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Delivery from shame

"Delivery from shame" Continued...

Issue: "Clutching two, dropping four," April 23, 2011

Ayenachew is one of the few who works in a rural area of the country. "Many of my friends left Ethiopia for better pay and better life," he told me. "I had some opportunities to leave but I stayed in. I feel it's worth it to stay in. And now I have my family." Mark Bennett, the CEO of the hospital and its offshoot projects, said, "We need to find ways for people like Fekadl to stay." Ethiopia's health ministry in a recent report found that one-third of trained Ethiopian doctors had left the country in the previous decade. The ministry also found that only 5.7 percent of women giving birth in the country had help from a health professional. Still, there's good news: The maternal mortality rate in Ethiopia has been cut almost in half in the last decade.

The Ethiopian government has attempted to address the scarcity of doctors in a number of ways, some of them desperate, such as mandating that all medical schools expand their class sizes. A more effective measure, which the fistula hospital has pioneered, is training Ethiopian midwives, sending them out to care for the particularly vulnerable rural mothers. The Addis Ababa Fistula Hospital has a network of five rural fistula clinics and plans to open another 25 rural clinics within the next four years.

The Ethiopian Emperor Haile Selassie commissioned the Hamlins to open a midwifery college when they first arrived in Ethiopia in 1959, on a contract to serve at a local hospital for three years. Between developing fistula surgery, setting up a hospital, and surviving ensuing coups, communist rule, and civil war, the fistula hospital didn't open its midwifery college until 2007.

Now hospital staffers see midwives as their front-line soldiers to prevent fistula. Midwives notice the first signs of a troubled pregnancy and help to provide care or to bring the woman to a hospital. The Hamlin College of Midwives selects students from rural areas to be trained in Addis Ababa, then the new midwives return to work in their rural communities. Last year the college graduated its first class-11 midwives-and plans to graduate 25 a year going forward.

Hamlin recalled a conversation from her early days in Ethiopia between her husband and the emperor, who became a friend:

"Why do my women get this disease?" the emperor asked.

"It's nothing to do with your women. It's your roads and mountains," replied Reginald Hamlin.

"Oh, I'm so glad it's not my women," the emperor said.

The country's geography-rugged valleys and towering tabletops-coupled with poor infrastructure make a journey to the main hospital in the capital arduous. Rural roads are still bad, according to Ayenachew.

One fistula patient walked 450 kilometers (280 miles) to the hospital, Hamlin recounted in her book, The Hospital by the River. Another woman with fistula arrived with a note from a missionary doctor dated seven years previous-she said it had taken her that long to beg enough money for the bus fare to Addis Ababa. Some bus drivers won't allow fistula women on their buses because of their odor. Reginald Hamlin would drive the family's Volkswagen down to the city bus station and ask if any women were leaking urine and bring them back to the hospital. He would also pick up fistula patients outside an old hotel in the city, the only place they were allowed to camp. Now, with the hospital's reputation it doesn't need to go after patients.

Age hasn't dampened Hamlin's good spirits. When I asked how she feels physically, she joked, "I feel like I'm going to perish at any moment!" Each day she rises early, has tea, and reads her Bible. She still performs surgeries and gardens. Her voice, though shaky, is mellow and glad. Whenever she mentions a place, she lovingly sketches out its landscape with her hands. The hospital in Addis, she tells me with sweeping gestures, stands on a slope near a river, and has a garden.

This same woman can describe gory details of fistula without flinching. Some patients arrived at the hospital with their babies dead in their wombs. Hamlin recalled many times delivering a dead baby who had been decaying inside his or her mother for days, the stench causing attending nurses to vomit or faint. Hamlin didn't faint, but her sympathy and sorrow for the mothers is constant. The horrors she has witnessed over 50 years in Ethiopia can be forgotten, though, when new, healthy babies arrive, giving the staff hope that one day the fistula hospital will become simply a maternity ward.

Learning on the job

A reliable surgery to repair fistula wasn't developed until the 19th century. Hamlin and her husband drew advice from an Egyptian doctor, Pasha Naguib Mahfouz, a Coptic Christian who was one of the pioneers of fistula repair in the first half of the 20th century and helped eradicate the condition in Egypt. He sent them drawings of his surgeries. The Hamlins wrote anyone around the world who had tried fistula surgeries to get their advice, and began developing their own techniques for the difficult operation.

The Hamlins had never seen a fistula until they arrived in Ethiopia. Reginald Hamlin performed his first attempted fistula repair on a 17-year-old whose husband had abandoned her, and he succeeded. The Hamlins were working under difficult circumstances: A blood bank, so vital for surgeries, was nowhere to be found when they arrived in Ethiopia in 1959. The refrigerator at the hospital where they first started usually had one or two pints of blood in it, according to Hamlin, and they had difficulty convincing suspicious staff and able patients to give blood. That's changed over the last 50 years.

Emily Belz
Emily Belz

Emily, who has covered everything from political infighting to pet salons for The Indianapolis Star, The Hill, and the New York Daily News, reports for WORLD from New York City. Follow Emily on Twitter @emzleb.

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