks in rural health centers talking with people impacted by HHOJ’s programs in hopes of understanding how best to assess impact on a larger scale in the future.

Big thanks to both HHOJ for the opportunity to work with them this summer and to my faculty mentor, Rahel Nardos, M.D., adjunct assistant professor of obstetrics and gynecology, OHSU School of Medicine. In addition to encouragement, guidance and logistical support for this project, her work with OHSU’s Global Women’s Health Initiative (GWHI) is what first piqued my interest in fistula. GWHI’s project in Ethiopia supports maternal health by providing training and surgical support, community outreach, and educational partnerships with local hospitals, health centers and students.

Learn more about the work of Dr. Nardos in Ethiopia.