U N I T E D N A T I O N S
Office for the Coordination of Humanitarian Affairs (OCHA)
Integrated Regional Information Network (IRIN)
ETHIOPIA: Interview with Dr Catherine Hamlin, founder of the Fistula Hospital
ADDIS ABABA, 29 November 2002(IRIN) - Dr Catherine Hamlin, 75, founded the world-renowned Fistula Hospital in Ethiopia with her late husband in 1974. In that time they have treated over 20,000 women suffering from appalling birth injuries. Here Dr Hamlin tells IRIN of why more needs to be done to improve a key millennium development goal of maternal health.
QUESTION: Why is it important to tackle fistula?
ANSWER: It is such an enormous problem. The World Health Organisation say 0.3 percent of all women having babies will have a fistula [injury to the pelvic organs caused by a long and obstructed labour]. In Ethiopia that means 8,500 new women every year and some million in the world. There must be an enormous backlog. Now these women are completed neglected. If you had 8,000 men with incontinence of urine something would have been done about them but because they are women they really are second-class citizens in this country – especially the provincial women. They are young women and it is a preventable injury. In Africa these women have been hiding for centuries and their plight is so sad.
Q: How does this injury affect the victims socially?
A: They become complete outcasts from their society. Their husbands desert them especially if it is a first baby. All our girls of 16 or 17 are deserted by their husband so they have no means of livelihood, nobody will employ them because of the stench. Most of the village thinks they have some awful disease so they are put onto the outskirts of the village. One woman we found had spent nine years in a darkened hut and never left it, with food being shoved in once or twice a day. These women have been ostracised by society.
Q: Why does it only now affect developing countries?
A: Well in Europe or America or Australia they have got plenty of hospitals, plenty of doctors and roads to get quick communications. A woman after one day of labour if she is at home will get to a hospital where she will have a caesarian section. She won’t be left in labour for five or six days. The only reason why they deliver is because a baby won’t survive more of two days of labour so the baby dies and shrinks and the woman can squeeze this baby out. Their plight is
terrible physical suffering, then to have a dead baby.
Q: Are early marriages or traditional harmful practices to blame?
A: It is more in developing countries because of poverty. A girl of 14 or 15 in Britain can usually have a baby. A lot of teenagers are getting pregnant in the west and they are fully developed. But here if they have been on a poor diet their pelvis will be contracted. Traditional practices only come into it if she gets pregnant before she has fully grown. People think if you get rid of circumcision you will get rid of fistulas but this is not so, it will make no difference whatever. It adds to the problem but is not the cause.
Q: What is the cause?
A: Poverty is an enormous cause and lack of education, enough medical facilities, lack of roads. It is a developmental and gender issue. It is preventable and is to do with the economics of the country. We are one of the poorest here. We have a very difficult country to make roads in. We question the patients and sometimes they are so poor that they have to beg for the money to get to the hospital – these are women that have been in labour for two days. By the time they get to the hospital it could be four or five days since the start of labour and the damage has been done.
Q: What are you doing to tackle these difficulties?
A: We have set up five centres in five provincial hospitals where we get a lot of fistulas where doctors will operate for a few weeks at a time. We get more fistulas from the north were Gondar and Gojam where early marriages go on. But we are getting a lot now from the Oromos. We have a village we have set up for incurable women or girls who are enormously crippled from the damage caused by this long labour. We will have physiotherapists there releasing beds here, so we can turn over more patients. The village will have two purposes, rehabilitation and others who stay there permanently.
Q: Is the problem of fistula increasing in Ethiopia?
A: It is increasing now because the population is increasing. Health facilities haven’t kept up with the population increase. And nobody really wants to practise in the country – no doctor will want to stay there. There is no school for his children, there are no decent houses, and hospitals are poorly equipped. There is no incentive for him to go there and no money for
fistulas especially. So he will return to the city and start a private practice to make some money for his family which is understandable. So unless the government will pay doctors to stay in the country and make things better for them I don’t how we are ever going to do much preventive work.
Q: What preventative work can you do?
A: When we go to these hospitals to operate we send some nurses into the villages nearby to talk to the women. We try to help them get a fund for any women that have an obstructive labour. Another possibility is to build small villages near provincial hospitals for women who have had birth problems. We can’t expand here now, certainly not on our budget. With have two main donors and if they pulled out we would be in trouble. So we are trying to set up an endowment of US $7 million that can be used to run the hospital because we are going to have fistulas for a long time yet, unless you build more hospitals and have more doctors in the country. We lose so many doctors. There are more Ethiopian doctors in Washington than in the whole of Ethiopia.
Q: Compared to other health issues how serious is fistula?
A: Well it is not as serious as malaria because it doesn’t cause death. It causes social disability, a few die from kidney failure but most don’t die they just become miserable. So it is not a priority for the government as they have so many other health issues.
Q: How do you then convince large donors?
A: It is very easy - you just describe their plight. These women are ruined for life. This is to do with childbirth, it is to do with young people – you are giving a new life to a young girl. How do they support themselves? People are touched.