‘A Fulfillment’: Local Physical Therapist Leads Childbirth Injury Care Training In Ethiopia

On the first morning of a trip to Ethiopia last winter, Christina Lee woke up in the guest house where she was staying and walked into the courtyard.

Lee — an Orleans resident with a physical therapy practice in Chatham — was in the country in February to spend a week training staff at a hospital specialized in treating childbirth injuries. 

Gathered and talking to each other within the courtyard of Addis Ababa Fistula Hospital that first morning were patients. They stood in puddles of their own urine. They were completely incontinent. 

Lee had read books and watched documentaries about the hospital in advance of the week, but she had never personally evaluated women with the level of childbirth injury— obstetric fistula (an opening between the birth canal and bladder or rectum) — as encapsulated in that moment.

“To see them be able to be laughing and socializing and not worrying about shame or being embarrassed because of what they're experiencing, because they're in a place where everybody understands was really, really moving,” Lee said. “The staff would just come by and really respectfully clean the floor and not say anything and not shame them, just really support them in a really beautiful way.”

The week in Addis Ababa training physical therapists, nurses and midwives at the obstetric fistula hospital was, in many ways, a full-circle trip for Lee. She was back on the African continent for the first time since 2014, when she’d served in the Peace Corps teaching children in Burkina Faso. It was there that a fifth grade student of Lee’s became pregnant, propelling her into the world of reproductive health.

Lee went on to become a pelvic floor physical therapist. Owing to her time in Burkina Faso, she volunteered for an organization called the Worldwide Fistula Fund, eventually joining the board a few years ago. The board had a partnership with Addis Ababa Fistula Hospital — a training program for urogynecology surgery fellows, physical therapists, nurses and other staff. The opportunity and need arose for Lee to join in order to provide more training.

“When I decided I wanted to go into pelvic floor PT, I set a goal for myself that I wanted to use that skill set back in Africa in some way, and so it was really a fulfillment of that goal to be able to go back,” Lee said.

Lee left Boston for Ethiopia on Feb. 6, joining up upon her arrival with co-instructors Tracy Spitznagle, a professor of physical therapy at Washington University in St. Louis, and Joshua Olinga, a Ugandan physical therapist Lee had helped to train. Over the course of six months leading up to the trip, the three had been teaching online lectures to the group they’d be working with at the hospital.

“We had some relationships already,” Lee said. “We taught kind of the basics, like this is what the anatomy is, the background science, and then when we got there, it was all hands-on, how to apply it.”

Addis Ababa Fistula Hospital was opened in 1974 by Australian surgeon Catherine Hamlin and her husband Reginald Hamlin, also a surgeon. They had originally arrived in Ethiopia for a temporary medical mission, only to realize that obstetric fistula was a devastating problem in the country. The Hamlins made Ethiopia their home, creating the specialty hospital that became the worldwide leader in treating the childbirth injury.

Dozens and dozens (possibly more than 100) languages are spoken in Ethiopia, which is one of two African countries to have not been colonized by European powers. The primary language in Addis Ababa is Amharic.

“A lot of their traditions are really well preserved in ways that's a little bit different from other parts of Africa where I've traveled,” Lee said. “So most of their indigenous languages are still spoken. Most of their indigenous culture and dances are still celebrated. The weather was beautiful, so to leave Cape Cod in February and get somewhere where it's 75 degrees and not humid was lovely. And people were overall really friendly and welcoming to us and we really, really had a great experience.”

With the number of different languages spoken by the nation’s population, though, communication became one distinct obstacle for Lee. Often, speaking with a patient necessitated a four-way translation. Say a patient spoke a local tongue and the Ethiopian physical therapist working with Lee spoke a different one. Lee would say something in English to the trainee, they would translate that into Amharic to another hospital doctor or physical therapist who knew the patient’s language, and that staffer would interpret Lee’s original statement — already translated once — to the patient.

That was a practical difficulty. There was also the emotional challenge of being surrounded by people with struggles far beyond anything Lee sees working on the Cape — a pull she also felt during her Peace Corps days.

“It was a familiar feeling of this helplessness, like I am here, and I'm feeling really good about the work that we're doing, but it's just getting such a small piece of what really needs to be done, and trying to keep myself out of that feeling of being overwhelmed by the amount of work that still needs to be done and trying to just stay present in the moment and appreciate what I'm able to do,” Lee said.

A closing ceremony in which all of the instructors and students received certificates marked the end of the trip. The medical director of the facility delivered a speech, and then each student, unprompted, stood and talked about what they had learned and drawn from the experience. 

One said the week completely transformed their practice. Another expressed a sentiment regarding how Lee’s group challenged and trained them in a way outside the colonialist mindset exercised by previous visiting European physical therapists. “No one ever gave me permission to use my brain before,” that student said.

“I think that is the thing that I'm most proud about — about the training — is that they really felt empowered, and that's absolutely the goal,” Lee said.