Understanding stomas
Thanks to fistula surgery, most women who come to Hamlin can return home cured. But for around 8% of patients, the damage caused by obstructed labour is simply too severe. When repair is impossible, urinary diversion surgery and a stoma may be the only way to restore comfort, confidence and independence.
What is a stoma?
In a small number of cases (around 8%), when there has been irreparable damage to a woman’s bladder or urinary tract, Hamlin offers urinary diversion surgery.
This removes a segment of the small intestine to allow urine to be diverted outside of the body via an opening (known as a stoma) in the abdominal wall. Urine is collected in a small pouch attached to the stoma. This must be worn continuously and changed every few days to avoid infection.
How do we help women living with a stoma?
Because it’s irreversible, diversion surgery is a last resort to manage incontinence. It leaves women dependent on supplies and ongoing care to ensure their stoma is managed hygienically.
In the UK, anyone with a permanent stoma can rely on the NHS for regular checkups and medical care. But in Ethiopia, the national health system is not able to offer this advanced treatment and follow-up care.
That’s why Hamlin Fistula Ethiopia provides the surgery, all medical equipment and follow-up care free of charge, including transport to and from hospital for biannual check-ups.
“We must keep our promise”
Tigist has worked as a registered nurse at Addis Ababa Fistula Hospital for sixteen years and supports women throughout their stoma journey.
“Most women coming here for fistula surgery are successfully treated. But if repair is not possible, the last option is to divert the urinary flow to the abdominal wall, where it exits into a stoma bag.
This is an irreversible surgery, so before a woman agrees to it I have to be sure she understands the procedure. Most have never heard of a stoma or what it means to live with one for the rest of their life, which can feel overwhelming.
Previously, many women refused the surgery. But as understanding has improved, more women are open to considering it. Sometimes, we encourage them to go home first, discuss it with their family and take time to make their decision.
After surgery, patients stay in hospital for six weeks to learn how to care for their stoma before returning home. This allows their wounds to heal fully, which is important because life and work in rural areas can be physically demanding.
Three months later, they return for an ultrasound and laboratory tests to check their kidney function. After that, they continue to attend check-ups every six months.
All of this care, from pre-operative counselling and surgery to lifelong stoma supplies, is provided free of charge. Stoma bags are expensive and most of our patients would not be able to afford them.
Patients often worry about whether stoma bags will always be available. They know they will depend on them for the rest of their lives. We must keep our promise to provide them.”
Iman’s story
Iman is a survivor of obstetric fistula whose injuries could not be repaired through standard surgery. In this film, she shares how Tigist helped her make the difficult decision to undergo urinary diversion surgery, a decision that transformed her life.
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