CHANGING LIVES IN Published in the Southern Highland News, Bowral, on October 18, 2004

Former Bowral resident Dr Andrew Browning is helping to change the lives of thousands of African women through his work at Fistula Hospital, an Ethiopian-based hospital set up to help women suffering from obstetric fistulas. JANE SEHLMEIER spoke to Dr Browning on a recent visit back home to the Southern Highlands.

Imagine you're a woman living in rural Ethiopia, you've just spent several days in painful obstructed labour without access to a doctor and have subsequently given birth to a stillborn child. Worse still, around two to three days after you've given birth and still grieving for your dead child, you notice urine and faeces starting to drip uncontrollably down your legs. Unbeknownst to you, the pressure of your baby's head on your pelvis during labour has killed the tissue and caused a hole to form between your bladder, rectum and vagina. Wherever you walk you leave a trail of urine and faeces behind you, you smell, and as a result of all this you end up abandoned by your husband, rejected by your community, and forced to live in isolation. Former Bowral resident Dr Andrew Browning meets women living in such horrendous conditions as this almost every day of his life- and he's part of a medical team helping to turn their lives around. Dr Andrew has spent the last three and a half years living and working at the Fistula Hospital; an Ethiopian-based hospital treating women who have developed a condition known as . A fistula occurs when a woman goes into obstructed labour and is unable to deliver her baby because her pelvis is too small or the baby's head is too big. In Australia, this problem is diagnosed within minutes and usually ends with a caesarian and survival, but in countries like Ethiopia, where a doctor is often a five day walk away, a woman can end up in labour for what can be up to 10 days before the baby dies. Because of the pressure of the baby's head on the surrounding tissue during birth, the blood supply is cut off to the tissue and it eventually falls away, leaving the woman with a hole, or a fistula, between her bladder, vagina and rectum. The result is the continuous drip of urine and faeces- and subsequent social isolation for the woman. "Because of the smell, the shame and so forth they live as outcasts for the rest of their lives, living in a little room or a hut away from their village where they will stay for the rest of their lives, without any social contact whatsoever," Dr Andrew said. Unless, of course, these women hear about the Fistula Hospital, and through simple surgery can be cured of their condition. The hospital, which was started by Australian obstetricians Drs Reginald and Catherine Hamlin in 1974, has cured more than 25,000 women with the condition. "It's quite a unique hospital, it's the only hospital in the world dedicated to treating women (for) obstetric fistula," Dr Andrew said. Following in the footsteps of his father, local obstetrician-gynaecologist Dr David Browning, Dr Andrew trained as a doctor in Australia and began his involvement with the African nations by spending some of his time as a medical student working in Tanzania and the Rwandan refugee camps. While working with his aunt's aid organisation in Ethiopia in 1996, Dr Andrew was first offered a job at the Fistula Hospital, and he came back to Australia to complete his /obstetrics training, as well as some theological training, so he could take on the job. These days, Dr Andrew is the only world lecturer in fistula surgery and has lectured and operated in a number of other third world countries including Chad, Uganda, Congo, Togo, India and Bangladesh. He is about to publish a paper in international medical literature for the 10th time, and has presented papers at a number of international conferences, receiving a standing ovation at one conference in Colorado, USA. However, none of these achievements compare to the satisfaction he feels from working in one of the world's poorest countries and helping to change the lives of women with fistulas. "The work is very rewarding; it's one of the few operations you can do as a doctor that literally transforms someone's life from being a total outcast," he said. "It's just a miserable existence for them, they often wish they'd died in the labour rather than survived, so you operate on them and you cure it, and people are transformed. Every day you see these girls beaming and dancing for joy because they're cured...We had a lady recently come by camel from Somalia who'd been operated on four times for her condition and just wanted to kill herself, she was so miserable. She traipsed across the desert just in hope of a cure, she came and she was cured and when I was sending her home she actually fell at my feet, kissed my feet and said 'I love you next to God, please have my daughter'. You get that every day here." His experience working outside of Ethiopia in other countries has also challenged and strengthened the strong Christian. "I remember one girl, this beautiful girl was raped in Congo by four soldiers who put a gun inside her vagina and had the trigger pulled," he said. "She had awful injuries but she was cured, and she was so happy...and I asked her how can you be so happy when you've been through such an awful ordeal, and she said 'Everywhere I've gone God's just provided people to care for me and look after me.' Seeing that sort of contentment and joy in the face of such awful suffering has to impact on you. It makes you much more content with what you have, and thankful that you've got so much." For the time being, Dr Andrew looks settled into life in Ethiopia and work at the Fistula Hospital. He met and married his bride Stephanie in Ethiopia just over 18 months ago, and both are committed to staying in the country for some time yet. However, with two million women suffering from obstetric fistula in developing nations around the world, Dr Andrew may be looking to expand his vision in the near future. "I'll be staying in Africa, I certainly feel as a Christian God brought me to Africa to work there and work with these women," he said. "Whether I stay at this hospital or whether I go out and start another one is something I'm continuing to pray about... there's so much need everywhere else it would be good to go to other areas." If you would like to hear more about Dr Andrew Browning's story and his work at the Fistula Hospital, St Jude's church is hosting a public discussion meeting on Wednesday, November 10 at St Jude's Anglican Church, Bowral, at 7.30pm

THE WORK OF THE FISTULA HOSPITAL AND FISTULA FOUNDATION The Fistula Hospital was established in the Ethiopian capital of 30 years ago by Australian obstetrcians/gynaecologists Drs Reginald and Catherine Hamlin. Pioneers of the surgical technique to repair fistula's, the work of the couple has helped to restore the lives of more than 25,000 women who would have otherwise suffered lifelong complications from injuries such as obstetric fistula. With Dr Catherine Hamlin today continuing work at the hospital after her husband passed away, the hospital provides free fistula repair surgery to approximately 1,200 women every year. The hospital also provides long-term care for women who cannot return to their villages, trains other surgeons to safely provide fistula repair surgery to other women throughout the developing world, and supports the growth of outreach and prevention programs across Ethiopia. The work of the hospital is supported through the Fistula Foundation, a non-profit corporation dedicated to the treatment and prevention of obstetric fistula by supporting the work of the Fistula Hospital. Much of the hospital is funded through donations and if you are interested in donating to this cause, you can do so by donating to the Hamlin Fistula Relief and Aid Fund — P.O. Box 965, Wahroonga, NSW 2076, AUSTRALIA, (02) 98752530 or by visiting www.fistulatrust.org.