THE ANGEL OF ADDIS ABABA:
She dedicated more than 60 years of her life to caring for Ethiopia’s most vulnerable women and their babies, and when Catherine Hamlin died aged 96, Australia lost a truly inspirational global treasure.
Catherine Hamlin and husband Reg dedicated their lives to Africa’s most vulnerable women
W hen Doctor Catherine Hamlin and her husband, Reg, arrived at the Princess Tsehai Memorial Hospital in Addis Ababa, Ethiopia, 1959, the patients they saw often had dreadful complications. Many of them were on the verge of death but the most sorrowful of all were the fistula cases. An obstetric fistula is an injury caused by an obstructed childbirth that can lead to severe incontinence and other complications. “These girls and women had suffered more than any woman should be called upon to endure,” Catherine said. “To meet only one was to be profoundly moved and called forth the utmost compassion that the human heart was capable of feeling.”
They had never treated such an injury before, but knew they couldn’t forsake these women and girls whose injuries resulted in shame and social isolation. Within a few years, the couple had mastered the treatment of fistula, and opened a dedicated hospital that drew destitute and desperate patients to its doors. The women travelled so far that Reg called them fistula pilgrims. Together, Catherine and Reg would restore health and dignity to more than 60,000 women.
Catherine had said that when she died, the hospital would go on until fistula has been eradicated and every woman in Ethiopia was assured safe delivery of their child. After she passed away at her home on March 18, the Chief Executive Officer of Hamlin Fistula Ethiopia, Tesfaye Mamo, promised that this dream would be realised. In this edited extracted from her book,
The Hospital by the River, Catherine tells how she begun her journey.
Being a Christian I never believe that circumstances simply happen at random. My husband’s greatgrandparents, James and Elizabeth Hamlin, were pioneering missionaries in New Zealand. My greatgrandparents, Henry and Catherine Young, were also evangelical Christians. These four unrelated family lines pursued separate destinies, their children married and had children of their own, who in turn married and produced their children. And in the middle of the twentieth century these wandering genealogical strands crossed at Crown Street Women’s Hospital in Sydney, Australia.
My mother came with me on the day I went for my [job] interview. While she waited outside, I was shown into a large, plain office by Dr Reg Hamlin. He was of medium height
with a good strong jaw, wavy brown hair, blue eyes and a Roman nose. Right from the beginning, as he questioned me, I thought he was a warm and gentle man. Crown Street was a wonderful training ground. Australia was in the midst of a postwar baby boom, and there was a shortage of hospitals.
As a junior resident, I was on duty in the labour ward for a week at a time. I soon found that this involved working practically non-stop. I used to fill my pockets with sweets because I knew I wouldn’t have time to sit down and eat. Although I worked hard, my hours were easy compared to Reg’s. He was driven by a tremendous concern for each and every patient.
I was nervous of him at first. He seemed always in a hurry. Once, when we were in the communal staffroom, I asked him why he was eating so quickly. “Because I know I’ll probably be called out,” he replied. And sure enough, in the middle of the meal he had to drop everything and run up to the labour ward to attend to a patient. He took me on his rounds of the labour wards, encouraged me and made sure he was always present at any difficult deliveries I was nervous about.
After I had been there about a year, an undeniable attraction began to develop, which I soon realised was mutual. At first we were discreet. I would walk down Crown Street towards the city, and Reg would follow a few minutes later and pick me up in a taxi. We would sometimes have dinner at Ushers Hotel or go to a film. If we had a day off together on the weekend, we might go surfing at Cronulla or Manly.
After we had been seeing each other for about six months, I went into his office one evening to discuss a patient. I was standing on the other side of the desk when he came round and put his arms around me. He kissed me and said he loved me. I was quite overcome and said that I loved him, too. The timing was rather unfortunate because I had already made plans to leave Crown Street and go to England.
The following day, a Saturday, we went to Manly for a picnic. We walked out to the headland, spread our rug and ate our sandwiches looking out at a lovely view. When we had finished, Reg asked formally if I would marry him. I told him I’d need some time to make up my mind and I would write to him from England. A few days later Reg, rather crestfallen, saw me off.
During that long sea crossing I had time to think about his kindness, decency and enthusiasm and all his endearing qualities which were so appealing, and I realised what my answer had to be. I wrote to him from Perth. A few days later, while he was going up in the lift at the hospital, he opened the letter. There was only one other passenger with him, Sister Martin from the labour ward. Reg read what I had written, turned to her with a delighted look on his face and to her astonishment declared, “Sister, she’s said yes”. He sent an engagement ring to me in England, and a year later I returned for our wedding.
After the honeymoon was over we returned to the hospital, where I had my old job back again, and we both moved into Reg’s little penthouse up on the roof. We still worked as hard as ever, only now we were a team in more than just a professional sense.
Reg and I left the hospital and sailed for England. We hadn’t been in England long when two important events occurred. I got pregnant and almost at the same time, I was diagnosed with a blood disease that could be fatal.
For the next two months I stayed in hospital having doses of penicillin night and day. All the time the baby was steadily growing. Reg tried to
“Neither of us felt suited to a life of predictable comfort in England.”
keep my spirits up by bringing in bunches of wattle to remind me of home. One day after I had left hospital, as I was crossing the street on my way back to our flat, I was knocked over by a bus. I was unconscious for a while and when I woke up I was lying on the pavement. The baby was due in three weeks, and the first thing I did was feel to see if it was still there. I was rushed to St Mary’s Hospital.
Three weeks later our child was born. Despite all of my professional expertise I was still unprepared for my own experience of childbirth. I should really have had a caesarian section, but because of the blood disorder this was not possible, the risk of infection being too great. So, I had a difficult, forceps delivery instead. The baby didn’t breathe properly for half an hour, but all was well in the end.
He was a lovely boy, and we named him Richard.
We could have stayed and made careers for ourselves but somehow neither of us felt suited to a life of predictable comfort in England. We needed something more challenging. We scanned all our medical journals for possible jobs – and one day saw the advertisement [seeking a gynaecologist to set up a training school in Ethiopia] in The Lancet.
It seemed ideal, and would fulfil Reg’s two great interests – midwifery and teaching.
We had seen our fair share of abnormal obstetrics at Crown Street but nothing like on the scale which we now encountered. We were dealing with women who had dreadful complications because of lack of medical care; often on the verge of death. We learned very early that blood was scarcer than gold. The idea of taking blood was rare in Ethiopia and the peasants, especially, were completely uneducated about anything medical. So naturally they were frightened. Consequently there was often no more than a pint or so of any one type in the refrigerator.
One woman due for an operation had a rare type. When I asked her husband if I could test him to see if he matched, he flatly refused. “But your wife might die,” I told him. “Better she should die than I give blood.” “What if you were sick? She would give blood for you, wouldn’t she?” “No, she wouldn’t. She’d wait until I died then quickly marry someone else.” In desperation Reg rang the British Embassy and went and collected car-loads of possible donors. We found one – a wispy little English girl who happily agreed to donate.
Thanks to that lovely English blood we successfully removed an enormous ovarian cyst.
We developed some unusual ways to save lives, one of which you won’t find in the medical textbooks. We saved many women by putting their own blood back into them, thus avoiding any risk of incompatibility. On the mornings when we were not operating we had huge clinics of over 200 people.
We had been at Princess Tsehai Hospital for only a week or so when we saw our first fistula case. She was a young woman of 17. The poor little thing had been in labour somewhere out in the country for five days and eventually gave birth to a stillborn child. She had suffered a complete breakdown of the bladder, and urine was just pouring out uncontrollably. Her husband of course had left her. Her father brought her in and told us she was his only child and he would spend every cent he had if we could only make her better. Neither Reg nor I had ever had to deal with injuries like this, and the thought of trying to operate was too daunting. We sent her to a German gynaecologist at another hospital who had some experience of fistula repairs.
What shocked us most was the realisation that if this girl had had access to a trained midwife early in labour, or better still, a doctor, they would have recognised something was wrong and sent her to the nearest hospital. There should have been trained midwives available all over the country but there were none.
Reg resolved to start some informal training right away for any of the sisters who wanted to come. He also sent off dozens of letters to newspapers in Australia and New Zealand and to private individuals, trying to raise money for the school.
One of the people to whom Reg wrote in his search for information about fistulas was an eminent
Egyptian obstetrician and gynaecologist, Pasha Naguib
Mahfouz. He was one of only three or four living surgeons who had wide experience dealing with these injuries. As the information began to arrive,
Reg and I spent numerous evenings reading the literature and discussing the techniques.
After absorbing all the information we could find, we felt able to tackle our first fistula. Reg performed the operation and I assisted. She was a brave little soul, trusting and calm.
She had no idea that her case was such a landmark for us. After about 14 days we took the catheter out, and she was passing urine normally. She went home completely cured. We were so excited that we took her outside the ward and had a photograph taken of her with Reg. I will never forget her gratitude as she kissed our hands and thanked us and set off to her village to begin a new life. We immediately treated two more fistula patients and they were also cured.
Our normal work continued at the same pace as before, but as word of our success spread we began to see more and more women suffering from fistulas. What a tragic sight they were. Offensive to smell, dressed in rags, often completely destitute, they would sometimes walk for two or three hundred kilometres to get to Addis Ababa. One girl turned up with her mother after walking for 15 days. They had no money and nowhere to stay, so we paid for the girl’s admission ourselves and allowed her mother to sleep on the floor beside her bed. Another young woman arrived after walking for 450 kilometres. She, too, was in rags and had no money. She was a difficult case. Reg operated on her and after two weeks she was
dry. It was an amazing transformation. Before she had been downcast and miserable; now she was reborn as a beautiful, smiling woman, with a look of joy in her eyes. We bought her a new dress to go home in, and she kept holding it up for everyone to see. When it was time for her to leave, we took her to the bus station and gave her the fare. She tried to kiss our feet and said, “God will reward you for all you have done for me.”
Soon the number of arrivals began to place a strain on the hospital facilities. Being desperately poor, the fistula patients were usually unable to pay for their admission. Reg was terribly touched by the plight of these poor women. He called them “the fistula pilgrims”, on account of the tremendous journeys they undertook to get to the capital.
These girls and women had suffered more than any woman should be called upon to endure. To meet only one was to be profoundly moved and called forth the utmost compassion that the human heart was capable of feeling. We wondered – what if we could raise the money to build a special hostel just for the fistula patients, so that they would have somewhere to live while waiting for a bed in the hospital? AWW