Dr. Catherine Hamlin
25th October 2009
Helen Dalley: Dr. Catherine Hamlin is remarkable Australian who has devoted her life to some of the most needy people on our planet. 50 years ago on a visit to Ethiopia to train midwives, she and her late husband were appalled at that country\u2019s lack of obstetric care. They made it their life\u2019s work, specialising particularly in the treatment of the awful maternal injuries from complicated births known as fistulas. And they established the Fistula Hospital. Now in her eighties and still performing surgery, Dr. Hamlin\u2019s just been honoured by the International Right Livelihood Foundation, whose awards are known as the Alternate Nobels. I spoke to her this week.
Helen Dalley: Yes, it\u2019s a great award. Now you and your husband went to Ethiopia in 1959 to train midwives, and you virtually have given your heart and your professional lives to that country since then. That\u2019s 50 years ago.
Dr. Catherine Hamlin: Yes, even worse, because our population has exploded to 80 million, and it was supposed to be 20 million when we came. So the number of patients coming to us has increased enormously.
Helen Dalley: Dr. Hamlin, you and your husband established a fistula hospital to help women who suffer problems after childbirth. Now most Australians don\u2019t even know what fistula means. How serious are these problems that these women suffer?
Dr. Catherine Hamlin: This is a terrible injury for a young woman or an older woman or any woman to suffer. It\u2019s due to long, obstructed labour. A fistula is just an opening from an internal organ to the outside of the body. And the fistula we\u2019re treating is from the bladder to the birth passage or the vagina, and/or very often from the rectum to the vagina as well. So imagine a young girl who\u2019s looking forward to her first baby, a young woman, and she may be 18, 19 or early 20s, and she gets into obstructed labour. And she labours for days, delivering a stillborn baby eventually and being left with this injury.
Helen Dalley: So these are not things that women in Australia suffer from, this is obviously a developing country, a poverty kind of issue. But what happens to these women and girls if they don\u2019t get treatment for fistulas? What happens to them in their villages, in their families?
Dr. Catherine Hamlin: Yes, I will tell you that. But I will tell you that fistulas were all over the world until not too long ago. And so it\u2019s not anything to do with the women of Africa being different. It\u2019s due to a small pelvis or a mal-position of the baby inside the woman. And it reduces a woman to abject poverty, shame, sorrow and ostracism from the rest of her community. She\u2019s leaking urine, and 20 percent are leaking bowel contents as well. And imagine her trying to live in a small hut, a small house with perhaps two rooms, with a husband who doesn\u2019t know what\u2019s happened. He will desert her. She\u2019s smelling. She can\u2019t work in the house, she can\u2019t be a wife to this man any more. And she is ostracised from her whole community, partly from shame, partly because the other members of the village think that she\u2019s got some disease. And they will keep away from her. They won\u2019t allow her to go to the well to draw water, to go to the market to buy food. She lives a lonely, terrible life of isolation, cut away from everything that makes her happy, because of this preventable injury.
Helen Dalley: So their husbands and villages even, whole villages disown them and cast them out. You mentioned small pelvises, but is the problem that they perhaps have too many babies? Or is it more that they have perhaps the malnourished frames, or their bodies are even too young to give birth and so they cannot easily bear a child?
Dr. Catherine Hamlin: That\u2019s a wonderful description. We have many women that have had three or four babies normally and had a family, and then get a fistula. Many of those women of course die if they get into obstructed labour from a ruptured uterus, where the uterus just bursts like a paper bag, and they bleed to death very quickly. If they don\u2019t get a ruptured uterus, they\u2019re left with a fistula, because the baby in the uterus must be in a bad position. She\u2019s had babies through the pelvis, so it\u2019s not the bones of the pelvis. It\u2019s the baby in a bad position, perhaps lying crosswise with the arm hanging out, or breach coming, or part of the head that can\u2019t be born easily without some help. And these are the main causes of fistula. And she is left with this injury. She may be a young girl of 18, 20, or even an older woman in the forties who\u2019s had children and then got a fistula. So it can occur at all ages of their childbearing life.
Dr. Catherine Hamlin: Yes, that is exactly what we do. It\u2019s sometimes simple, if it\u2019s a small hole and there\u2019s no scar tissue. But it can be the most challenging of surgery. You\u2019re operating really like in the toe of a boot. You have instruments of course to put in the vagina and you can cut the vagina open, but the scar tissue and the destruction of the nerve supply to the bladder and to the urethra, it makes some operations extremely difficult. Some operations we can do in half an hour to an hour; others take four to five hours.
Helen Dalley: So Dr. Hamlin, you have helped something like 30,000 plus women in your hospital since you started, but you\u2019re obviously doing surgery after they get the problem. But you said before that it\u2019s preventable. Now will it occur again every baby they have? Or can your work actually prevent it from happening in the first place?
Dr. Catherine Hamlin: This is what we hope will happen. Sweden put a midwife in every village in 1875 and halved their maternal death rate. They were worried about the number of women dying in labour. If we put a midwife, a well trained midwife in every village, we could prevent this fistula. We could eradicate fistulas from Africa. This is an enormous task. We have started the midwifery college, we\u2019re training girls we\u2019ve taken from the countryside, not from the city of Addis Ababa, because they would never go back and stay in the countryside. We\u2019ve taken them from the very village areas where they come from, from the high schools. They\u2019re 12th grade students who\u2019ve done well and they have been interviewed, they\u2019ve been asked, would you like to help the women in your area to have safe deliveries? And they\u2019re committed to work for us and to go out into the countryside. It\u2019s a three year course. Then they\u2019ll be trained not only as birth attendants to deliver normal babies, but to diagnose when a women is likely to get into obstructed labour. And we\u2019re so excited that at last after all these years we\u2019ve started something towards prevention.
Dr. Catherine Hamlin: They marry younger than that, but they don\u2019t get pregnant till puberty, which is often late in a woman that\u2019s malnourished. And they\u2019re small for their age. They may have a baby at 15. The youngest I have seen is 13, but I believe some have been 12.
Helen Dalley: Now you are in the midst of building five new mini fistula hospital centres as we understand it, in other centres in Ethiopia. Did you have to raise the money for yourselves from donations? Are governments helping you, or do you need more from individuals?
Dr. Catherine Hamlin: We\u2019ve got four centres running beautifully. One centre was completely funded by the Australian government, AusAID, and our own Trust in Sydney. We have a fifth centre being built at the moment which is being funded, certainly some funding from the Dutch Foundation that we\u2019ve set up to raise money, and from others. And that will be open we hope in January or February. The midwifery school, we were very, very excited when Stephen Smith came to our college and visited that college and gave us a huge donation. I don\u2019t know whether I\u2019m supposed to say how much, but it was a very large sum. And we\u2019re so excited. And he said to me when we were leaving, there\u2019s more from where that came from.
Helen Dalley: That\u2019s very good news! Now you\u2019ve also had a lot of help from ordinary Australians donating both money and the knitted squares for the patchwork blankets that your patients are wrapped in. What\u2019s your most urgent need from Australia now?
Dr. Catherine Hamlin: It\u2019s money for our midwifery college. Next year we\u2019ll be deploying our midwives; the first group after this three years, they will complete their training in possibly September next year. We will deploy them into the countryside from where we took them, so when we do this of course we\u2019ll need a lot of money.
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