Close your eyes, and imagine...

A young, beautiful, pregnant girl, in her early teens, is pacing up and down or squatting in her mud and stick home. She is trying to give birth. She is in great pain.

There is no chemist, handy supermarket or local shop where a neighbour could go to buy even a packet of Paracetamol. No pain relief. No money for even simple pain relief, anyway, and her agony continues, unabated, hour after hour.

Her baby is in the breech position--she struggles on and on to deliver the child. After 4-5 days the baby inside her dies, its head constricts, and with the skull bones softened, the young girl is able to expel the still-born child.

Temporary relief--but then the nightmare begins again.

The girl is leaking urine and faeces, and the flow won’t stop. So begins a life of misery, on-going pain and rejection.

This scenario is the stark reality for thousands of young girls and women in the Third World, who have no access to medical facilities. I had often wondered what happened to women living in remote areas, in under-developed countries, who had difficulties with pregnancy and childbirth. Now I know. Horrifying reality.

But I now also know that, in Ethiopia, there is the most wonderful hospital where such girls, if they can reach there, can find help and restoration for their shattered lives and bodies. It is the Fistula Hospital in the capital city, Addis Ababa.

I am a regular visitor to Ethiopia since going to visit my sponsored “daughter” in Addis Ababa many years ago. Since then I have developed firm friendships with many of these wonderful people--proud, beautiful--and unbelievably poor.

Knowing of my burden for the country and its people, a friend of mine sent me a book which she felt might interest me. The front cover depicts the beautiful face of a young African girl, peering out from under a bright pink headscarf. The title--The Hospital by the River--a Story of Hope. I couldn’t put it down. Harrowing in parts, yes, but truly a story of hope and wonder.

Written by the founder of the Fistula Hospital in Addis Ababa, Dr. Catherine Hamlin, it tells how she and her fellow-gynaecologist husband, Reg, were led to work in Ethiopia in the late 1950’s. Both committed Christians, they felt God was calling them to use their skills to help women in this poverty-stricken, war-torn land, often associated primarily with famine and starvation.

When these dedicated doctors became aware of the extent of women suffering horrendous childbirth injuries, they focussed their skills on specialising the technique for repairing the fistulas (holes) which are created between the bladder, rectum and birth canal as the result of untreated, protracted labour. Catherine and Reg campaigned for a hospital of their own, dealing specifically with childbirth injuries. Thus the Addis Ababa Fistula Hospital was born, in 1974, with funds raised in Great Britain, the United States, Australia and New Zealand.

The success of the hospital is due to its small, efficient independent position. It provides the largest fistula repair service in the world (over 1,200 patients annually.) No patient is turned away, and all treatment is free. The philosophy of the hospital is to respect the dignity of every human being, whatever their condition.

Catherine is an Australian (as was her husband), and her book has, until now, only been available in Australia and New Zealand. Now, thanks to Monarch Books (a branch of Lion Hudson) it will be available in bookshops in this country and the USA from October 2004.

After reading her book, I wrote to Dr. Hamlin. I really wanted to visit this hospital. Typically, (as I now know) and graciously, I received a prompt, hand-written reply from this amazing lady, saying I would be very welcome anytime. I couldn’t wait to get there.

With the help of one of my young Ethiopian friends as guide, my cousin and I went to visit the hospital on my last trip to Addis. On the outskirts of the city, located by the Akaki River--hence the title of the book--surrounded by eucalyptus trees, it was a beautiful place to visit.

Catherine, now a widow (Reg died in 1993) had had a busy day, as usual. She had been operating in the morning, then entertained for lunch a surgeon from London, Dr. Gordon Williams. A prominent urologist from Hammersmith Hospital, Gordon goes regularly to the hospital to help with the most challenging cases.

After a computer lesson at 2.00pm, Catherine said she would be free to meet us at 4.00pm. She is 80 years old! Physically, anyway!

What a privilege to spend the next couple of hours with this enthusiastic, humble lady, who personally guided us around the hospital and grounds. The wards are immaculate and spotlessly clean--the 60 beds occupied by beautiful, smiling, grateful patients. In the main ward, a photo of Reg Hamlin looks down from the wall. His presence is very evident, and there is a memorial to him in the gardens, which are one of Catherine’s pride and joys. She has planted the trees and shrubs and knows it intimately. She entertained us to English-style afternoon tea in her lovely home on the hospital compound--an oasis of calm and orderliness, which seemed to epitomise the ethos of the whole hospital. The pervading atmosphere was one of love, caring and mutual respect. Despite the inevitable aroma of urine emanating from the girls patiently awaiting their operations, they appeared relaxed and happy--united in mutual hope and anticipation for a joyful release from their suffering.

As well as providing immediate help for hundreds of women, the Fistula Hospital is helping to reduce the problem in the long run. Midwife trainees and gynaecologists are sent regularly to the hospital in order to expose them to the harsh realities of the conditions. Not only does this raise awareness, it also increases the capacity to meet the needs of suffering women, many of whom are just girls. Traditionally, in Ethiopia, girls as young as 4 or 5 are betrothed and “married off” in their early teens. They often become pregnant before their bodies are sufficiently developed to cope with pregnancy and labour. Agrarian life is hard for women, and if they cannot fulfil their role as wife and mother, they lose all sense of self-worth and become social outcasts, often discarded by their husbands. For some, a caring relative may manage to take them to the Fistula Hospital in Addis Ababa--this has until recently been the main centre for fistula repair.

Patients may arrive, usually on a donkey, or carried on the back of a relative or friend. Sometimes they have to save for many weeks to find the cost of a cheap bus fare. Conditions that are unbelievable to us, with our National Health Service and medical facilities readily available wherever we live. Vesico-vaginal fistula is virtually unheard of in the Western world.

The work of the Fistula Hospital is expanding. Outreach projects mean that it will no longer be necessary for fistula sufferers to make the long, arduous journey to Addis Ababa to have their condition treated. There will be trained Ethiopian surgeons capable of fistula repair throughout the more provincial areas. There are now five fistula clinics attached to hospitals throughout the country.

Another wonderful development is “The Village of Joy”--“Desta Mender.” This is situated on donated land, 25 kilometres northwest of Addis Ababa, and comprises a “village” of 10 bungalows, a large community centre and a teaching area, enabling residents to learn to read and write. There is a dairy, mill and barn, and eggs and milk are provided for use locally and at the hospital. The village provides space for women who require weeks, or often months, of therapy before they can be operated on. This leaves beds free for those requiring urgent surgery at the hospital.

Some of the more unfortunate residents cannot be completely cured through surgery and need to wear a urostomy bag for the rest of their lives. These women become permanent residents, benefiting from daily medical attention. They are taught new skills such as weaving, knitting or spinning silk. Their handicrafts can be sold in the markets. These activities help to give these poor women a feeling of self-worth, fulfilment and happiness. They are able to lead a life similar to the one that their tragic circumstances have forced them to leave behind.

The fortunate patients have their dignity restored after a successful operation. After a course of physiotherapy, they are sent home in a new dress, with their bus fare. Many are accepted back by their husbands and go on to have successful pregnancies, although they are strongly advised to seek medical attention throughout their pregnancy.

Catherine seems to never tire of telling folk about the hospital, and campaigns unceasingly for funding. Her travels have taken her to many parts of the world and last year she appeared on the Oprah Winfrey show in America. She is an amazing lady, quite self-effacing, giving all the glory to the God she serves so faithfully. A friend of the late Emperor Haile Selassie (she and Reg treated members of his family) she keeps company with the rich and famous, yet like Mother Teresa, serves the poorest of the poor.

Since opening its doors in 1974, the Fistula Hospital has repaired the lives of over 25,000 women.

The charity ETHIOPIAID has supported the work of the Fistula hospital for many years. Donations can be made through them and they can be contacted at: Ethiopiad, PO Box 31052, London, SW1X 9WB. (Reg. Charity No: 802353). Credit card hotline and enquiries: 020 7201 9981 or 01753 868277.

£100 will pay for the complete treatment of one fistula victim.

£50 will buy vital medical supplies for the hospital.

£25 can help to equip the physiotherapy room at the hospital.

£10 can buy enough food to build one patient up to full strength, so that she can undergo an operation.

A friend of mine heard of the work of the Fistula Hospital and decided to support it as the cause was close to home for her. Her first child was a breech baby--only delivered safely due to quick medical intervention. She was told that both she and her daughter would almost certainly have died without it. Her two subsequent children were delivered by Caesarean section.

You can make even more girls smile again.

Imagine--there but for the “accident” of where you are born, it could be you, your daughter, granddaughter, sister or niece...

(John Kelly--adapted from a paper for the Year Book of the Royal College of Obstetricians and Gynaecologists, 1994.)

A quote from the book:

“When I reflect back over the years, certain faces come swimming unbidden out of the tide of memory. Even though everyone’s story was amazing, some were even more so. One young woman arrived at the hospital and handed us an envelope with a letter inside that had been written by a missionary doctor down near the Kenyan border. It introduced her and asked us to treat her fistula. There was nothing especially unusual about her. Like so many of our patients, she was dressed in rags and weak from hunger. The sealed envelope was so worn and grubby you could hardly read it, but inside the letter was clear and legible enough. To our surprise it had been dated seven years ago.

“Why has it taken you seven years to get here?” I asked. She told me she had been begging at the bus station for her fare. That was how long it took to raise the money.”

The Hospital by the River--a Story of Hope by Dr. Catherine Hamlin with John Little is published by Monarch books in April 2005. ISBN No: 1 85424 673 9.