OBSTETRIC FISTULA

Obstetric fistula  is a devastating medical condition which affects mothers during childbirth. There’s no subtle description for it: a fistula (hole) develops between the birth canal and either the bladder or rectum (or both), and is usually caused by days of obstructed labour without adequate medical care, when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to the surrounding tissues. 

Nearly all affected women are afflicted with urinary and/or faecal incontinence, foul smelling discharge, irritation and infections, as well as suffering stillbirth and ensuing infertility. If that wasn't traumatic enough, as they are unable to control their flow of urine, the result is an offensive odour that they are unable to rid themselves of. Most women are then sadly abandoned by their husbands and families, and ostracised from their communities. It is the social isolation, stigma and loss of dignity that leaves the most damaging scars – the unimaginable suffering these poor, humiliated women endure is truly heartbreaking. 

Obstetric fistula is not a pretty story, but it is such an important one to tell, as it is almost entirely preventable. It is considered a disease of poverty because of it’s tendency to occur in women in poverty-stricken countries, such as sub-Sahara Africa, who do not have the health resources like we are so fortunate to have here in Australia.

DR CATHERINE HAMLIN AC

Described by The New York Times as a modern-day "Mother Teresa", the remarkable Australian obstetrician Dr Catherine Hamlin is a two time Nobel Peace Prize nominee, and now at 92 years of age, has selflessly devoted almost her entire life to healing mothers in Ethiopia, suffering from obstetric fistula.

Dr Hamlin arrived in Ethiopia in 1959, with her now late husband Reg Hamlin, to set up a midwifery school; but they were so taken with the fistula patients they met (an affliction they had never encountered before), that they stayed and founded the Addis Ababa Fistula Hospital together in 1974. 

Hamlin Fistula Ethiopia (Australia) is an Australian charity dedicated to supporting Dr Hamlin's work and her network of healthcare facilities; including over 550 Ethiopian staff servicing six hospitals, a rehabilitation centre and the Hamlin College of Midwives. There are currently 34 rural health centres staffed by Hamlin midwives. Midwives in these centres are preventing hundreds of maternal and neonatal deaths and are saving many mothers from suffering devastating childbirth injuries. 

So far over 50,000 African women have received free medical treatment, counselling and loving care   – all funded purely on philanthropic donations from generous donors.

"I shall call her Enatanesh, a common name in Ethiopia. It is evening. She crouches by the fire burning in the centre of the hut, somewhere out in the country far from the nearest town, preparing food for her husband. Three cows, their entire wealth, stand and chew their cud quietly in the shadows. Outside the hyenas howl.

There is barely enough was to feed them. Enatanesh and her husband break off pieces of injera which they use as a scoop. As ever Enatanesh takes the smaller portion, and when the meal is over they are both still hungry. They accept this as normal. A little hunger is better than starvation, which they have experienced all too often when famines ravage the countryside.

Enatanesh could be fourteen or fifteen, I have seen them younger, but lets say she is seventeen – married for a year and pregnant with her first child.

After finishing the meal they do not stay up. They are exhausted from their long day working the little plot where they grow a few vegetables, perhaps some sugar cane and the tef for the injera. They have no books. They could not afford such things and, anyway, they are illiterate. They build up the fire, check the door to see that the cattle are secure, wrap themselves in their blankets and curl up on the mat to sleep.

In the middle of the night Enatanesh feels her first contractions. She welcomes them but she is also afraid. She knows that childbirth may not be easy. She has heard bad stories. She tries not to think about them and faces the coming ordeal with fortitude. For better or worse it must be endured, for she is a woman and without children she is nothing.

By morning the contractions are coming at closer intervals. Her husband lets out the cattle and drives them off for the day. Before he leaves he alerts his mother. The mother is experienced in these matters. She tells her daughter-in-law to get out of bed and crouch. It will help the baby to be born. All that day Enatanesh squats, straining in agony, but the baby does not come.

Her husband is not an unkind man. That night when he comes in from the fields, he enquiries after his wife's well-being. He does not put his arm around her or hold her hand. Such displays of affection would be inappropriate. Still, he is concerned, and his thoughts are for her.

By morning she is very weak. her mother-in-law gives her a sip of water and counsels her to squat once more. Somehow she manages to crawl out of bed and do as she is advised.

The day wears on. It seems the pain will never end. It is constant now. But the baby, obstinately, still does not want to be born.

On the morning of the third day the child inside her dies. Enatanesh knows it with certainty. Yet the contractions continue. Four days. Five. In the late afternoon of the sixth day she feels a change. The baby is coming. It is coming. Grimacing with effort, her eyes screwed tight, she pushes. And screams. And the child is expelled – a dead little being, who will never know the world. A tear trickles down Enatanesh's cheek. She rolls herself in her blankets and sleeps the sleep of utter exhaustion.

Late next morning she wakes. But what has happened? The bed is wet and smelling. With alarm she sees that she is lying in urine. Her first instinct is to hide the shame. Perhaps if she keeps absolutely still, with her legs together, whatever has happened inside her will heal before her husband comes home. She pulls her knees up and lies on her side. She prays to God to make her whole.

But there is no hiding her condition. Despite the difficulty of keeping herself clean, the sorrow of losing her baby and the shame of her condition, she tries to be brave, to greet her husband with a smile and prepare his meals. But it is no use. She is ill, weak and wretched. Soon he moves out.

The long, obstructed labour has left Enatanesh with terrible internal injuries. She stays like this, forlorn and alone for months. Or years. Or a lifetime. She is fit only for work in the fields. The village women shun her. She is abandoned to her shame.

Sometimes in her unhappiness Enatanesh asks, 'Why has this happened?' She believes she is cursed by God for some misdemeanour, and that only a miracle can cure her. She is unaware that far away in Addis Ababa, the capital, there is a place where healing is possible.

Most likely she spends the rest of her life in misery. But occasionally her story ends with joy. Somehow she hears about the hospital. Somehow she begs the fare or persuades a relative to take her on the long, frightening journey to the unimaginable confusion of the capital.

The hospital is quiet and clean, set amongst flowers. People treat her with kindness. She is bathed and experiences the strange luxury of a soft bed with clean sheets. And the miracle she has hardly dared to believe in happens. After a time she returns home, cured, to begin life anew.

In various versions I have heard Enatanesh's story 20,000 times. Each one is part of my story."