July 21, 2014
Once a year, an extraordinary international medical event takes place, an event that puts women's health ─ and women's quality of life ─ front and center in Gimbie, Ethiopia.As they have for several years, Renée Edwards, M.D., MBA, associate professor of obstetrics and gynecology, OHSU School of Medicine, Rahel Nardos, M.D., adjunct assistant professor of obstetrics and gynecology, OHSU School of Medicine and W. Thomas Gregory, M.D., associate professor of obstetrics and gynecology, OHSU School of Medicine, led a team of OHSU health-care providers, nurses and surgical medical students to Gimbie, in February.
There, in partnership with Gimbie Adventist Hospital, they provided free surgeries to women with urogynecological issues, especially pelvic organ prolapse. Dr. Nardos, who grew up in Ethiopia, is a leading force behind the nonprofit Footsteps to Healing, which supports and coordinates the trips and the surgeries.
Dr. Nardos and Dr. Edwards, a co-director of the OHSU Center for Women's Health, this year led a diverse team – which included three surgeons, two nurses, two surgical technicians, two anesthesiologists and three residents – who performed almost 50 advanced pelvic prolapse surgeries in just 10 days.Team unloading supplies.
If that sounds like a rigorous schedule, it's not one that bothers this team.
"I never imagined I would be educated in the U.S.," says Dr. Nardos, who holds a clinical position at Kaiser Permanente in Portland as well as a faculty appointment at OHSU. "But for some reason things kept falling into place. So I now have access to medical skills and treatments that are out of reach for most people in Ethiopia." For her, it was natural to help give back to her community.
Dr. Edwards says she is honored to be part of this program. “We are so lucky in the West,” she says. “We are so lucky just to have been born here” and to have access to top health and wellness care. “I also feel grateful to have my surgical skillset, and I think that should be shared.”
Pelvic-floor prolapse is a silent epidemic among Ethiopian women, deeply affecting the quality of their lives. Pelvic-floor muscles can be damaged during protracted childbirth where there is limited health care. In extreme cases, the damage can result in pelvic organs like the bladder, the bowel and the uterus to “prolapse” out of the body through the vagina. In addition, Ethiopian women experience a lifetime of strenuous physical activity—typically working 13 or 14 hours a day carrying wood and water over mountains—which makes the condition much worse.
“A surgery to fix a prolapse costs about $200 in Ethiopia,” says Dr. Nardos, “but that’s 10 years’ income” for a family in rural Ethiopia. And while pelvic-organ prolapse may not immediately cost a woman her life, say both doctors, it absolutely affects her quality of life, including her bodily functions as well as her ability to be intimate with her partner.
So Dr. Nardos, Dr. Edwards and Dr. Gregory lead these trips each year, with assistance from OHSU colleagues, including residents who assist in as many as six surgeries a day. “These residents participate in more pelvic-floor surgeries in one day than they sometimes would in an entire surgical rotation,” Dr. Nardos says.
The trip earlier this year offered some new twists. The team arranged with a dressmaker in Gimbie to make dresses of local fabric and in a style fashionable among local women, so each patient received a dress as well as a pair of locally made earrings along with her surgery. “We were happy to help the local economy in this way—and the patients really loved their dresses!” Dr. Edwards says.
The doctors also have some exciting news. The Gimbie program has been so successful that they are in talks to expand the program to a university hospital in the northern part of Ethiopia, College of Health and Sciences at Mek’ele University. The team hopes that this new collaboration will allow OHSU providers not only to provide much needed service but also build health care capacity by teaching local providers, building on the successes in Gimbie.