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Giving Hope to Rural Women with Obstetric Fistula in Ethiopia the World Is More Aware of the Problem of Obstetric Fistula Thanks to the Work of Catherine Hamlin

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Giving Hope to Rural Women with Obstetric Fistula in Ethiopia the World Is More Aware of the Problem of Obstetric Fistula Thanks to the Work of Catherine Hamlin News Giving hope to rural women with obstetric fistula in Ethiopia The world is more aware of the problem of obstetric fistula thanks to the work of Catherine Hamlin. The Australian gynaecologist and obstetrician talks to Fiona Fleck. Q: What is an obstetric fistula? A: This is a condition which occurs Catherine Hamlin has devoted her life to providing when a woman is in labour for four or repair surgery for obstetric fistula in Ethiopia. She five days. The bony head of the baby graduated in medicine at the University of Sydney presses on the pelvis for so long that a in 1946 at the age of 22 and subsequently gained hole develops between the vagina and qualifications in gynaecology and obstetrics. She and the bladder or between the vagina and her late husband, Dr Reg Hamlin, first arrived in Ethiopia the rectum, resulting in urinary or faecal to train midwives in 1959, but soon became aware of incontinence. It’s possible to prevent this the problem of obstetric fistula among women living injury by delivering the baby by caesar- Hamlin Courtesy of Catherine ean section. But in Ethiopia there are in rural areas. After providing repair surgery for many not enough doctors in the countryside years in Ethiopian hospitals, they co-founded the Addis able to do this operation. Women with Ababa Fistula Hospital in 1974. Today it is a global centre of expertise and trains this condition are completely ostracized surgeons from all over the world. Hamlin has been internationally recognized from society, their husbands leave them, for her work as a pioneer in fistula surgery techniques, has won many accolades they have no friends, because of the and, in 2010, a life-time achievement award from the Ethiopian president and smell of urine or faecal matter that leaks. Ethiopian citizenship, in 2012. She describes her life’s work in a book: The hospital Women who live with this for months, by the river: a story of hope. even years, often have suicidal thoughts. Repairing this childbirth injury gives them new hope and new life. trained at the American University in the urologists, and they helped us. One Q: When you first arrived in Ethiopia, you Beirut, and we didn’t have medical train- urologist used to come regularly from had never seen a case of obstetric fistula ing at the university in Addis Ababa un- England and we would keep the urologi- in your life. How did you learn to perform til 1966. We had a good nursing school cal procedures to be done by him. He surgery that had become obsolete in the with tutors from overseas, so we were also trained several of our Ethiopian developed world? well equipped with nurses. doctors in this particular operation. We A: There were things written about had a lot of visitors passing through. We obstetric fistulas. We knew several doc- Q: At that time, in the 1960s and 1970s, had a good Ethiopian surgeon who was tors who had been repairing them. We you were innovative in your field, but a great help, he was the godson of the had a great friend in England who used how did you keep up with medical Emperor Haile Selassie and had studied to go to India to operate and we got in knowledge before the digital age? in Edinburgh. touch with him. We also had manuals, A: We had medical journals com- drawings of the actual operation from a ing, friends passing through, our doctors Q: One of your colleagues once said: “It’s wonderful Cairo-based professor Pasha had trained overseas. We had Australian difficult to find a surgeon who is highly Naguib Marfouz, he was a great help to gynaecologists who came to work at skilled enough to perform fistula surgery us. We used to talk to him, we didn’t get the Princess Tsehai hospital and several but also has the drive to work in poor to meet him, but we learned from his English ones working in other medical countries.” What has driven you to do textbooks. We are gynaecologists, so we fields, including an English physician this work for all these years? are used to operating for other things, and a Czech surgeon. A: My husband was also driven. We such as stress incontinence, so we were came together with the same agenda to quite familiar with the anatomy, and Q: Fistula surgery is complex; spanning help people in a developing country and we soon learnt. We started with small the boundaries of urology, plastic sur- we felt motivated to come. I believe it fistulas which any gynaecologist can fix gery, colorectal surgery and gynaecol- was from God that we felt this urge to without much training, and gradually ogy. How did you succeed in providing come. I just love the work and I love the tackled more difficult ones. such sophisticated tertiary care in a people. I did not feel I was marginalized developing country, where primary care or that I was missing out on anything. Q: What was it like to be a fistula surgeon is often seen as the priority? In those days, Addis Ababa was quite in Ethiopia in the 1960s? What were the A: We didn’t start with the difficult an exciting place to be, we had a big in- challenges in finding qualified staff and cases, we started with cases that we ternational community which included adequate medical supplies? could do. Once we were successful in many doctors. A: We were in a hospital that was curing these, we gradually took on the very similar to the ones in Australia. difficult ones. As you say, it involves Q: You were invited by the government We did not find it primitive in any way. urology and so many other fields in to work in Addis Ababa on a three-year The Princess Tsehai Memorial hospital medicine apart from gynaecology, but contract in 1959 and have not left the had good doctors. These doctors were we were able to talk to our colleagues, country since. How did you manage to 724 Bull World Health Organ 2013;91:724–725 | doi: http://dx.doi.org/10.2471/BLT.13.031013 News continue working through all the turbu- Q: In your book, you say your work is Q: Are things going in the right direction lent years of revolution, conflict and war? important but that it’s more important given that the campaign to end fistula A: We did live through a bad period to prevent fistula in the first place. Why has been going on since 2003, WHO clini- but we couldn’t have left. Who would run isn’t more done to prevent this terrible cal management guidelines for obstetric the hospital? Who would look after these childbirth injury? fistula have been issued and the Interna- women? They kept ringing us to say, “The A: In the cities in Ethiopia you tional Federation of Gynaecology and last plane out is tomorrow night, are you never see an obstetric fistula because Obstetrics, the International Society of ready?” My husband and I said, “No, there are doctors there. Of course that’s Obstetric Fistula Surgeons and others we are not leaving, we are going to stay the answer. The gynaecologists deal have published the first guidelines on here.” The professor of pathology was an with it. The countryside hospitals are obstetric fistula repair surgery? Englishman, he and his wife came to stay almost denuded of doctors; many of A: There is certainly more aware- with us for a while in our home built in them have left the country. We need to ness of the problem of obstetric fistula the grounds of the fistula hospital. We raise the salaries and living conditions and knowledge as to how to deal with had a bad time with bullets and things for rural doctors. Our midwifery col- it in the world today, but these initia- flying about. One landed on the sofa in lege was set up to prevent fistula. We tives are not making much of a differ- our living room. The headmistress of the could flood the country with midwives ence in Ethiopia in terms of preventing English school rang me to say, “Are you but, even if we did, where should they the problem. I hear that things have coming up to shelter in the British Em- refer somebody who needs a caesarean- improved in Kenya and [the United bassy grounds?” I said “No, I am staying section? We’d have to set up operating Republic of] Tanzania. The problem of here at the hospital.” And then a bullet theatres in every antenatal clinic and get obstetric fistula can be prevented with came shooting through the roof and midwives to do caesarean-sections, but the provision of better transport in rural landed just where I had been sitting on there is so much more to just doing a c- areas for women who are about to give the sofa and I told her, “I think you saved section than just taking the baby out by birth and good maternal health-care my life, you made me get up and come to a surgical procedure. The woman may services. Ethiopia is a difficult country the phone.” It was only a spent bullet, it lose a lot of blood or have an eclamptic for transportation. It’s a very beautiful wasn’t aimed at me. We were restricted, seizure. The midwife must have a gyn- country of great contrasts, full of moun- we couldn’t leave Addis Ababa without aecologist somewhere, to whom she can tains and deserts, and the population is a permit, we had to go through check- refer cases.
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