A fistula is any opening, which does not normally occur, between two cavities lined with epithelium. A vesicovaginal fistula is an opening between the vagina and the bladder. A rectovaginal fistula is an opening between the vagina and the rectum. Either type of fistula is usually a complication of childbirth, caused when the baby’s head presses against the wall of the birth canal long enough to cause necrosis of the tissue. It can also be the result of female genital mutilation or violent rape.
Every year, an estimated 10,000 Ethiopian girls and women are affected by this condition, according to Rebekah Kiser, CEO of Trampled Rose, a not-for-profit rehabilitation center operating in Addis Ababa. The lot of these girls is a miserable one indeed. They are unable to keep themselves clean. In plain language, they stink and draw flies. If they are married, their husbands abandon them. If they are single, they considered unmarriageable. Believed to be cursed, they are ostracized by their communities and even banned from their churches and mosques. Often they are confined to a tiny hut, outside the main family dwelling. There they languish, underfed and neglected, their lives effectively over. Others end up living in the streets, fighting with stray dogs over scraps of food.
We were introduced to one young girl, who refused to be interviewed or photographed, who was there as the result of a knife rape. Rebekah said the condition can also be the result of female genital mutilation, which is still shockingly common in Ethiopia. It can also be the result of early penetration – in one case, as early as two years of age. But, she told me, 99% of the girls developed their condition as a result of childbirth. In most cases the baby dies, as well.
“Some of these girls, when they first come here, are so traumatized they just sit in a corner and rock all day,” Rebekah told me. “We try to keep them as busy as possible.”
Trampled Rose gives these young women a second chance at life. (Rebekah always insists on referring to the girls as “students,” never as “patients” or “clients”). The organization arranges for the girls to have surgery for their condition, and here they learn basic literacy and money management skills, as well as marketable trades such as cooking, sewing, basket weaving, jewelry making, and hairstyling. Most of these girls, Rebekah told me, have literally never held a pencil before coming there.
Currently 30 girls and women reside there, although in the past they have had as many as 70. Rebekah told me that they have never turned anyone away, although some of the girls find the program too demanding and wash out. “I’m not willing to give up my life for someone who isn’t willing to help herself,” she explained.
I asked from how far away do these girls come. Rebekah told me about one young woman who walked barefoot all the way from Somalia, carrying a two-year-old child with her. (The child was suffering from syphilis and cancer and died soon thereafter.)
The rehabilitation program takes one year. After that, Rebakah explained, they help the girls to rent houses – usually four girls to a house – and try to arrange apprenticeships for them. Most of these girls will never be able to return to their natal villages. If they re-marry, Rebekah told me, any children they have would be considered the property of their first husbands.
It was lunchtime by the time my wife Yaa and I arrived, but we toured the grounds and viewed the classrooms, the workshops, and the dormitories. Rebekah told me the girls are taught to maintain scrupulous personal hygiene, and that all their clothing and bedsheets are washed daily. Despite all these efforts, a faint scent of urine hung in the air.
We met Belaynish, who suffered a fistula as the result of female genital mutilation as a young girl (“Too young to remember,” I was told, when I asked). When she arrived at Trampled Rose, she was suffering from a severe infection and had been given two months to live. That was six years ago. It turned out her injuries were too severe to be corrected surgically, but she’s still here, and employed full-time at Trampled Rose as a nanny for the youngest girls and as a cleaner.
After enjoying some delicious lentil stew for lunch (Rebekah told me that between the dietary restrictions of the Muslims, and those of the Ethiopian Coptic Christians, it’s a lot less of a hassle just to serve a vegetarian diet, so that’s what they do) we tried to get the girls to talk about their experiences. None of them would talk about their lives prior to coming to Trampled Rose. Rebekah told me that criticizing one’s own family is strictly forbidden in Ethiopian culture.
Before we left, we met with Manera, age 19, and her friend Melcom, age 15. Rebekah told us that Manera has been with the program for a year, is now reading at a tenth-grade level, and dreams of becoming a teacher. Melcom is looking forward to a career as a hairdresser. Without the help of Trampled Rose, these girls would have no life at all.
To learn more about Trampled Rose and its efforts on behalf of Ethiopian women, click here.
To make a donation, click here.
All photos by author