The Hamlin Fistula Hospital is well known in Ethiopia. I had first learned of it last year in Kenya when I spent time with Dr. Hillary Mabeya in Eldoret.
Fistula: a narrow passage or duct formed by disease or injury; an abnormal opening between one hollow organ or cavity to another.
Medical people in America know about obstetric fistula, even though they are practically non-existent here thanks to timely Caesarian sections.
For the 3 million sub-Saharan African women with inadequate medical care, obstetric fistula is a life-changing situation. It is estimated there are between 50,000 to 100,000 new cases every year and pitifully few doctors willing to treat it. It is the “by-product” of an uneducated culture firmly rooted in its traditions and maintained thru relentless poverty. Young girls are married off early, often by 14, so as to assure their virginity for a suitable marriage partner. They are frequently treated as second class citizens (domestic violence is not uncommon) and they are prized for their ability to procreate. Far removed from medical facilities and with no prenatal care, it is not unusual for these very young women to be in labor for several days, frequently resulting in death of the fetus. The prolonged and unrelenting pressure of the infant’s head in the birth canal cuts off blood flow to the wall between the bladder and the vagina (or rectum, or both, in some cases), leading to tissue death. This tissue death leads to erosion with “holes” (fistulas) to the neighboring organs. Vesicovaginal fistula is an opening between the vagina and the bladder that allows the continuous and involuntary discharge of urine into the vagina, from where it flows freely out of the body. Rectovaginal fistula, occurring in 20% of the cases, is bowel incontinence thru the vagina. Some women may have both bladder and rectal fistula. With subsequent childbirth, these fistulas often enlarge and get infected. Without treatment, this leads to weakness, cachexia and possible death.
The psychological toll almost defies description. Imagine being an adolescent girl in such an appalling situation! They often restrict liquids and food to decrease the seepage, resulting in marked malnourishment and kidney disease. They are shunned by their husbands who frequently leave them, and their own family members view them as offensive. It is not unusual for them to be sequestered in small outlying huts with limited personal contact. They are so poor that they use whatever rags they can find to absorb the soiling, then wash, reuse, wash, reuse. Eventually they may present to the fistula hospital with extreme leg contractures /foot drop from having spent months, even years curled up in a ball, thinking, erroneously, that this would encourage healing. It is estimated that 500,000 women die every year due to fistula and its complications.
The Hamlin Fistula Hospital was founded by Australian born obstetricians and gynecologists Reginald Hamlin and his wife Catherine in 1974 in Addis Ababa. While treating a broad range of obstetric situations they set their focus on fistula repair and perfected a surgical technique with a high success rate. Their hospital has continued to grow, thanks to generous funding by private donors as well as World Vision, Ethiopia Aid and the Fistula Foundation in Santa Clara, CA.
 |
| Catherine Hamlin, a very, very wonderful woman |
Today the Fistula Hospital can accommodate 140 patients, has 4 operating rooms and 3 physicians. It has also created 5 birth centers in outlying areas, each with its own doctor. In 2006 it established the School of Midwifery with the intent of training midwives to manage difficult births in the countryside. Each midwife commits to 5 years of this work upon certification from the program.
In 2004 Catherine Hamlin appeared on the Oprah Winfrey Show to discuss her 50 years of service to the women who suffer with fistula and the 25,000 surgical repairs that were done at her center, all at no cost to the patients. In 2005, so impressed with Dr. Hamlin’s actions, Oprah visited her hospital in Addis and taped a second segment, which elicited an outpouring of donations from her many fans; enough to add a new wing and classrooms.
I had made an appointment to visit and was invited to come by in the early morning, outside of the regular “touring hours”. I approached the main station and saw Catherine Hamlin in a lab coat and white skirt, starting to gather the nurses around her. After a quick introduction, she asked me to sit down beside her. She did a short Bible reading and then spoke from the heart, out loud, in Morning Prayer. She asked for divine help in healing the women of her beloved Ethiopia, that they be given strength to endure the hardships and that their children may come to know an even better life than the ones their mothers have. After an “Amen” the nurses dispersed to attend to the 40 post-op beds and 8 recovery beds in the large ward. Catherine started to chat with me at length about her life. I felt very honored that she made herself so available for conversation.
She and her husband Reginald had leased then bought the original multi-acre site for their hospital. After being donated a neighboring lot, they expanded the center to include a state -of-the-art physical therapy dept. (tunturi bicycles, treadmills, weights, etc), a counseling office, occupational workshop with knitting, sewing and weaving, a large dining hall and a teaching center with classrooms for education and nurses-aide training. After half an hour, she asked Sister Yalemtshaye (Ethiopian for “Sunshine”) to show me around. The entire compound was the epitome of charm thanks to Catherine’s great love of flowers, and roses in particular. It was like a lush tropical resort. I watched gardeners gently plucking faded blooms off verdant shrubs as we walked on stony paths from one small building to another, all laid out with that element of surprise: what will I see around this next corner? The main office was a large tiki-style hut with a thatched roof. The hospital wing was clean and sparkling and fresh with windows open to the sunshine. I could hear gentle subdued voices in the distance but they only enhanced the feeling of being in a private area. Sister Sunshine took me to the kitchen where 8 Ethiopian ladies were starting to prepare lunch. She handed me a warm yeast bun straight from the oven rack and poured me some tea (for which Ethiopia is famous). Sister Sunshine had worked here almost 40 years and would be retiring soon; she wasn't sure what she would do with her free time.
Catherine had trained some of her fistula –survivors to become nurses aides; this was their first opportunity for employment (since most are illiterate, they cannot be certified by the state).
A disturbing complication that was being seen more frequently was girls coming in with cut ureters, post- C-section . She said it was due to new young doctors being careless with their scalpels...pardon me? These are tricky to repair, said Sister Sunshine.
A disturbing complication that was being seen more frequently was girls coming in with cut ureters, post- C-section . She said it was due to new young doctors being careless with their scalpels...pardon me? These are tricky to repair, said Sister Sunshine.
 |
| A delightful day with Catherine Hamlin and Sister "Sunshine". I purchased a hand woven basket sold in their small handicraft store. All proceeds go directly to the patient who created it. |
