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Major funding for NOVA
is provided by the following:
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Supporting NOVA and promoting
public understanding of science.
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Funding for "A Walk
to Beautiful" is provided by:
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00:00:37,913 --> 00:00:39,814
And by the following:
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And additional funders:
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Major funding for NOVA
is also provided
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for Public Broadcasting
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and by:
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(rooster crows)
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00:01:16,551 --> 00:01:18,085
MOTHER:
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DAUGHTER:
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MOTHER:
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00:02:07,335 --> 00:02:11,539
AYEHU:
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00:02:42,437 --> 00:02:44,672
AYEHU'S MOTHER:
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00:02:55,784 --> 00:02:57,384
AYEHU:
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FIKRE:
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00:04:51,666 --> 00:04:52,866
AYEHU:
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00:04:52,934 --> 00:04:53,801
FIKRE:
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00:04:53,868 --> 00:04:55,369
AYEHU:
20
00:04:55,437 --> 00:04:57,204
FIKRE:
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00:04:57,272 --> 00:05:00,941
AYEHU:
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00:05:01,009 --> 00:05:02,776
FIKRE:
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00:05:05,213 --> 00:05:07,281
FIKRE:
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(rooster crowing)
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MOTHER:
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00:06:00,235 --> 00:06:02,102
AYEHU:
27
00:06:13,681 --> 00:06:15,416
MOTHER:
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00:06:17,218 --> 00:06:20,421
AYEHU:
29
00:06:21,389 --> 00:06:24,958
MOTHER:
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00:06:38,907 --> 00:06:43,477
(women singing unaccompanied)
31
00:07:30,124 --> 00:07:31,225
(music stops)
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00:07:39,400 --> 00:07:42,169
(bus motor humming)
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00:07:54,048 --> 00:07:57,050
(men and women conversing)
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(horns honking)
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(no voices)
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00:10:01,916 --> 00:10:06,086
DOCTOR:
These women are not welcome
in a general hospital.
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00:10:06,154 --> 00:10:09,623
They can't often get in because
of the tremendous pressure
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00:10:09,691 --> 00:10:12,759
on the hospitals
for other, more urgent, things.
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00:10:12,827 --> 00:10:14,861
Also they're not welcome
because they're smelling
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00:10:14,929 --> 00:10:16,763
and they're poor,
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00:10:16,831 --> 00:10:20,200
and they're often turned away
by the guard at the gate.
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00:10:20,268 --> 00:10:21,868
This is really why
we built the hospital.
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00:10:32,847 --> 00:10:34,114
MAN:
44
00:10:34,182 --> 00:10:36,583
AYEHU:
45
00:10:36,651 --> 00:10:37,584
MAN:
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00:10:37,652 --> 00:10:38,285
AYEHU:
47
00:11:03,111 --> 00:11:06,480
(patients laughing)
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00:11:52,493 --> 00:11:53,927
DR. HAMLIN:
Some help is needed
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00:11:53,995 --> 00:11:56,530
when the baby can't be born
in the usual 12 hours
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00:11:56,597 --> 00:11:59,933
that it takes to have a baby.
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00:12:00,001 --> 00:12:02,202
Usually it's due
to a small pelvis
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00:12:02,270 --> 00:12:05,906
or a malposition of the baby
inside the mother's uterus.
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00:12:07,842 --> 00:12:10,177
DR. HAMLIN:
It occurs all over the world.
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00:12:10,244 --> 00:12:13,246
In five percent of all labors,
help is needed.
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00:12:25,993 --> 00:12:27,394
DR. GETANEH:
56
00:12:27,462 --> 00:12:28,628
AYEHU:
57
00:12:28,696 --> 00:12:30,497
DR. GETANEH:
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00:12:30,565 --> 00:12:31,431
AYEHU:
59
00:12:31,499 --> 00:12:34,501
DR. GETANEH:
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00:12:38,739 --> 00:12:40,106
AYEHU:
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00:12:41,843 --> 00:12:43,276
DR. GETANEH:
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00:12:43,344 --> 00:12:44,678
AYEHU:
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00:12:49,484 --> 00:12:50,851
AYEHU:
64
00:12:50,918 --> 00:12:53,620
DR. GETANEH:
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00:12:53,688 --> 00:12:55,155
AYEHU:
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00:13:04,665 --> 00:13:07,300
DR. HAMLIN:
She starts labor,
and she expects
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00:13:07,368 --> 00:13:09,302
to be perhaps delivered
by the evening
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00:13:09,370 --> 00:13:11,505
if it's the morning,
early morning.
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00:13:11,572 --> 00:13:13,740
But the day goes by and
she hasn't had the baby.
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DR. HAMLIN:
The village women encourage her.
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The second day goes by,
and even a third and fourth.
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00:13:28,189 --> 00:13:30,323
Up to ten days, I've had
a woman in labor.
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00:13:30,391 --> 00:13:36,196
By that time, the little girl
is exhausted, dehydrated,
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00:13:36,264 --> 00:13:39,366
and she finally pushes out
a dead baby.
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00:13:39,433 --> 00:13:42,402
But she wakes up
to a worse horror.
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00:13:42,970 --> 00:13:43,870
DR. GETANEH:
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00:14:17,805 --> 00:14:22,409
DR. HAMLIN:
Every time the uterus contracts,
it pushes that baby's head
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00:14:22,476 --> 00:14:24,945
against the bone of the pelvis.
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00:14:25,012 --> 00:14:28,048
The blood supply of that area
is cut off.
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00:14:28,115 --> 00:14:32,185
So that lump of tissue
that's being squashed will die,
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00:14:32,253 --> 00:14:35,589
and it just drops out.
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00:14:35,656 --> 00:14:38,825
So this means that she's lost
some of her bladder
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00:14:38,893 --> 00:14:41,094
or some of her rectal wall.
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00:14:48,002 --> 00:14:51,471
FEMALE DOCTOR (in English):
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00:14:55,743 --> 00:14:58,712
In the countryside,
being a woman
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00:14:58,779 --> 00:15:02,282
is being able to be a wife,
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00:15:02,350 --> 00:15:05,585
bear a child, too, you know,
and have a family.
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00:15:23,971 --> 00:15:27,140
DR. HAMLIN:
The husband, he says,
"You go back to your family."
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00:15:27,208 --> 00:15:30,010
He'll just send her off
with a bundle on her back.
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00:15:30,077 --> 00:15:32,045
They run out to welcome her,
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00:15:32,113 --> 00:15:34,781
thinking that she's
coming home with a baby,
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and they find her in this state.
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00:15:38,085 --> 00:15:41,021
Her life is ruined.
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00:15:41,088 --> 00:15:43,890
So they'll build her
a little hut outside,
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00:15:43,958 --> 00:15:47,060
and there she will stay
till death,
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00:15:47,128 --> 00:15:49,896
unless she hears
that she can be cured.
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00:17:34,735 --> 00:17:37,370
DR. HAMLIN:
Most peasant women
in the developing world
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00:17:37,438 --> 00:17:38,838
have to do all the hard work.
99
00:17:41,609 --> 00:17:44,110
They have to do the cooking,
the grinding of the corn,
100
00:17:44,178 --> 00:17:46,646
collecting of the water
from the well,
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00:17:46,714 --> 00:17:49,415
carrying sticks from the forest.
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00:17:49,483 --> 00:17:54,587
So, all her energy has gone into
work instead of into growth.
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00:17:54,655 --> 00:17:57,390
She hasn't had enough
nourishment.
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00:18:14,608 --> 00:18:16,843
KENNEDY:
If we take someone
like this little girl,
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00:18:16,911 --> 00:18:20,380
what has happened is,
at the age of two,
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00:18:20,447 --> 00:18:24,217
she started carrying
a jar of water.
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00:18:24,285 --> 00:18:25,785
he of eight,
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00:18:25,853 --> 00:18:29,189
she's carrying something
that I can't lift.
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00:18:29,256 --> 00:18:33,026
But all those years, she's
been eating a good diet,
110
00:18:33,093 --> 00:18:34,594
but not enough calories.
111
00:18:34,662 --> 00:18:37,664
What happens is
she grows short.
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00:18:37,731 --> 00:18:41,067
Now, if I stand, you'll
just see how short she is.
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00:18:41,135 --> 00:18:42,669
And I'm an average height.
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00:18:42,736 --> 00:18:44,971
I'm five-foot three.
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00:18:45,039 --> 00:18:48,474
A girl, especially a girl
in the countryside,
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00:18:48,542 --> 00:18:50,076
they are too small
for their age.
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00:18:52,513 --> 00:18:55,982
So, if she gets pregnant
at the age of 14,
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00:18:56,050 --> 00:18:59,619
definitely, the baby will be
too big for her pelvis
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00:18:59,687 --> 00:19:01,988
to pass through during delivery,
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00:19:02,056 --> 00:19:05,325
so she will end up
in obstructed labor.
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00:19:14,935 --> 00:19:18,371
WUBETE:
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00:19:43,330 --> 00:19:46,499
(young women repeating
words after instructor)
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00:20:22,469 --> 00:20:23,703
DR. WOLDEMICHAEL:
They usually think
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00:20:23,771 --> 00:20:26,439
they are the only person
in the world who leaks urine.
125
00:20:26,507 --> 00:20:32,078
So being at Fistula Hospital
is a part of psychotherapy.
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00:20:32,146 --> 00:20:34,280
They discuss their problem
with other women.
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00:20:34,348 --> 00:20:37,817
They start to understand
that there are other women
128
00:20:37,885 --> 00:20:40,653
with the same kind of problem.
129
00:20:40,721 --> 00:20:44,824
DR. HAMLIN:
So this is very important,
to nurse them together.
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00:20:44,892 --> 00:20:47,493
And they have a social life
together.
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00:20:47,561 --> 00:20:49,162
We see them talking.
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00:20:49,229 --> 00:20:51,164
They feel at home.
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00:20:51,231 --> 00:20:53,499
They feel they're not
being ostracized
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00:20:53,567 --> 00:20:55,268
from their society.
135
00:20:55,336 --> 00:20:57,937
And they're loved,
and they feel welcome.
136
00:20:58,005 --> 00:21:00,807
So, this is where
the healing process starts--
137
00:21:00,874 --> 00:21:03,776
of the mind,
and this is very important.
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00:21:49,089 --> 00:21:52,492
ANESTHETIST:
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00:22:17,117 --> 00:22:18,851
DR. HAMLIN:
We've got this girl
with her whole life ahead,
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00:22:18,919 --> 00:22:20,286
and if she's not cured,
141
00:22:20,354 --> 00:22:25,124
it's going to be a misery
and a horror to her forever.
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00:22:30,064 --> 00:22:34,300
DR. HAMLIN:
This is the fascination
of fistula surgery--
143
00:22:34,368 --> 00:22:37,470
to make a new life for
a young girl that's suffered
144
00:22:37,538 --> 00:22:41,407
more than any woman should be
called on to endure.
145
00:23:42,669 --> 00:23:47,373
DR. HAMLIN:
We leave her with a catheter
draining for 12 or 14 days,
146
00:23:47,441 --> 00:23:49,342
and we hope that she's going
to be able
147
00:23:49,409 --> 00:23:51,344
to pass urine normally.
148
00:24:08,228 --> 00:24:11,430
(insects chirruping)
149
00:24:11,498 --> 00:24:14,834
(rooster crows)
150
00:24:29,016 --> 00:24:31,517
NURSE:
151
00:24:39,660 --> 00:24:44,363
WUBETE:
152
00:25:53,400 --> 00:25:56,535
(reading quietly)
153
00:25:57,437 --> 00:25:59,372
DR. TAFESSE:
154
00:26:11,551 --> 00:26:13,786
(in English):
155
00:28:32,826 --> 00:28:35,594
WUBETE:
156
00:31:26,633 --> 00:31:29,201
DR. AYTENFISHU:
157
00:32:46,746 --> 00:32:48,047
NURSE:
158
00:32:58,692 --> 00:33:03,395
DR. HAMLIN:
We are able to close the fistula
in about 93% of cases.
159
00:33:04,931 --> 00:33:08,300
We're able to operate
on 30 women a week,
160
00:33:08,368 --> 00:33:11,170
and so we hope this year
that we'll be able to do
161
00:33:11,237 --> 00:33:15,007
1,500 operations.
162
00:33:15,075 --> 00:33:18,677
But we estimate that there are
over 100,000 waiting
163
00:33:18,745 --> 00:33:22,314
in the countryside
in Ethiopia alone.
164
00:33:28,455 --> 00:33:34,493
My husband and I came
to Ethiopia in 1959.
165
00:33:34,561 --> 00:33:37,730
The previous gynecologist
that we replaced
166
00:33:37,797 --> 00:33:39,231
said to my husband,
167
00:33:39,299 --> 00:33:42,334
"The fistula patients
will break your hearts."
168
00:33:42,402 --> 00:33:43,535
And that's really what they did.
169
00:33:50,910 --> 00:33:54,279
We didn't plan to stay,
but as we began to cure them,
170
00:33:54,347 --> 00:33:59,384
of course more and more came
to us, so we stayed on
171
00:33:59,452 --> 00:34:01,620
and I've been here ever since.
172
00:34:01,688 --> 00:34:03,889
My husband would still be here
if he was alive.
173
00:34:28,348 --> 00:34:29,882
SISTER AZEB:
174
00:34:31,518 --> 00:34:33,519
WUBETE:
175
00:34:37,423 --> 00:34:40,659
SISTER AZEB:
176
00:35:13,893 --> 00:35:16,328
SISTER AZEB:
177
00:35:42,355 --> 00:35:45,424
SISTER AZEB:
178
00:36:19,092 --> 00:36:21,760
Fistula, it's a hidden epidemic,
a silent epidemic.
179
00:36:21,828 --> 00:36:23,662
Nobody talks about it.
180
00:36:25,565 --> 00:36:28,267
Because it's a problem
of poor women,
181
00:36:28,334 --> 00:36:30,369
it's a problem of women...
182
00:36:30,436 --> 00:36:34,373
but it's 100% preventable.
183
00:36:34,440 --> 00:36:36,441
Lack of good obstetric service--
184
00:36:36,509 --> 00:36:39,511
this is the main cause
of fistula.
185
00:36:42,148 --> 00:36:47,152
DR. HAMLIN:
For a population of 77 million
people now in Ethiopia,
186
00:36:47,220 --> 00:36:51,623
we've only got 146 gynecologists
and obstetricians.
187
00:36:51,691 --> 00:36:54,393
And most of these
are in the cities.
188
00:36:54,460 --> 00:36:58,530
So, the country women are
just completely neglected.
189
00:36:58,598 --> 00:37:00,299
This is a tragedy.
190
00:37:31,864 --> 00:37:33,765
NURSE:
191
00:37:39,339 --> 00:37:40,539
SISTER EJIG:
192
00:38:03,129 --> 00:38:05,230
AYEHU:
193
00:38:24,017 --> 00:38:25,884
AYEHU'S MOTHER:
194
00:38:58,418 --> 00:39:02,020
(clapping hands and singing)
195
00:39:02,088 --> 00:39:04,189
AYEHU:
196
00:39:40,827 --> 00:39:46,898
AYEHU:
197
00:40:55,535 --> 00:40:59,704
Okay, she is on the eighth
postoperative day
198
00:40:59,772 --> 00:41:01,506
and until now, she's okay.
199
00:41:01,574 --> 00:41:06,444
So she will be here
for another week.
200
00:41:06,512 --> 00:41:08,280
So after that, we will check
201
00:41:08,347 --> 00:41:09,447
whether the bladder is healed
or not
202
00:41:09,515 --> 00:41:11,383
and the rectum is healed or not.
203
00:41:11,450 --> 00:41:13,118
If it is okay, she will go home.
204
00:41:21,827 --> 00:41:23,161
PATIENT:
205
00:41:40,646 --> 00:41:44,616
(women singing unaccompanied
in background)
206
00:42:08,541 --> 00:42:10,242
And then when she feels
her bladder full,
207
00:42:10,309 --> 00:42:11,910
she just pulls this out...
208
00:42:11,978 --> 00:42:14,179
and the urine comes away.
209
00:42:14,247 --> 00:42:16,648
SISTER AZEB:
210
00:42:21,988 --> 00:42:23,555
WUBETE:
211
00:42:23,623 --> 00:42:26,157
SISTER AZEB:
212
00:42:31,063 --> 00:42:32,130
WUBETE:
213
00:42:32,198 --> 00:42:33,798
SISTER AZEB:
214
00:42:42,942 --> 00:42:43,908
Is she?
215
00:42:43,976 --> 00:42:44,876
Okay.
216
00:42:53,953 --> 00:42:56,588
DR. BROWNING:
Usually it's very difficult
for these girls to learn
217
00:42:56,656 --> 00:42:58,823
how to put these plugs
into their urethra.
218
00:42:58,891 --> 00:43:01,493
It's a very small spot
to try and aim for.
219
00:43:01,560 --> 00:43:03,028
But she was good at first go.
220
00:43:03,095 --> 00:43:05,730
First time I've ever
seen anyone get it
the first go,
221
00:43:05,798 --> 00:43:08,300
so I'm sure she'll be able
to manage it very well.
222
00:43:18,511 --> 00:43:20,845
WUBETE:
223
00:43:23,282 --> 00:43:26,785
SISTER EJIG:
224
00:43:26,852 --> 00:43:27,485
WUBETE:
225
00:43:28,854 --> 00:43:30,789
WUBETE:
226
00:45:00,212 --> 00:45:01,246
She's happy.
227
00:45:01,313 --> 00:45:03,081
I mean...
I can't explain it.
228
00:45:03,149 --> 00:45:05,083
I have no words.
229
00:45:05,151 --> 00:45:06,918
I mean, I'm happy,
very much happy.
230
00:45:06,986 --> 00:45:11,189
To make a lady, I mean,
who has been incontinent
231
00:45:11,257 --> 00:45:14,459
for both urine and feces,
to make her continent,
232
00:45:14,527 --> 00:45:18,396
I mean, that is...
her happiness is a prize
233
00:45:18,464 --> 00:45:19,864
that I'm getting now.
234
00:45:19,932 --> 00:45:21,132
Okay?
235
00:45:21,200 --> 00:45:25,570
(women singing)
236
00:45:32,077 --> 00:45:36,047
DR. HAMLIN:
As soon as they are cured, we
talk to them about their future.
237
00:45:36,115 --> 00:45:37,682
We tell each patient,
238
00:45:37,750 --> 00:45:41,286
"You must get to a hospital
for the next baby."
239
00:45:41,353 --> 00:45:43,321
We give every patient a card
240
00:45:43,389 --> 00:45:45,757
with a description
of the operation,
241
00:45:45,825 --> 00:45:47,158
with all the findings.
242
00:45:47,226 --> 00:45:49,694
So we say, "When you feel
the baby walking
243
00:45:49,762 --> 00:45:53,798
inside your stomach, you start
walking towards the hospital."
244
00:47:00,566 --> 00:47:01,866
ALMAZ:
245
00:47:31,964 --> 00:47:35,133
(women singing Ethiopian song)
246
00:48:12,471 --> 00:48:18,376
WUBETE:
247
00:49:28,814 --> 00:49:30,748
WOMAN:
The children are orphans
248
00:49:30,816 --> 00:49:34,018
because their parents died
of H.I.V.
249
00:49:36,188 --> 00:49:37,922
We've given Wubete
250
00:49:37,990 --> 00:49:41,292
four children to take
responsibility for
251
00:49:41,360 --> 00:49:44,762
and we've told the children,
"This is going to be your mom."
252
00:49:44,830 --> 00:49:48,332
And already in the little ones,
you can see that they love her,
253
00:49:48,400 --> 00:49:50,635
so the bonding is starting.
254
00:50:11,123 --> 00:50:13,991
(laughing)
255
00:50:17,963 --> 00:50:20,832
I think just to have some
future to look forward to
256
00:50:20,899 --> 00:50:22,633
has made her grown-up,
257
00:50:22,701 --> 00:50:25,369
and now she has work to do
and she's learning
258
00:50:25,437 --> 00:50:29,941
and it makes people grow,
giving them responsibility.
259
00:50:30,008 --> 00:50:31,809
It helps them enormously.
260
00:50:33,846 --> 00:50:39,817
WOMAN:
(with African instruments):
Â♪ Amazing grace
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Â♪ How sweet the sound
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Â♪ That saved a wretch
like me... Â♪
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Â♪ I once was lost
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Â♪ But now I'm found Â♪
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Â♪ Was blind
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Â♪ But now I see.
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Â♪ Through many dangers
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Â♪ Toils and snares
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00:51:48,620 --> 00:52:00,531
Â♪ I have already come...
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Â♪ This grace has brought me
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Â♪ Safe thus far
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Â♪ And grace...
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On NOVA'"A Walk to Beautiful"
website,
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00:52:21,020 --> 00:52:23,054
go behind the scenes
with the producer,
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00:52:23,056 --> 00:52:24,956
test your understanding
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00:52:24,958 --> 00:52:28,259
of women's health issues
worldwide, and more.
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00:52:28,261 --> 00:52:30,228
Find it on PBS.org.
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00:52:34,299 --> 00:52:38,002
Captioned by
Media Access Group at WGBH
access.wgbh.org
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00:52:48,680 --> 00:52:53,117
This NOVA program is available
on DVD at shopPBS.org,
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00:52:53,119 --> 00:52:53,117
or call 1-800-PLAY-PBS.