After 50 years, Dr Hamlin is still fighting to end fistula in Ethiopia

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Addis Ababa, 24 May 2014 (WIC) -  On International End Fistula Day, an Australian gynaecolgist shares her experiences of a lifetime working to improve the lives of women with a degrading and preventable condition.
Obstetric fistula is a degrading condition in which women who suffer traumatising labours are left incontinent and often ostracised by their community.

Since 1959, Dr Catherine Hamlin has worked to restore the lives of women with fistula in Ethiopia by performing surgeries, training doctors and nurses and fundraising to build hospitals. On International End Fistula Day, she shares her experiences below.
We [Hamlin and her late husband Reginald] came to Ethiopia from Australia in response to an advertisement to work as obstetrician/gynaecologists at a hospital in Addis Ababa, Ethiopia. We were touched and appalled by the sadness of our first fistula patient: a beautiful young woman in urine-soaked ragged clothes, sitting alone in our outpatients department away from the other waiting patients. We knew she was more in need than any of the others. She had been through a long labour of five days with only the village women to help. And so we saw the first of many fistula sufferers.

Five per cent of all women who give birth have an obstructed labour and cannot deliver their child without help, but a caesarean section or some other skilled delivery is not available for women in rural Ethiopia. The fistula patients are the survivors of an obstructed labour, many don't survive. The maternal death rate in Ethiopia is one of the highest in Africa.
Fistula patients are ashamed of their injuries and are often ostracised by their village communities, living alone and hiding from others, so the world is not aware of them.
When the word spread about our surgery, women started arriving at the hospital from all over the country hoping for the operation.

To cater for the demand we began fundraising and opened the Addis Ababa Fistula Hospital in 1974. Over the next thirty years we opened five regional hospitals across the country.

Since then, we have treated about 40,000 women for this preventable injury. We now work in close collaboration with the Ethiopian ministry of health and have increasing support from them.
Much has improved since we started our work. The ministry of health has given health services to the rural population by building health centres throughout the countryside. The government also started a medical faculty at Addis university in 1966, which meant we could train our doctors there instead of sending them to train at a US-established medical training centre at Beirut University.

Now we have doctors from our own universities, but unfortunately few are willing to work in the rural areas – many have left Ethiopia hoping to live a better life abroad. This is a great tragedy and loss. Our country hospitals have almost no doctors in them.
Going forward our greatest need is to have a well-trained midwife in every village in Ethiopia. We set up a midwifery training college in 2007. We take 12th grade students from countryside schools to train on a four-year degree course.

These girls go back to their homes to work in antenatal clinics attached to the many health centres. We are hoping to spread our midwives throughout the country, but they need doctors in the referral hospitals to do the caesarean sections.

We can't do it all alone. We need to continue to work in closer collaboration with the ministry of health and key partner organisations to eradicate obstetric fistula from Ethiopia. Then women won't have to suffer this devastating ordeal. (The guardian)

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