Fistula hospital continues services for young women

Most describe her as a modern day saint, quietly curing young women of horrific childbirth injuries often caused by bearing babies at far too young an age. However, Dr Catherine Hamlin is the first to admit she is no martyr. The gynaecologist, now 81, performs relatively simple, cheap operations that radically change lives. Every year 100,000 women across the developing world find their lives destroyed by fistula, an injury sustained during difficult, obstructed labour. According to the UN, early pregnancies are the leading cause of death for girls aged 15 to 19 in the developing world. Like female genital mutilation (FGM), fistula and all its horrific consequences have roots in arcane practices, local traditional and taboos. Fistula typically occurs when a teenage girl - pushed into an early marriage - cannot deliver a baby because it is too big for her pelvis. Untreated, it can be fatal and survivors are usually left incontinent for life and unable to bear any children. The United Nations Population Fund (UNFPA) estimates around two million women worldwide live with the problem. In Ethiopia, around 8,000 women each year suffer from the problem, yet less than a third receive any kind of treatment - around 1,200. In most countries, no one bothers to estimate the number of sufferers. "These women are completely neglected," Hamlin told IRIN. "They are young women and it is a preventable injury. They become complete outcasts from their society. In Africa these women have been hiding for centuries and their plight is so sad." The ostracism faced by many women, adds Hamlin, is unimaginable. She often tells the harrowing story of one woman who lived alone in a darkened hut for nine years, unable to move after suffering an agonising fistula that broke her pelvis. Villagers used to shove food into the hut each day, too fearful to enter because of the stench caused by the woman losing control of her bodily functions. The muscles in her legs had diminished. Still, while the problem is widespread in developing countries, teenage births in the West - a growing problem in countries like Britain - haven't seen a similar rise in fistulas. Hamlin notes that it is often poor diet that compounds a fistula and because this is largely a problem in the developing world, it is often overlooked. A woman born in Ethiopia is expected to live to only 44 - a life expectancy half that of a European woman. She will likely marry at age 17 and give birth to six children, not counting those she will lose during pregnancy or within the first five years of life. Only a third of women can read or write, while half will live below the poverty line of US $1 a day. These statistics mean pregnancy and childbirth are risky endeavours for a woman in Ethiopia, where the maternal-death rate is among the highest in the world, adds Hamlin. The women also deliver in a squatting position. There is usually no midwife or medical treatment, and often the baby's head gets stuck. Very often, the baby will be stillborn.

Women at the DOCS centre for victims of sexual violence, in Goma, DRC preparing food for patients. Fistula is often the result of violent rape particularly when women are violated with implements that damage the internal organs. Credit: IRIN

The long labour - sometimes six days - also puts a huge strain on the internal organs, often creating a hole in the bladder or rectum, which is known as a fistula. After the agonies of a complicated childbirth, the women find themselves abandoned by their husbands and forced to live alone because of the stigma attached. "Their plight is terrible - physical suffering and then to have a dead baby," Hamlin pointed out. The other reason these women have suffered in silence, adds the Australian-born doctor, is because of their gender. "If you had 8,000 men with incontinence of urine, something would have been done about them," she frequently notes. UNFPA, who are helping spearhead a campaign to highlight and treat fistula, said a simple operation that costs around $350 can cure the problem and it has a 90 percent success rate. They are working alongside Hamlin to try and train new doctors to tackle fistula. The UN has honoured Hamlin's work. She was awarded the Order of Australia, given the coveted Gold Medal of the Royal College of Surgeons and has been nominated for the Nobel Peace Prize. Despite this, her work often goes unnoticed, even though it is the only hospital in the world dedicated exclusively to victims of obstetric fistula. For the young women, the hospital is an oasis, many sitting chatting to each other or walking among the flowerbeds that adorn and decorate the grounds. It is easy to mistake the grounds for a well-maintained public park, a rarity in Ethiopia, away from the dirt and filth that typify the surrounding neighbourhoods. Even the wards, newly painted and clean, are a world away from the squalor and decrepitude that often mark other Ethiopian hospitals. The hospital, which is run entirely on charitable donations, has also won international acclaim. It has begun an outreach programme that sends teams to train local surgeons in fistula repair. This project has extended the service and philosophy of the hospital to much of sub-Saharan Africa, including Chad, Togo, Uganda and Kenya. More than 100 surgeons from throughout the developing world have also received fistula-repair-surgery training. The first of five new fistula-style hospitals has opened across the country that, Hamlin hopes, will transform the lives of thousands of Ethiopian mothers. Last year the fistula hospital, first opened by Hamlin and her late husband, Reg, in 1974, celebrated its 30th anniversary. In that time, 25,000 women have been cured. One of those women, Mamitu Gashe, first came to the hospital when it opened, suffering an agonising fistula. She is now helping treat young women who arrive daily. Since being trained, she has helped 2,000 young ladies overcome injury. For Mamitu, the work of Hamlin has been vital, not just for her, but for thousands of other women. "No women should have to suffer what I went through because it is easily preventable," she concluded.