Read this fantastic article written by the ABC’s Jane Hutcheon about her recent visit to Ethiopia and the Addis Ababa Fistula Hospital.
Catherine Hamlin has been Changing Women’s Lives in Ethiopia for 60 years
Weaving slowly through the choked traffic and high-rise malls of Addis Ababa a few weeks ago, I was keen to learn about the change sweeping through this African nation of 110 million people since Abiy Ahmed, a reformist Prime Minister, came to power in April last year.
Specifically, I wanted to know about the prospects for Ethiopian women in a country where they make up half the labour force but are largely unpaid; and where female genital cutting and child marriage are still too common. According to the country’s first female president, Sahle-Work Zewde, 40 per cent of girls marry before the age of 18.
Mr Ahmed was named by Time Magazine as one of its 100 most influential people of 2019 and some of his early decisions appear to be groundbreaking.
Six months into his term, he has appointed women to half of the Cabinet positions, to chief of the Supreme Court and, of course, the presidency.
Ethiopia, located in the Horn of Africa, is a nation made up of at least 80 ethnic groups. Over the past 50 years it has faced famine, war and revolution and yet has emerged as one of the best-performing economies in Africa.
I travelled there a few weeks ago as a tourist, and from the vantage point of an old 4WD I could see women involved in every aspect of urban city life.
They were waiting in queues, driving, wearing make-up and teetering on heels while carrying babies on their backs. Some wore veils, others tight jeans, and some were weaving through the stalled traffic, begging.
The city-country divide
But the capital Addis Ababa is not the real Ethiopia. Just 20 per cent of the population are city dwellers. I was keen to know whether women were as liberated elsewhere in the land, so I asked my driver, a man in his 60s who has lived through the ups and downs of his homeland, ‘what’s it like for Ethiopian women today?’.
“It’s different here,” he said, indicating the Addis women outside the malls. “In the countryside, Ethiopian women are treated like multi-purpose donkeys.”
A 60-year Australian connection
On the outskirts of Addis, we stopped to ask for directions to a hospital that takes its name from Australian doctors Reg and Catherine Hamlin, who came to Ethiopia from Sydney six decades ago.
The only word I can recognise in the conversation between the driver and a man on the street, in the official language of Amharic, is “fistula”.
The pedestrian immediately lights up with recognition. “Fistula?” he repeats, and then points further up the road. We have turned off too soon.
The Hamlin Fistula Hospital sits on sloping land near a river.
We couldn’t see the river, but we could hear it, although with the city in the claw of a construction boom, birdsong and the tinkling of flowing water are often interrupted by earth-movers.
Like Addis, the hospital is also expanding and when we arrived it was getting ready for a celebration to commemorate the Hamlins’ arrival in Ethiopia 60 years ago, for a posting that was supposed to last just three years.
(When the ceremony did take place in late May, the Prime Minister himself was seated next to Dr Hamlin.)
Dr Hamlin, 95, has a revered status in this country as an honorary Ethiopian citizen.
She lives in the hospital grounds in a cottage she once shared with her husband and her son, Richard, although she no longer performs life-changing fistula surgery.
What is a fistula?
Obstetric fistula is an injury that happens during childbirth.
When the Hamlins worked in Australia in the 1950s they had barely heard of the condition, but in Ethiopia there were tens of thousands of cases.
Caused by prolonged and obstructed labour, often in a woman whose pelvic bones are not fully developed, a fistula is a hole between the birth canal and the bladder or rectum.
A woman often loses her baby as a result of the difficult birth and is left leaking urine and faeces from her vagina. Sufferers, who are frequently from poor or remote areas, are left disabled.
They are often abandoned by their husbands and shunned by the village because of the smell and shame of the condition.
“Sometimes having a fistula injury is seen as a curse,” Aschalew Tadesse, from Hamlin Fistula Ethiopia, said.
Ethiopia’s Ministry of Health estimates 39,000 women still suffer untreated fistula injuries and there are approximately 4,000 new cases each year. The Hamlin Hospital has treated about 60,000 patients.
Rainy season was around the corner and the verdant landscape of the hospital burst with bougainvillea and manicured pink roses, Dr Hamlin’s favourite flower.
There was so much colour. Outside the whitewashed recovery ward, patients gathered for brief spells of sunshine, wrapped in the signature woollen blankets given to every woman who is treated.
At the physiotherapy centre I met 25-year-old Mary. Like many of the young women, she is a devout Orthodox Christian, although women of all regions and religions are treated without any cost to them.
Mary was temporarily paralysed after a near-death experience giving birth.
She was now having light therapy on her legs, so that she would again be mobile before her horrendous injuries were fixed.
In the meantime, she wore diapers. Mary’s child Obsi (it means “God can”) played nearby. Notwithstanding the severity of her condition, Mary is one of the lucky ones. Despite her injuries and instant divorce by her husband, her baby, now seven months old, was eventually born safely.
A place to recover and find hope
A 30-minute drive from the Hamlin Fistula Hospital is Desta Mender, otherwise known as Joy Village.
Opened in 2002 as an adjunct to the hospital, it’s the site of a recovery centre and a training college for midwives set in a mountainous grove, surrounded by dairy cows.
Outside one of the bungalows I met Astang Adang who wore a bright yellow dress and was knitting in the fickle sunshine.
Like all the patients, she had been taught how to sew and make crafted goods, which are sold by Hamlin Fistula Ethiopia to earn income for the women.
Astang came from a remote village in southern Ethiopia called Gamu-Gofa.
Like many, her village has no running water or electricity. It’s three days’ travel (one day by foot to the nearest road then two days by bus) from the capital.
Astang remembered the day nearly three years ago, when she went into labour with her first child. Just 18 years old, she had fallen pregnant immediately after her marriage to a much older man (arranged — as is the custom — by her family).
Like 90 per cent of Ethiopian women, Astang gave birth at home after the sudden onset of labour. Her labour continued for days and was accompanied by excruciating pain. The baby she said, refused to come out. For seven days, she pushed and waited. Eventually the baby died and as its body began to decompose, it was eventually pushed out.
For a time after the birth, Astang lapsed in and out of consciousness, wondering when the frightening pain would diminish. Her legs were paralysed as a result of the trauma and she was horrified to discover urine and faeces leaking uncontrollably all over the bed.
Her husband had walked out on her, leaving her in the care of her father, stepmother and little sister. “I just laid there, crying, every single day,” she said.
Astang was bedridden for 18 months before a local health worker — trained by the Hamlin Fistula Hospital — discovered her. He made arrangements for her to travel to the local medical centre and then by ambulance to the hospital in Addis Ababa.
When I visited Desta Mender in late May, Astang had undergone two rounds of surgery to repair her double — anal and then a urinary — fistula. Sadly, her injuries were so severe, her bladder couldn’t be completely repaired.
As a result, her urine is collected in an external stoma bag that she has been taught to empty regularly. To me, it wasn’t obvious anywhere beneath her clothes. She told me this is a small price to pay for an otherwise normal life.
Astang has been given psychological counselling and physical therapy to enable her to walk again and, in a few months when she’s completely healed, she plans to return to somewhere near her home village where she hopes to open a small grocery store.
Hamlin Fistula Ethiopia will provide the funds to help her start her new business.
Midwives in training
At the same facility, is a training college dedicated to Ethiopia’s neonatal and maternal health.
Each year, 25 young women graduate from a four-year course in midwifery and are sent out into the regions to work with district health centres.
Since 2007, 145 midwives have graduated from the program.
I watched as a group of third-year students underwent their end-of-term exams. Dressed in hospital garb and using baby dolls and medical torsos, they demonstrated how to tackle difficult births as their examiners looked on.
The goal is to encourage more Ethiopian women to give birth at a health centre. Recent figures show only one in 10 births takes place in a facility, but changing the culture of early marriage is also vital to improving maternal health. A fistula is not related to female genital cutting, which is an entirely different issue.
A long way to go
After leaving Addis Ababa, I spent 10 days travelling by plane and 4WD through Ethiopia’s historic northern highlands. One afternoon, beside a two-lane mountain highway, I saw a group of men in the lashing rain leading a mule, all moving at an urgent pace.
Seated astride the mule was a heavily pregnant woman, arms around the animal’s neck, her face crinkled in pain and desperation. Before I could process the image, I finally understood some of what 80 per cent of women in Ethiopia contend with.
And then our 4WD turned a bend and swept past a district health centre. I exhaled, relieved, knowing the pregnant woman did not have far to go before a midwife (which she wouldn’t have to pay for) was at hand.
In Australia, while Indigenous women are often far from help during childbirth, for many other women, quality medical attention is widely available.
My visit to Ethiopia underscored how vital the work of midwives and fistula surgeons are in a country where until recently, women have had few champions, little power or powerful supporters resolved to improve their lives.
Jane Hutcheon is the presenter of One Plus One on ABC News Channel.