After a lifetime devoted to Ethiopia’s social outcasts, the fistula women, Catherine Hamlin is close to realising her dream to put a midwife in every village.
Catherine Hamlin has been dubbed “the new Mother Teresa of our age” and “the angel of Ethiopia”, but speak to her sister and there’s a stifled giggle as memories come flooding back. “Let’s just say she was not what you’d call a placid child,” Ailsa Pottie says of their childhood in Ryde.
“She was full of mischief, always in strife and had plenty of ideas when it came to leading her five siblings astray. We are all terribly proud of her but when I remember what she got up to as a child, it does seem odd to think she’s a Nobel Peace Prize nominee, doesn’t it?”
Hamlin, now 84, is not making much mischief these days. She’s too busy putting the finishing touches to the Hamlin Midwifery College in Ethiopia’s capital, Addis Ababa, a project she hopes will produce a midwife for every village in the impoverished nation, saving hundreds of thousands of lives and fulfilling a dream she has harboured for 50 years.
The journey began when Hamlin and her obstetrician husband, Reg, answered an advertisement in The Lancet medical journal to set up a midwifery school in 1959.
“As a medical student I thought I must go and help somewhere in the world but [Ethiopia] was Reg’s idea,” Hamlin says. “The contract was only for three years, but we were so struck by the plight of the women that we stayed a lifetime.”
Many of those women had walked for days through rugged ravines and badly eroded tracks, some so ill they had to be carried by relatives, to seek help for horrific childbirth injuries.
“I had never seen injuries like that before,” she says. “Our hearts broke at the sight of these women and what they were experiencing, and we knew we could not ignore it.”
The injuries, called fistulas, are caused when a baby’s head becomes stuck in the birth canal, sometimes for up to five days. The baby usually dies, but its skull rubs a hole through the mother’s bladder or rectum, causing uncontrollable urinary and faecal incontinence. The injury can only be fixed with surgery. In the developed world, episiotomies and caesarean sections have all but eradicated fistula injuries, but in countries such as Ethiopia, more than 9000 women a year, usually those giving birth alone in remote villages and provinces, fall victim.
Women with fistulas are shunned by their husbands and families because of their smell, and are often forced to live in small huts away from others.
“They have no clothes, no underpants, nothing,” Hamlin says. “They have to put a banana leaf between their legs because they have no way of stopping everything pouring out. Their plight is one of terrible sorrow. They hide away and don’t want to mix with the villagers.
“Other village women say, ‘You’re smelling, you’ve got a disease, please keep away.’ They are not allowed to go to markets or the river with the others so they have to creep out at night. It is a terrible life of isolation and ostracism.”
The West’s last dedicated fistula hospital closed its doors due to lack of need in New York in 1895. In Sweden, the government put a midwife in every town in 1876 and halved the maternal death rate within six months. By 1920 fistulas had been eradicated in England.
The Hamlins, refusing to leave the women suffering, founded a fistula hospital in Addis Ababa in 1974, operating on about 1500 women a year, restoring them to good health, and offering education or work to those who were too bady injured to return to their villages.
“The women kept coming and we kept mending them,” she says.
“But eventually we realised we were making no difference to the numbers. If anything, we were seeing more and more women as the years went by because the population exploded … But what happens to the others? Do they live with the problem? Or do many die of infection? We knew we had to get out to the villages, but we just didn’t have the resources.”
Hamlin and her husband went on a tireless merry-go-round to seek funding, holding out the hat wherever they went, organising charity events, entreating governments, becoming “professional beggars”.
It worked. Their hospital, and five new centres being built in the provinces across Ethiopia, are now receiving financial support from across the globe, including a recent donation of more than $US3 million ($3.25 million) from Oprah Winfrey’s television show viewers and $2 million last week from Australia’s overseas aid program, AusAid.
Money well spent, according to Alexander Downer, Australia’s former foreign affairs and trade minister, who describes Hamlin as one of the “most beautiful, wonderful people you’ll ever find”.
“I could not speak more highly of anyone else on this earth,” he says. “She is saintly, a brilliant example of humanity and an Australian who has made an enormous difference out there in the world.”
Hamlin had been receiving a token grant from AusAid when Downer and his daughters sat down together to watch a television show one Sunday night on the Addis Ababa hospital. “My daughters turned to me and said, ‘Oh Dad, you must give that woman more money.’ The next morning I rang AusAid and increased her grant to $1 million and I’m very, very glad I did.”
Sue Ndwala, World Vision Australia’s maternal and childhood health adviser, has worked with Hamlin on joint projects and calls her “a doggedly determined woman who has had her head on this issue her whole life”.
“People listen to her,” agrees her colleague Joseph Kamara, World Vision Australia’s country program director for Ethiopia. He visited Hamlin last year and found her enchanting. “The issue has always been there but she’s put in on the table. She has a way with people.”
Indeed, she has. Her determination to open a midwifery school has finally come full circle, with the college accepting its first 12 students two months ago, the girls hand-picked from 12th grade classrooms in the north, south and east of the country. They will undergo a three-year diploma in midwifery and return to their villages to practise.
“There’s no point in sending someone from the city out to the country,” Hamlin says. “They won’t stay. We wanted girls who were committed to staying in their own villages because that’s where we need help.”
The students are living in temporary housing with bunk beds, a kitchen, laundry and a house mother, but Hamlin expects to move them into purpose-built accommodation before the next 20 students arrive at the end of the year.
After graduation, they will have access to health centres in each province, including radio phone support from the Addis Ababa hospital. “The midwives will be diagnosticians. Not only will they will able to deliver normal babies but they will able to diagnose when a woman is likely to get into obstructed labour,” she says.
“Five per cent of all women go into obstructed labour, no matter where they are living. It has nothing to do with being African. But a good midwife can detect when a woman is going to have an obstructed labour and can often help turn the baby before the birth if it is laying transversely. Or they can get them to a health centre where they can stay until labour begins and have a caesarean section.”
The visionary plan is music to Hannah Dahlen’s ears. The child of missionary parents, she spent six months living in Ethiopia in 1970 and has seen first hand the horror of fistulas. Now secretary of the NSW Midwives Association, she calls Hamlin “an amazing woman because she’s helping women help themselves”.
“For too long we’ve gone into other countries and imposed our ways on them, then left them in a worse state,” Dahlen says.
“Upskilling locals is the only way to sustain health changes, but she does more than that. She pulls these untouchables back into society which is magnificent from a physical perspective but also a cultural and societal angle.”
For Hamlin, the next few years are crucial.
“If we can make a success of this, maybe someone like [Microsoft founder] Bill Gates will step in and flood Africa with midwives,” she says. Her eyes glow. “That’s ambitious, but I don’t care. I see these little girls arriving, after having walked for days, and to save one life is worth it. To give a woman back her normal life is wonderful.”
As soon as Hamlin finishes this whirlwind trip home to generate financial support and reconnect with family, she will be on a return flight to the mud-brick home she and Reg built by the river. It’s the end of the harvest season in Ethiopia and men, finished in the fields, have time and energy to walk or carry their damaged daughters and wives to Hamlin’s door.
“A few Saturdays ago we had 17 women show up in one day,” she says. “Eight in the evening and we had no beds, nothing. We have hostels in the grounds because there isn’t always a hospital bed and you can sleep two to a bed if you have to, with both wetting the bed, but it’s better than being on the street.”
Years of experience have taught her that while there is always one more beseeching face of anguish, one more life to mend, some cannot be saved.
“If a woman has a bad fistula and cannot have more children [the belief is that] there is no point in her being alive. Her whole point in life is to produce children and look after her husband and be his slave. It’s the end for them if they’ve got this terrible problem,” she says, her face darkening.
“Two years ago we had a little girl in the hospital who had horrible injuries. She was plaiting wool day after day and we wondered what she was making. Then we found out. It was a rope to hang herself with on the hospital veranda.”
Hamlin is passionate about educating girls to prevent them being forced into child marriage, rife across Ethiopia.
“Many are betrothed at the age of eight or nine. [Until she reaches puberty] she’ll be a slave in the mother-in-law’s house doing all the hard work. All her energy will go into hard work so she’s usually stunted and small and she’s the last one in the family to be fed because she’s a girl,” Hamlin says.
“Everyone thinks if we do away with early marriage, we’ll able to stop fistulas and women dying in childbirth, but I don’t agree. Many of them do have obstructed labours because their pelvises are small, but children in the countryside are small anyway because of a lack of enough food. We won’t stop early marriage until we put something in its place, like education, and give these girls more options.”
She admits the fulfilment of her dream, to have a midwife in every village, could take another 100 years, and she knows her time is limited, but Hamlin’s quiet confidence is fuelled by a deep spirituality.
“I do believe this is a God-given job. I know I’m there for a reason and I love being there.”
Now a grandmother to four, Hamlin was described in her Sydney University year book in 1946 as “sincere, understanding and [someone who] lives up to her high ideals. We are sure her good influence will always be widespread.”
Her sister, Ailsa, laughs when she hears this. “She turned out to be quite good, didn’t she?”
Source: The Sydney Morning Herald – 29 March 2008