The saint of Addis Ababa

February 2, 2018

She’s been restoring dignity and hope to Ethiopian women for six decades. Even at 94, Catherine Hamlin isn’t done yet.

  • From The Weekend Australian Magazine
  • February 3rd, 2018

n the grassy banks of Lake Tana, the fabled source of Africa’s Blue Nile in northern Ethiopia, a young local asks where I’m from. “Ah! Australia!” he chimes, a wide grin splitting his face. “Crocodile Dundee and Catherine Hamlin!” In nearby Lalibela, the World Heritage site of ancient rock-hewn churches, a chewing gum seller by the roadside sees a label on my bag and stops to chat. “We think of her as Mother Teresa,” he says. “She has been so kind to us.” And in the frenetic capital, Addis Ababa, a taxi driver asks me who I’m going to visit. “Oh my God!” he exclaims. “Catherine Hamlin! She is a woman who is so good, so good. She is a saint.”

He doesn’t know it, but his words could well prove to be prophetic. The much-awarded Sydney gynaecologist and obstetrician — a two-time Nobel peace prize nominee for her work over nearly 60 years trying to eliminate ­fistula childbirth injuries in one of the poorest countries in the world — is now actually being considered for sainthood by the Ethiopian church.

Yet all this adulation cuts no mustard with the woman herself. Sitting in the modest mud-brick house she built with her late husband Reg down the steep path from the women’s hospital they set up on the fringes of Addis Ababa in 1975, the tall, lean, stately 94-year-old takes little notice of such attention. She’s more concerned that she doesn’t have any lemon cake for her visitor. Sitting in her favourite yellow rose-flecked armchair in the ­cluttered loungeroom, she glances at a black-and-white photo on top of the piano of a young, handsome Reg, smiles fondly, smooths her checked skirt, adjusts her pale blue cardigan, and apologetically offers a plate of biscuits instead.

“Really, I am just an ordinary woman,” Hamlin insists. “All I can do is to carry on with this work and try to tell the story of these women. And it’s not only me. My husband was the one that set it all up, he was the driving force. I’ve got a very ­dedicated staff. So it’s a whole group of people, it’s not only me. Now, will you have more tea?” She smiles genially and her constant companion Mamitu scurries to bring a fresh pot. Mamitu was one of Hamlin’s first fistula patients and, despite having no early education, went on to become a fistula surgeon herself.

Hamlin with Mamitu. Picture: Martha Tadesse
Hamlin with Mamitu. Picture: Martha Tadesse

“I don’t do any cooking or work myself these days,” Hamlin continues sadly, her beautifully modulated accent reminiscent of a bygone era. “I stopped operating five years ago now, when I was 89. My memory’s not so good now either, but I hope I do remember the important things. I have a grave plot reserved near my husband. It’s in a big cemetery for special people, I understand. My worst fear, however, is being put in a coffin while I’m still alive. I do hope that doesn’t happen …”

She laughs, a girlish laugh that she brought with her to Ethiopia back in 1959 when she and Reg arrived with their six-year-old son Richard on a three-year contract to set up a midwifery service at the main city hospital. A graduate of the ­University of NSW, she was interviewed for a job at Sydney’s Crown Street Women’s Hospital by Reg, then the medical superintendent. Both committed Christians from missionary families, they’d worked together, married and then decided they would do some good in the wider world.

A week after they started in Addis Ababa, they encountered their first fistula patient — a 17-year-old girl who’d endured an obstructed labour for five days that delivered her a stillborn child and tore a hole between her birth canal and bladder, leaving her leaking urine uncontrollably. They’d no experience of such a serious injury; ­fistula had long been virtually eradicated in developed countries by the availability of maternal healthcare and caesarean sections for difficult births. But, to their horror, they discovered it was a common occurrence in a country where early marriage, malnutrition and heavy manual labour at a young age meant little girls with underdeveloped bodies were routinely at risk, especially in remote ­villages where access to basic healthcare was hampered by towering mountains, deep gorges and lack of infrastructure.

From that day on, the Hamlins dedicated themselves to repairing these women. They were never to return home again, except for holidays that they spent, as Catherine says, “begging for money to allow our work to continue”.

That work survived waves of unrest: the fall of supporter and friend Emperor Haile Selassie in 1974; the military coup and bullets from warring factions that peppered the wall of their house; over the following 17 years of civil war, the “Red Terror” slaughter of up to 500,000 opponents of the new Communist government in the late ’70s; and terrible famine during the ’80s. Everyone saw what an incredible job the Hamlins were doing and simply left them alone.

When Reg, 15 years Catherine’s senior, died of cancer 25 years ago, she wondered if she could keep going. “We’d done everything together and it was hard to suddenly be alone,” she says. “I did feel like giving up. It all felt too much for me. But my friends here told me not to leave and said they would help me get through it. And we did, together. Of course, I miss Australia sometimes, but this is my home, these people are my family.”

With the support of donors who continued to raise funds so the fistula treatment could be offered free, she barely missed a beat. As a result, her organisation has now operated on well over 50,000 women, and has established hospitals in five regional areas of ­Ethiopia as well as the central Addis Ababa Fistula Hospital. It is also about to set up a pilot project, its first service outside the country, with a local partner in Uganda. In addition, it trains midwives through its Hamlin College of Midwives to work in rural regions, supports 40 government health centres with midwifery and, as a globally recognised centre of excellence and innovation in fistula ­surgery, with a newly established fellowship, instructs doctors around the world.

Today, the outdoor reception area of the ­Hamlin hospital must be one of the most forlorn places in the world. New arrivals sit on the benches waiting to be seen, their eyes downcast, their ­bodies bowed in shame as urine pools beneath them and nurse aides — former fistula patients themselves — try to comfort them. Some have walked for days to reach here; others have borrowed money from family and friends, sold the family cow or begged to raise the bus fare, praying they won’t be kicked off because of their smell. Once they’ve made it this far, however, they’re safe; no one is ever turned away.

A few metres away inside the hospital, the scene couldn’t be more different. Three-quarters of the 40 beds arranged in four long rows down the whitewashed ward are filled with beaming patients, either waiting for surgery or recovering from it, relaxing, eating lunch or sitting on beds chatting excitedly. All the windows either side are flung open to let in the afternoon breeze, while Hamlin, who has just walked up the hill to the hospital on her twice-daily stroll — stick in one hand, the other holding onto Mamitu’s arm — sits proprietorially in a chair on the veranda.

By her feet lounge a clutch of post-operative women, wrapped in the hospital’s brightly coloured patchwork shawls knitted by supporters in Australia, NZ and the UK, talking and laughing and trading stories. They all refer to Hamlin as Emaye (“Mother”), and one kisses her hands.

Adanech, 30 and her newborn. Picture: Martha Tadesse
Adanech, 30 and her newborn. Picture: Martha Tadesse

This hospital has a 97 per cent success rate and many former patients return for the safe delivery of subsequent children by caesarean. In one bed, new mum Emebet nurses her week-old daughter. She was married at 16, fell pregnant at 19, and after four days of labour at home suffered both a stillbirth and a fistula. “I was three months at home, then I came here — and was totally cured and dry,” she says. “Then I went home, and then came back for my pregnancy. I met Catherine and gave many thanks to her. She is wonderful.”

One of the worst cases anyone has ever encountered is Asrebeb, who now lives at Desta Mender, or “Joy Village”, the specially built farm community on 60ha donated by the Ethiopian government on the city’s outskirts for the three per cent of women who can’t be totally cured. There she shares a simple house among the ­juniper trees and beds of native flowers with three other women while they each undergo extensive rehabilitation to prepare them for life outside. It can be hard to hear their stories.

Asrebeb. Picture: Martha Tadesse
Asrebeb. Picture: Martha Tadesse

Asrebeb was a child bride and fell pregnant at 12; she was in labour for many hours before her child was stillborn and she was left with horrific injuries, including a double fistula, in which a hole is torn between the vagina and both bladder and rectum. She spent the next seven years curled on a bed in a tiny hut in her remote village, leaking urine and faeces, abandoned by her husband and shunned by her community, many of whom saw her plight as some kind of punishment by God. She spent her days wishing she were dead. By the time health officials heard about her, went to visit and immediately whisked her off to hospital, she was a tiny ghost of herself, weighing 22kg and unable to walk.

Today, after a number of surgeries and four years of intensive physiotherapy and rehabilitation, she has her life back. “The first day I walked again was like being reborn,” says ­Asrebeb, now 23. “Catherine never thought I’d be able to do it, but she never told me that. Instead, she just cared for me so much, and then walked behind me when I walked. We both cried a lot we were so happy. I was very overwhelmed and so ­grateful. I just wish I could give her my years so she could live forever.”

Patients at the fistula hospital in Addis Ababa. Picture: Martha Tadesse
Patients at the fistula hospital in Addis Ababa. Picture: Martha Tadesse

It’s the stories of women like Asrebeb that have kept Hamlin here for so many years. “They’re so terrible, they really broke our hearts,” she says. “We felt tremendous compassion for them, and sadness to see their plight and hear their stories. That’s why we stayed, and tried to do something for them. And seeing them recover and reclaim their lives … there aren’t the words to describe it.”

Asrebeb is one of 25 women at Desta Mender who receive lessons in life skills, problem-solving, finance, small business, literacy and numeracy, as well as managing their health issues. Originally intended to be their permanent home, under the stewardship of rehabilitation and reintegration manager Beletshachew Tadesse it has become more of a halfway house, helping them to return to communities, stronger and better equipped to cope. “Catherine understands how important it is that we show them there’s a new life out there, and lots of things they can achieve,” Tadesse says. “We’ve had some great successes with women doing well at business, one setting up in food and beverage, another founding a grain store, while another has become a leader in her community. It shows you miracles do happen.”

But it’s never easy, for either the women or the organisation itself. As the original small, family-and-friends-run Hamlin outfit was restructured into a large, professional entity, there was a very public rift between two funding groups in 2012, and there have been rows between directors and among staff, and even tensions with the Ethiopian government. “Catherine is very charming and charismatic, but she can cause havoc with the administration at times,” says her nephew Dr David Knox, a gynaecologist in Orange, NSW. “She is saintly and devoted to the patients but if she doesn’t like something, she’s very determined to make sure it changes. I think sometimes that can cause problems …”

Yet with enormous reserves of diplomacy from others, all the issues have gradually been sorted out, with the main organisation renamed the Catherine Hamlin Fistula Foundation to enshrine her legacy and the two fundraising bodies co-ordinating to support Catherine’s work. Her son, now an IT expert, visits regularly from his home in the UK. Hamlin’s role is now as the organisation’s revered figurehead, with Ethiopians appointed to all major roles to ensure continuity, particularly after — no one wants to say it — her death. “It won’t make any difference now to the hospital,” she says. In the meantime, she still lives on site in her cottage and keeps a keen eye on everything going on. Everyone is careful to keep her in the loop, visiting her with updates and running any major changes past her, more as a courtesy than anything else. “She always wants to know not only about the surgery, but about the patients and their stories and then what happens at home for them,” says clinical director Dr Fekade Ayenachew. “So while we’ve done a lot of work on updating ­strategy and the administration systems with our partners, we’ve also worked hard to keep the Hamlin legacy, her holistic clinical care model. She’s always a great inspiration for everyone.”

That means the staff as well as the patients. The hospital matron, Sister Wude, says it was always her dream to work with the poorest people, ­especially women and children. “It isn’t easy ­working with fistula; it’s a heart-sad problem,” she says. “But Dr Hamlin is my mother. She is a strong woman, a rare, good, honest person who loves other human beings. She even told my daughter she should become a gynaecologist — and now she’s a doctor, starting gynaecology.”

Similarly, the surgeon in charge of the Hamlin hospital in Bahir Dah in the north of the country, Dr Bitew Abebe, was inspired to become a gynaecologist after Catherine repaired the fistula his aunt had had for nearly 30 years. He then trained under her. “Catherine has given her whole life to my country,” he says. “She is so patient and caring and kind; she shows us how doctors should be.”

Hamlin, one of only two foreigners ever to be awarded Ethiopian citizenship, has also forged close relations with the Ethiopian government. Its work with her foundation has seen the maternal mortality rate slashed in the past 15 years from 1400 deaths in every 100,000 live births to 350. Laws against early marriage, encouragement for women not to give birth at home, as well as a ­dramatic increase in the number of midwives, health extension workers, hospitals and health centres have all played a part.

“Our former prime minister promised her for her 95th birthday there would be the least ­possible number of fistulas in Ethiopia,” says Dr Ephrem Lemango, director of maternal and child health in the Ministry of Health, as well as chair of the charity Hamlin Fistula Ethiopia. “We hope by 2020 they will be very limited. I can’t imagine what the situation would have been here without Dr Hamlin. When she first came, there was ­nothing; the government wasn’t ­thinking about hospitals, let alone about looking after women in such cases. But she became a ­catalyst to inspire change and her model of ­compassionate and respectful care is now embedded in our five-year plans.”

Her example has encouraged huge displays of generosity, too. Appearing on the television show Oprah in 2004 proved a watershed moment, bringing her work to the attention of a global ­audience and raising ­hundreds of thousands of dollars. Ten years later, Sydney businesswoman Sonia Fenton donated $1 million from the sale of her harbourside apartment, becoming their biggest ever individual donor. “I don’t regret it for a moment, even though I now have a $1 million mortgage on my new home,” she says. Sydney mergers and acquisitions lawyer Mike Barker, 51, was so moved by a “life-changing” visit last year that he burst into tears on arrival; his party of 15 raised $280,000 for the hospital and he now ­regularly speaks at functions about its work.

Hamlin is never surprised at the effect it has. “To meet only one of these women is to be ­profoundly moved,” says the woman who has, by public vote, even had a Sydney ferry named after her. “Childbirth should be a joyful occasion, but to them it’s become a nightmare. To see these poor women coming through the gates of the hospital in a state of dejection with nothing in this world but faith and hope that we can cure them, and urine-soaked clothes, it touches the hearts of everyone who meets them. Then of course, after they are treated, they can go on to lead a normal life. They leave us, on dancing feet, with a new dress and hope for the future.”

“I can’t turn my back on these poor women,” says Hamlin. Picture: Martha Tadesse
“I can’t turn my back on these poor women,” says Hamlin. Picture: Martha Tadesse

She pauses. She knows there are around 3000 new cases of fistula reported every year, and a backlog that studies put at about 39,000 women. “I won’t see fistula eradicated from Ethiopia in my lifetime, but you will in yours,” she adds. “I am still trying to wake up the world and tell people about the women we treat. To think that this injury is still happening when we have so much in medicine! I can’t turn my back on these poor women, and it warms my heart when I see Australians supporting this work.”

Back home in Australia, Hamlin’s family can only marvel that the second eldest of six kids from Ryde in Sydney’s north has made such a mark on the world. “But she was always a leader,” says younger sister Ailsa Pottie. “She was energetic, she’d ride around on horses like a lunatic and when anything was going on — like throwing manure over the fence into the garden next door — she’d be in the thick of it. And she always was single-minded about anything she wanted to do.” She’s humble about her achievements too, says her niece Alison Morgan. “She honestly doesn’t think she’s anything special,” she says. “She really does think anyone in the same situation would have done the same as she has.”

But saintly? Hamlin may look angelic yet, even at her most frail, she can be brutally forthright. She once told a family member — in earshot of their betrothed — that they weren’t right for marriage, and is quick to comment on any new staff hairstyles she doesn’t like. “She’s like a queen,” says reconstructive urologist Dr Renate Roentgen, a German who volunteers at the Addis hospital. “She often doesn’t like to accept other people’s opinions and she can be so stubborn! People adore her like a saint, but she is human.”

Close friend and former Australian governor- general Quentin Bryce says it was stories like Hamlin’s that inspired her as a little girl. “‘Charismatic’ is a very overused word these days but every so often you meet someone and realise the true meaning of the word,” Bryce says. ­“Catherine is charming, courteous and elegant, but behind it is a steeliness and determination to get things done.”

In that, she has certainly succeeded. Whether or not she ever does become a saint — and no one quite knows the procedure for that, since that would be another first for a contemporary figure — she’s ensured the world will never be the same again. “Hers is, quite ­simply, an incredible story,” says Dr Tesfaye Yacob, the CEO of Hamlin Fistula Ethiopia. “It’s a tender, ­loving story about giving back hope and dignity to the most marginalised, ostracised women in the world. And to those, and many more, she will always be a heroine.”


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