[Music] foreign speech [Music] speech foreign spe [Music] speee spe for foreign [Music] speech foreign [Music] no speech for speech foreign fore foreign for speech speeech fore foreign speech foreign foreign spee fore for speech [Music] foreign speech speech [Music] speech [Music] for speech speech [Music] speech foreign fore speech foreign spe [Music] forch fore speech foreign foreign speeech speech speech foreign speech spe for speech fore foreign spee speech [Music] this thise spee fore speee speech for for for [Music] [Music] in entry [Music] [Applause] [Music] foren foreign speee foreign speech for foree speech foreign speech foreign speech foreign [Music] Fusion [Music] [Music] these women are not welcome in a general hospital they can't often get in because of the tremendous pressure on the hospitals for other more urgent things also they're not welcome because they're smelling and they're poor and they're often turned away by the guard at the gate and this is really why we built the [Music] hospital [Music] for [Music] [Music] [Music] [Music] spee help needed when the baby can't be born in the usual 12 hours that it takes to have a baby usually it's due to a small pelvis or a Mal position of the baby inside the mother's uterus it occurs all over the world in 5% of all neighbors help is [Music] [Music] needed [Music] [Applause] [Music] spe she starts labor and she expects be perhaps delivered by the evening if it's the morning early morning but the day goes by and she hasn't had the baby eage women encourage her the second day goes by and even the third and fourth up to 10 days I've had a woman in labor by that time the little girl is exhausted dehydrated and she finally pushes out a dead baby but she wakes up to a worse [Music] horror so the size of the f is 2x 3 cm [Music] every time the uterus contracts it pushes that baby's head against the bone of the pelvis the blood supply of that area is cut off so that lump of tissue that's being squashed will die and it just drops out so this means that she's lost some of her bladder or some of her rectal wall the fish it's not only physical trauma they are suffering of it's a social and then psychological you know in the countryside it's being a woman is be able to be a wife and be a child to you know and have a family but when they fa to do that they considered themselves that they are not like any [Music] woman the husband he said you go back to your family he'll just send her off with a bundle on her back they run out to welcome her thinking that she's coming home with a baby and they find her in this date her life is ruined so they'll build her a little Hut outside and there she will stay till death unless she hears that she can be [Music] cured fore spee speech foreign speech foreign fore [Music] spee around now [Music] [Music] around [Music] [Music] speech [Music] [Music] speee most P women in the developing world have to do all the hard work they have to do the cooking the grinding of the Corn collecting of the water from the well carrying sticks from the forest so all her energy has gone into work instead of into growth she hasn't had enough [Music] nourishment [Music] if we take someone like this little girl what has happened is at the age of two she started carrying a jar of Water by the age of eight she's carrying something that I can't lift but all those years she's been eating a good diet but not enough calories what happens is she grows was short now if I stand you'll just see how short she is and I'm an average height I'm 5'3 a girl especially on a girl in the countryside they are too small for their age so if she gets at pregnant at the age of 14 definitely the baby will be too big for her per pelv to pass through during delivery so she will end up in obstructed labor foreign foreign fore speech fore foreign foreign [Music] speech foreign fore [Music] [Music] for usually think they are the only person in the world who leaks urine so being a fisha hospital is a part of psychotherapy they discuss their problem with other woman they start to understand and there are other women with the same kind of problem so this is very important to nurse them together and they have a social life together we see them talking they feel at home they feel they're not being ostracized from their society and they're loved and they feel welcome so this is where the healing process starts of the mind and this is very important spee fore foreign foreign fore foreign speech for [Music] spee for [Music] was [Music] we've got this girl with her whole life ahead and if she's not cured it's going to be a misery and a horror to her forever is not very big well mobilized now and uh I'm going to close it this is the fascination of fistular surgery to make a new life for a young girl that suffered more than any woman should be called on to [Music] endure we just finished closing the fish La now and then we are going to do a die test to make sure that the uh s line is water tight so we put a d if there is any hole the D comes through the the hall now it's uh there is nothing coming through the hle this mean that the hall is closed [Music] completely know we leave her with a catheter draining for 12 or 14 days and we hope that she's going to be able to pass you [Music] normally [Music] [Music] a new clothes it's a symbol for us they are cured they are going to start a new life for spee foreign [Music] foreign fore foreign spee foree spe foreign speech is negative stress in Dynamics the F that is the hole on the bladder is closed and uh now uh the bladder function is not restored so we are going to uh do certain examination run certain tests and see where where the problem actually is that's what we are meing this is a urodynamic examination this is a machine uh which measures the uh intraabdominal pressure and it also measures the same time the pressure inside the bladder and then the machine will give us the bladder capacity how much the bladder can hold according to the results she has reduced bladder capacity it is reduced by half as compared to normal persons but the good thing is that there is some regeneration capacity of the the bladder that we hope with time her BL capacity will increase to some extent spee speech speech for foreign speech fore [Music] speech foreign fore foree for speech spech fore speech speech for Fore foree speech fore speech foreign speech [Music] [Music] [Music] forign [Music] foreign [Music] speech foreign foree spee fore [Music] speech [Music] [Music] alas she was found to have a double fista double fista means a whole communicating between rectum and vagina and blading vagina you don't have to be a woman to understand woman's problem if somebody's in continent and cannot control here for fces and urine this is simple to predict what's going to happen to her in the community and in the in the family so to relief such a problem it's very very I mean good good job [Music] I've repaired the platter and now I'm doing the rec [Music] rep [Music] [Music] we are able to close the fista in about 93% of cases we're able to operate on 30 women a week and so we hope this year that we'll be able to do 1,500 operations but we estimate there over 100,000 waiting in the countryside in Ethiopia [Music] alone my husband and I came to Ethiopia in 1959 the previous gynecologist that we replaced said to my husband the fistular patience will break your hearts and that's really what they [Music] did we didn't plan to stay but as we began to cure them of course more and more came to us so we stayed on and I've been here ever since my husband would still be here if he was alive [Music] theee foreign spee for foreign speech spee foreign spee forch speech foreign for [Music] Fore foree fore speech speech speech speee for foreign speech speech fore foreign [Music] chal light a hidden epidemic it's silent epidemic nobody talks about it because it's a problem for poor women it's a problem of woman was 100% preventable lack of good obic service this is the main cause of fistula for a population of 77 million people now in Ethiopia we've only got 146 gynecologists and Obstetricians and most of these are in the cities so the country women are just completely neglected this is a tragedy [Music] fore foreign for Fore speech speech M if there is no any leakage on the bed that means they are dry but up to now she is dry and we hope that she will be [Music] okay foreign foree fore [Music] speech [Applause] [Music] spee fore foreign speech [Music] speech fore foreign foreign [Music] foree speech fore for [Music] speech [Music] foreign [Music] foreign [Music] I'll [Music] [Music] goas [Music] [Music] [Music] okay I mean she's on the E postoperative day and until now she's okay so she will be here I mean for for another week so after that we will check whether the blood is healed or not and the rectum is healed or not if it is okay she will go [Music] home [Music] you [Music] [Music] speech speech and then when she feels the blood full she just pulls this out and the UR comes away foree speee speee speech spee foreign spe speech foreign speech fore she okay usually it's very difficult for these girls to learn how to put these plugs into urethra it's a very small spot to try and a for but she was um got first go first time I've ever seen anyone get it the first guy so I'm sure she'll be able to manage it very [Music] well I for foree speeech [Music] [Music] gu [Music] she's happy I mean I can't explain I have no words I mean I'm happy very very much Happy I mean to make a lady I mean who has been in continent for both urine and fces to make her continent I mean that is a I mean her happiness is a prize that I'm getting now [Music] okay she secur we talk to them about their future we'll tell each patient must get to a hospital for the next baby we give every patient a card with a description of the operation with all the findings so we say when you feel the baby walking inside your stomach you start walking towards the [Music] hospital [Applause] [Music] for [Music] speech foreign spee hey [Applause] [Music] knowe [Music] foree speee [Music] foree fore [Music] foree fore speech fore speech foreign for [Music] foreign foreign speech [Music] forign [Music] [Music] the children are orphans because their parents died of AG [Music] IV we've given bet four children to take responsibility for and we've told the children this is going to be your mom and already in the the little ones you can see that they love for so the bonding is [Music] starting [Music] yes I think just to have some future to look forward to has made her grown up and now she has work to do and she's learning and it makes people grow giving them a responsibility it helps them enormously [Music] sing How Sweet the S that's [Music] light my [Music] was [Music] but I'm [Music] was [Music] just and [Music] I [Music] this this gra [Music] has [Music] me [Music] [Applause] [Music] Nova is a production of WGBH Boston [Music] I am PBS