1. Yirgalem hospital (Dr.Zerihun Alemu) -Background: inaugurated in 1968 g.c previously run by Norwegians but currently it's a self run hospital with little informal support from government. 200 beds Serving 4 million peoples 300 k.m south of Addis

2. -The emergency situation Acting referral hospital ~1000-1500 deliveries and ~2000 major operations per year. From Jan -June,2004: -442 normal labours -480 abnormal and complicated labour -57 ruptured uterus cases( 11 death)

3. -The referral situation our referrals are mainly from Sidama zone and the neighboring zones & region which includes Gedeo, Amaro, Burji and wolaita + Oromia region. ~75% of our cases are referrals most labour related referrals present late in the hospital with complicated obstructed labour and commonly ruptured uterus. The referral system is still poor

4. Transport is the main cause for the delay -not available -Very very expensive -Usually lorry on a very bad road -towards our hospital mothers travel an average of 150k.m.

5. HOME (01 day) HEALTH CENTER (06 hour) YIRGALEM HOSPITAL

6. -What can be done Transport should be made available(*) Increasing community awareness(*) Refreshing our health center staff with obstetric courses Strengthening the referral system

7. -Social issues Males can marry many wives Not willing to give blood & accept complication of obstructed labour Fistula cases: -Before treatment -After treatment

8. -The future Fistula hospital with 20 beds We need help to give at least two complete circle help