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Report on a physiotherapy visit to Ethiopia

Thursday 19 Apr 2018 {{NI.ViewCount}} Views {{NI.ViewCount}} Views

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Catherine Hamlin Fistula Foundation

Doctors Reg and Catherine Hamlin established the Addis Ababa Fistula Hospital in 1974 and it continues to thrive in 2018. In addition to offering quality, holistic care to women who have experienced devastating childbirth trauma, the hospital is also active within the FIGO fistula surgery training initiative. Physiotherapists Selam Aregawi and Muluken Agumas lead a team of aides at the hospital and Hamlin’s five centres throughout Ethiopia. There is emerging evidence on the positive impact of pre and post-operative physiotherapy with women who are undergoing repair of vesico-vaginal fistula, as reported in earlier ICS News items https://www.ics.org/news/379 and https://www.ics.org/news/475).

I visit Addis Ababa annually to support the physiotherapy team with their continuing professional development and to participate in the Urogynaecology Fellowship education programme. In 2018 Selam and I spent a productive week producing a manual for the physiotherapy and nurse aides, to be introduced later this year when aides from the outreach centres will be invited to Addis Ababa for a week of theoretical and practical training. In addition, there was the day-to-day physiotherapy for inpatients, including those whose rehab needs are addressed before and after their fistula repair surgery.

Ethiopia Medical Project

Ethiopia Medical Project (EMP) is a registered charity based in Scotland, which funds a pelvic organ prolapse service in the Buccama Clinic, Soddo, Ethiopia. Donations cover all service running costs and the purchase of equipment and consumables.

My involvement with the clinic was a stroke of serendipity. The charity was mentioned during a radio phone-in, and a quick Google search led me to their website via which I contacted one of the founders, Jo Middlemiss. The nurse-led clinic assesses women with pelvic organ prolapse and staff may fit a ring pessary if indicated. Some women are referred for a gynaecological opinion in the nearest town. Until now, women have not been advised on pelvic floor muscle exercises, so Jo was happy to accept my offer of a visit this year during my annual trip to Ethiopia, which I arranged to coincide with her stay at the clinic.

Buccama Clinic is situated near Soddo in south-central Ethiopia, a bumpy 45-minute drive from the nearest road. Despite this remote situation, it serves a rural population of more than 20,000. My accommodation was in the adjacent Franciscan convent. During my 3-day visit I had the opportunity to talk to staff about pelvic floor muscle (PFM) function, assessment and exercises, and gave preliminary advice to large groups of local women (see photo) who were attending because of symptomatic pelvic organ prolapse and other gynaecological dysfunctions. Each woman was then seen individually and examined to assess not only their prolapse, but also their PFM function. Since my visit was short and training time limited, we agreed that the women they assess who can correctly contract the muscles will be given advice on a simple programme of PFM exercises three times a day, plus appropriate guidance on lifting and other activities of daily living. Those who cannot actively contract, or do it wrongly despite guidance, will be told not to practice PFM exercises. Not ideal, but perhaps the safest option in the circumstances.

Jo and Maureen from the EMP charity, clinic head Sister Haimanot, and all the staff there are an inspiration offering an excellent service to the local population. Since my visit, I have sent them a simple teaching programme for current and future staff and, who knows, I might pop down to Soddo during another visit to Ethiopia!

Gill Brook, co-opted member of the ICS Physiotherapy Committee and President of the International Organization of Physical Therapists in Women’s Health.

Photograph provided by Gill Brook.

For further information

Catherine Hamlin Fistula Foundation https://hamlin.org.au/

Ethiopia Medical Project https://www.ethiopiamedicalproject.com/

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