Interview with Dr. Catherine Hamlin: Pioneer in Fighting Fistula

Among the outstanding women selected to be part of the Women Deliver 100 is a pioneer in the field of obstetric fistula, Dr. Catherine Hamlin. The Australian obstetrician and gynaecologist was among the first people to call attention to this devastating injury of childbearing, which she has been treating for more than 50 years. In an exclusive interview with UNFPA, she talks about her crusade to fight fistula.

NEW YORK — When Dr. Catherine Hamlin started her work in Ethiopia, where she arrived in 1959 with her late husband, Dr. Reginald Hamlin, she didn’t know they would stay so long. But that was before she saw how much they were needed.

“It really broke our hearts to see the condition of these poor women and girls in their teens, living with this terribly devastating condition. We were so touched by their plight that we decided we would stay on.”

After ten years, she and her husband decided to build a hospital exclusively to treat obstetric fistula. This would help not only by responding to the increasing demand for fistula surgery, but more importantly, to the special needs of the patients.

From the now world-famous hospital in Addis Ababa, where she still operates, Dr. Hamlin shares good practices and techniques with other professionals around the world, setting standards followed by the international community. The hospital also employs a number of fistula survivors, who, because of what they had suffered, really had nowhere else to go.

Fifty years of fighting fistula

Dr. Hamlin is one of the few people who can give a 50-year perspective on how the world has responded to this childbirth injury, an issue neglected for centuries. It’s been a long struggle.

When it comes to preventing the devastating injury from occurring, her disappointment is palpable: “I feel we haven’t made much progress, barely anything until five or six years ago.”

After more than five decades of continuous work in Ethiopia, Dr. Hamlin strongly believes that preventing fistula from occurring in the first place is still the weak link in the series of actions needed to make fistula a thing of the past.

“We really must do something. We are so involved in mending these women, trying to get them back to their communities, that we neglect the prevention side,” she says.

According to Dr. Hamlin, prevention should go hand-in-hand with early diagnosis and treatment, preferably in the communities. But the challenges are enormous and strongly related to poverty and the lack of education.

Poverty is a root cause

“We have to deal with the poverty of the patients, we have to deal with the uneducated state of the patients, and we have to reach them in their villages.” Poverty, lack of education and the low status of women conspire to perpetuate the problem, accentuating stigma and the typical lack of compassion for its survivors.

“They have had no help for a long time because of poverty, because of the lack of facilities, because of the lack of knowing about this condition,” said Dr. Hamlin. “Very few people, even in Addis Ababa, know what fistula is, what it causes in a woman’s life. We have to tell this is not some disease that these women have gotten, not a curse.”

The idea that fistula is somehow a woman’s fault is ingrained in culture, according to Dr. Hamlin. This heightens the sense of shame and sorrow of survivors, since they are left alone, stigmatized and ostracized by the rest of the community.

A new midwifery programme in Ethiopia initiated by Dr. Hamlin trains secondary students drawn from the countryside and then deploys them back to their villages. The aim is to use health workers who understand community dynamics to help change them. Some 56 students are enrolled in her midwifery college, and one day, Dr. Hamlin believes, there will be midwives all over Ethiopia, in strategic places and in all regions. This will foster a more tailored approach to fistula prevention, diagnostic and treatment, with better results, she said.

Compassion is key

“We show them how to treat these women with compassion. This is better than any medicine. To show that you recognize them as normal women and show that you love them and that you want to help them,” she said.

Compassion is the force that has driven much of Dr. Hamlin’s work, including the establishment of a specialized hospital for fistula survivors.

“They didn’t like going to a general hospital and mixing with other patients. They were not welcomed, they smelled, they were poor and the other patients despised them. Then they didn’t like the prying eyes, looking at them with this injury,” she said. She also spoke about some of the heartbreaking situations she has dealt with.

“We had one little girl not too long ago, who had terrible injuries. She had been lying curled up for nine years on the floor on a mat,” she said. “Her mother had been looking after her, thinking perhaps that the urine would dry up. She was in a state of malnutrition, 22 kilograms, as she was carried on the back of her poor old mother, coming into the hospital. She broke our hearts.”

Much work remains to be done

Although there is some commitment to change the situation, Dr. Hamlin believes that there is still need for more human resources, equipment and motivation to respond more effectively to fistula.

“I’m very excited that we’re working with UNFPA on this terrible affliction that is causing trouble and sorrow all over Africa. There are so many dying every year in Africa from pregnancy-related and labour conditions. We have to do something about this in this 21st Century. When everything else has been done in medicine, great advances made, what are we doing about mothers?

“A mother is a family’s richest possession,” she added, “A being of priceless value. This is what we have to realize, that we are helping these mothers to have a safe delivery and a live baby. Every woman should be able to have this in the world.”