The Addis Ababa Fistula Hospital: An holistic approach to the management of patients with vesicovaginal fistulae

Ethiopia is amongst the world's poorest countries. It is estimated that approximately 30,000 women have an untreated vesicovaginal fistula, the overwhelming proportion of which are complications of neglected, prolonged or obstructed labour. When unrelieved, the presenting foetal part is impacted against the soft tissues of the pelvis, resulting in a widespread ischaemic injury. This ‘field injury’ often results in multiple other injuries, in addition to a vesicovaginal fistula. Focusing simply on the ‘hole’ between the bladder and vagina will ignore many of the other injuries these women have sustained. These include both physical and social problems, stress and urge urinary incontinence, hydronephrosis, renal failure, rectovaginal fistulae, third degree tears, amenorrhea, secondary infertility, vaginal scarring and foot drop. Over 50% will be divorced by their husband and excluded from religious activities, their home, public transport and hospitals. The Fistula Hospital in Addis Ababa in Ethiopia, founded in 1975 and run entirely by charitable donation, is dedicated exclusively to the care of women with obstetric fistulae, and the treatment of other physical and social injuries they have sustained.