Physiotherapy for obstetric fistula, Ethiopia

Gill Brook, United Kingdom/Ethiopia

Physiotherapist, Teacher, President International Organization of Physical Therapists in Women's Health (IOPTWH)

I have been a women’s health physiotherapist since 1987, first in Hastings and latterly Bradford and West Yorkshire in the United Kingdom. In the early 1990s I became involved with the UK women’s health physiotherapy group but my international interests came slightly later, when I became a committee member for the International Organization of Physical Therapists in Women’s Health (IOPTWH), an official subgroup of the World Confederation for Physical Therapy (WCPT).

In 2008 I became aware of the Hamlin Fistula Ethiopia (HFE) when another UK physiotherapist, Lesley Cochrane, contacted me.  Lesley had been visiting the Fistula Hospital regularly since 2003. At that time there were no qualified physiotherapists and the physiotherapy was carried out by two nurse aides. Over the following eight years massive developments in physiotherapy services were made, in no small part down to Lesley’s knowledge, teaching skills, and dedication during her regular visits and via email whilst home in Scotland. Local nurse Azeb and her colleague Yemenhushad successfully completed a physiotherapy diploma and took over the day to day running and development of the service. I visited the hospital with Lesley in 2010, and have continued to go annually on my own since then.

Obstetric fistula is something which is rarely seen in many countries, but it is estimated that it still affects tens of thousands of women a year in some countries, including Ethiopia. It occurs when labour is obstructed with the baby unable to pass easily through the pelvis, resulting in severe soft tissue damage. The result may be a hole (fistula) between the vagina and bladder, or vagina and rectum. Women are then incontinent of urine or faeces. Units like the Fistula Hospital and its centres throughout Ethiopia offer surgery to repair the fistula.

There is a lot that physiotherapy has to offer for women who have experienced a fistula. When they realise they are leaking urine or faeces after childbirth, some stay in bed for weeks or months in the hope that it will stop. As a result, they can become very weak and develop contractures, particularly in the lower limb joints. In addition, some women develop foot drop, related to the obstructed labour itself or possibly due to prolonged squatting during labour with subsequent nerve damage in the leg. Physiotherapy is the ideal treatment for these problems, and the HFE team see women in the physio gym six days a week for group exercise and individual therapy. In addition, the physiotherapists assess the women’s pelvic floor muscles (PFM) and advise them on appropriate PFM exercises. Despite the fistula repair successfully closing the hole, unfortunately many women still have serious bladder problems so PFM exercises and other specialist physiotherapy is extremely important.

Now there are two Ethiopian physiotherapists – Selam and Muluken – who are very ably assisted by a team of physio aides, all of whom are ex-patients themselves. They offer an excellent service, both on the wards and in the physiotherapy department.

What is my role? Well, the service is now well established so I offer mentorship and further education for the team, to help with their professional development and to support any service development they wish to undertake. In addition, I was invited to offer some educational sessions for medical staff who are undertaking a gynaecological Fellowship programme and this is ongoing.

For more information about the hospital and its work visit http://hamlinfistula.org/