Hamlin Midwives Preventing Mother to Child Transmission of HIV

Skilled midwives are the difference between life and death, the difference between healthy mothers and horrendous fistula injuries and often they are also the difference between healthy babies and those born with HIV.

The Hamlin College of Midwives was established in 2007. For more than a decade now, Hamlin has worked with the Ethiopian Ministry of Health and Regional Health Bureaus to establish Hamlin-supported Midwifery Clinics. Hamlin and the MoH are focussed on providing safe, effective, high quality care to ensure healthy mothers and babies.

The impact of this program cannot be overstated. Each week, midwives at the Hamlin-supported Midwifery Clinics deliver around 600 babies, undertake more than 1400 antenatal care visits and provide more than 800 interventions to prevent mother to child transmission of HIV (PMTCT).

Mother to child transmission of HIV/AIDS can occur during pregnancy, delivery or as a result of breast feeding. Without preventative treatment up to 40% of children born to HIV-positive women will be infected.

In remote rural areas all over the world, midwives are a critical part of PMTCT and the largest group of health workers engaged in the fight against HIV.

In 2019 in partnership with Regional Government Health Bureaus, Hamlin Midwives provided PMTCT to more than 42000 expectant Ethiopian mothers and counselled mothers about their reproductive choices and family planning options.

Hamlin Midwives continuum of care provides holistic, comprehensive support for pregnant women and new mothers. They provide antenatal care, delivery, postnatal care, short acting family planning, long acting family planning interventions and screening for PMTCT.

The clinical training and leadership skills developed at the Hamlin College of Midwives along with the trust our midwives build with the women in their local communities means they are an effective conduits for delivery of PMTCT interventions.

MumandBub2 | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.

Help Achieve the UN Sustainable Development Goals

Obstetric fistula changes the lives of the women who live with it. Grief, loneliness, confusion, isolation; a life of needless suffering that leaves women with emotional and physical scars.  

What is obstetric fistula?  

Obstetric fistula is an entirely preventable child-birth injury. It is caused by prolonged unrelieved obstructed labor that can result in a hole between the birth canal and the bladder or rectum. This hole will leave survivors leaking urine or feces – and sometimes both. 

Tragically, 93% of obstetric fistula survivors give birth to a stillborn baby, often after an agonizing obstructed birth lasting days, sometimes one week. 

How can I help achieve the SDGs? 

Goal 3 - Health and Wellbeing  

You can help provide treatment and rehabilitation to those living with a fistula, helping to restore their health and overall wellbeing.  

Over 60 years ago, Dr Catherine Hamlin realized that adequate access to maternal healthcare can spare a woman the pain and isolation of fistula - giving her the chance to finally have a live baby. By ensuring a woman’s maternal health and wellbeing, you’re ensuring her long term happiness and safety.  

Goal 10 - Reduced Inequalities  

Ethiopian women living in rural areas are at a disadvantage when it comes to accessing their human right to sexual and reproductive healthcare. With greater access to healthcare comes fewer instances of obstetric fistula.  

You can play a part in training midwives from rural areas, allowing Hamlin to deploy them back to their communities - ensuring no woman is left behind. When a Hamlin Midwife arrives at a clinic, new cases of fistula drop to almost zero in nearby villages.  

Goal 8 - Work and Economics  

The overpowering smell of a fistula leaves women isolated from their communities, and work is rarely a possibility. Desta Mender, Hamlin’s rehabilitation and reintegration facility, equips women with skills training; enabling them to return to their villages and live independently with dignity and choice following their life-restoring treatment. This training is provided completely free of charge because of generous supporters and friends like you.  

Goal 4 - Quality Education  

Women at Desta Mender don’t just learn skills for business. Patients also attend literacy and numeracy classes, rebuilding their self-worth through educational empowerment and helping them regain independence.   

Goal 5 - Gender Equality  

The gendered disadvantage of obstetric fistula cannot be overlooked. Being isolated has vast repercussions on these women and their communities. The cycle of inequality continues as they are pushed further and further from society.  

You can help reduce the inequality felt by these women by supporting treatment and rehabilitation that empowers and helps them overcome these obstacles.   

Goal 1 - No Poverty 

The ongoing cycle of disadvantage often felt by women with fistula can be stopped. Access to safe and ongoing maternal healthcare, like that provided by our Hamlin Midwives can help women make informed choices about their sexual health, giving her space for choice and the chance to have a healthy productive family.  

Patients rehabilitation and reintegration empowers women with job skills they may not previously have had, helping reduce income gaps and providing sustainable lines of work for herself and her family.  

Finally, by treating and healing women who have needlessly suffered for such a long period of time we are helping to break this cycle. 

By helping us eradicate fistula you’re taking a huge step towards a fairer and more just world for all. Click here to learn more about how you, your family and your friends can help eradicate fistula, forever, by donating today.

Help finish what Catherine started

Make a tax deductible donation to help eradicate fistula. Forever.
Donate Now
dr hamlin | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.

Bravery Exemplified: Semenesh’s Story

Life before fistula 

School was never an option for Semenesh. The small, rural village in Southern Ethiopia where she grew up was so isolated that it would take seven hours to walk to the nearest school or bus stop. 

The employment opportunities in her village were limited; Semenesh and most of her family members would spend their days searching for work in surrounding farms. The youngest of three, Semenesh spent her childhood doing odd jobs to help contribute to her family’s income. Her childhood, however, was cut too short when she was married to a man in a nearby village and soon became pregnant. 

With the closest government clinic more than seven hours walk away, Semenesh did not have health checks during her pregnancy. 

Like most mothers in her village, Semenesh delivered her child at home without the assistance of a trained midwife. Her mother and a group of female elders assisted with the delivery at home. 

The isolation of fistula 

After three agonizing days in labor with no medical assistance, Semenesh was finally transported to a government hospital where she delivered a stillborn baby while unconscious. She was left with a double fistula and severe injuries to her legs that left her immobile. 

“I had never seen or heard of such a shameful health problem in my life. We all believed it was incurable and went back home to await my fate. One year later, my husband left me. I was alone in my house with no one around to help me move or manage myself. There were times where I wished death over living in such agony, but I never gave up hope in God; I prayed day and night,” Semenesh recalls. 

For three years, Semenesh remained isolated and uncared for, crumpled on a goat skin rug, leaking urine and feces. A few villagers would bring her food, but no one was there to care for her. 

“One day I woke up and I started a desperate journey seeking for help from someone, somewhere. I preferred death to staying home in such a shameful way, so I walked for a full day to reach the closest government clinic,” says Semenesh. 

From the government hospital, Semenesh was transferred to Hamlin Fistula Ethiopia’s Yirgalem Fistula Hospital. Though she underwent two consecutive surgeries to repair her fistula, she could not be fully cured of her extensive injuries. 

So, after completing physiotherapy at Yirgalem, Semenesh was transferred to Hamlin’s center of excellence in the capital, Addis Ababa. 

A full recovery at Hamlin 

Once she reached the Addis Ababa Fistula Hospital, Semenesh was able to receive the further life-changing treatment which she so desperately needed. The final diversion surgery that cured her of the double fistula she had suffered with for so long was performed. 

In addition to the surgery, Hamlin’s social worker identified Semenesh for rehabilitative training. Semenesh stayed at Desta Mender, Hamlin’s Rehabilitation and Reintegration Center, for three months, where she learnt life and business skills while in rehabilitation. She has since graduated from the program and returned home with her health, newfound confidence and hope for her future. 

Dr Catherine Hamlin, or ‘Emaye’ as the patients called her, and her team made Semenesh’s full recovery possible. “For me, this is like being born again. If I had not arrived here, I could have been dead by now. I would see Emaye while walking around the hospital and I stare at her just to make sure she is human because I believe her life’s work, looking after poor women like me, was the deed of angels. I have so much respect and gratitude for her and for all of the staff,” rejoices Semenesh. 

Eradicating fistula in Ethiopia 

Over the past 61 years, the Hamlin team have restored the health and dignity of more than 60,000 women. But Catherine's vision was to eradicate fistula in Ethiopia forever. With the help of our new Patient Identification Program we want to turn Catherine’s vision into reality by 2030. 

We are educating and mobilizing local health officers, who will search for over 31,000 women still suffering in silence in the most remote regions of the country. Most of these women don’t know that help is out there. This program will search Ethiopia’s vast landscape to bring them hope, and offer life-changing treatment and care. It will help women restore their dignity and their place in the community. 

You can help us find and treat more women like Semenesh by donating today. Together, let's eradicate fistula. Forever. 

Help finish what Catherine started

Make a tax deductible donation to help eradicate fistula. Forever.
Donate Now
dr hamlin | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.

A Global Center of Excellence

The Addis Ababa Fistula Hospital has become known as a global center of excellence in fistula surgery. By 2014, word of Dr Catherine Hamlin’s work and the need to eradicate obstetric fistula had spread – in particular, the Hamlins' work in training Ethiopians to become best-practice surgeons. Recognizing the excellent care and surgical practice maintained at the Addis Ababa Fistula Hospital, the International Federation of Gynecology and Obstetrics (FIGO) partnered with Hamlin Fistula Ethiopia as part of the FIGO Fistula Surgery Training Initiative.  

Helping to treat more fistulas in more places 

Hamlin's clinical team began working in partnership with FIGO to increase the number of trained fistula surgeons around the world. These surgeons train at Hamlin to acquire surgical skills and knowledge to treat fistula injuries beyond the borders of Ethiopia. Beyond surgical technique, the FIGO participants learn about how to treat patient using the Hamlin Model of Care

To date, 28 surgeons and six nurses from around the world visited and trained at Hamlin's Addis Ababa Fistula Hospital to learn Hamlin's best-practice technique for fistula surgery. These surgeons are now using their skills to help women in Madagascar, Ghana, Afghanistan and the Democratic Republic of Congo.  Globally, the FIGO Fistula Training Initiative has trained 52 surgeons and resulted in more than 7,500 fistula repair operations across the developing world. 

Eradicating fistula, both in Ethiopia and across the globe, is only possible when fistula patients have access to quality medical care. You can help give fistula patients the care they need by donating here. 

Help finish what Catherine started

Make a tax deductible donation to help eradicate fistula. Forever.
Donate Now
dr hamlin | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.

Building a Fistula-Free Future

When I die, this place will go on for many, many years until we have eradicated fistula altogether – until every woman in Ethiopia is assured of a safe delivery and a live baby.

Dr Catherine Hamlin

If we ever need proof of the good in humanity, we only need to think of Dr Catherine Hamlin. Catherine was confident that the work she devoted her life to would continue. Her legacy is one of service, compassion and the belief that one person can make a difference. This ethos is at the heart of Hamlin Fistula Ethiopia’s work to eradicate fistula. Forever. 

Building off a successful foundation 

Since Catherine arrived in Ethiopia in 1959, over 60,000 women have successfully had their obstetric fistula injuries repaired – more than any other facility in the world. Thousands more women have had fistula injuries prevented through Hamlin-supported midwifery clinics, and fistula surgeons from around the world who have trained at Hamlin’s Addis Ababa Fistula Hospital. 

As Catherine planned, Hamlin’s hospitals, midwifery clinics, rehabilitation and reintegration center and the Hamlin College of Midwives will continue their excellent work. Today, over 550 Ethiopians are employed by Hamlin. Ethiopian professionals – many trained by Catherine – have for some time been appointed to all major roles at Hamlin Fistula Ethiopia to ensure continuity well into the future. 

Transforming lives through surgery 

This strong foundation for the continuation of Catherine’s work after her passing ensures that even more women will be able to access life-changing treatment. An obstetric fistula can usually be repaired with a single life-changing surgery, that can take as little as two hours.  Given that some women have suffered with the condition for decades, the transformation that this single operation makes is breathtaking. The operation can cost as little as $700. All patients at Hamlin hospitals are treated free of charge, as most are too poor to pay. 

A fistula-free Ethiopia by 2030 

Catherine was confident that fistula could be eradicated from Ethiopia by 2030. It is up to us to continue her life’s work and see this goal come to fruition. If we can eradicate fistula from Ethiopia, we will be making major inroads towards its eradication globally. The work of the Catherine Hamlin Fistula Foundation is only possible thanks to the thousands of supporters who give so generously to this cause. 

It is our hope that others will join us in our efforts to finally eradicate this debilitating but treatable condition. It would be a fitting tribute to a life of love and service. 

Will you join us? You can help us realise Catherine's dream by donating here today. 

Help finish what Catherine started

Make a tax deductible donation to help eradicate fistula. Forever.
Donate Now
dr hamlin | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.

A Summit Advocating for the Advancement of Women's Rights

On 10th December 2019 over 100 stakeholders, advocates and dignitaries attended an advocacy event organized by the United Nations Population Fund (UNFPA), the Ethiopian Ministry of Women, Children and Youth Affairs, and the Ethiopian Human Rights Commission. With the aim of influencing public policy and the means of eliminating discrimination and gender biases, the event highlighted the specific barriers – including lack of access to quality medical care – which hindered gender quality in Ethiopia. 

Women’s health: the cornerstone of development programs 

The event, held on Human Rights Day, featured panel discussions and guest speakers such as the Simegn Wube, the State Minister of Women, Children and Youth Affairs. The theme of the summit was ‘Celebrating the Role of Women in Protecting and Advancing the Rights of Women and Girls.’ The discussion focused on the urgent need to place gender equality and human rights high on public policy agenda. The event posited that the broadening of women’s choices over their health resulted in greater agency for women and girls. It was contended that greater reproductive rights and women’s agency was the cornerstone of any development program. 

Hamlin Fistula Ethiopia provides both short-term and long-term family planning services, giving women more control over their health and increasing the likelihood of safer pregnancies. Hamlin-supported Midwifery Clinics provided 145,078 patients with short-term family planning services and 77,290 patients with long-term family planning services in 2018/19. 

A wider conversation on gender equality 

The conversation on gender equality in Ethiopia gaining momentum; the UNFPA event was organized in connection with the ’16 Days of Activism Against Gender-Based Violence’ initiative and part of a series of advocacy events.  Gender-based violence has unfortunately been a factor for many obstetric fistula patients, with spousal abandonment being a common occurrence for patients arriving at Hamlin hospitals. 

The UNFPA event was held as part of the UNFPA’s ‘Preventing and Responding to Sexual and Gender-Based Violence, including HTTPs and the Rehabilitation of Survivors’ program; the program is supported by the Canadian government. Female empowerment programs – including literacy and vocational skills training – in Ethiopia have gained international attention; the generosity of Hamlin supporters has made a significant difference in the quality of life for tens of thousands of Ethiopian women. 

Advancing women’s rights through a holistic approach to healthcare 

In celebrating the role of women in protecting and advancing the rights of women and girls, the impact of Dr Catherine Hamlin’s work over 61 years in Ethiopia cannot be understated. The Hamlin Model of Care treats each person with the respect and compassion she inherently deserves; a holistic approach to treating fistula provides patients with rehabilitation, counseling and reintegration courses; and the creation of regional hospitals and clinics provides free health services for geographically isolated and impoverished women. The importance of improving the quality of life for women after their treatment is a key aspect to the Hamlin approach to healthcare. “To send women home to experience again a normal life after all they have suffered is the greatest reward we can have and is shared by all who look after fistula patients,” said Catherine. 

You can help improve the healthcare and quality of life of women in regional Ethiopia; find out how you can help here. 

Help finish what Catherine started

Make a tax deductible donation to help eradicate fistula. Forever.
Donate Now
dr hamlin | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.

2020: International Year of the Midwife

The World Health Organization (WHO) has designated 2020 as the International Year of the Nurse and the Midwife. Through this designation, the WHO is recognizing the work of the world’s 22 million nurses and two million midwives, including the life-saving work of midwives in Ethiopia. Prevention – through the work of Hamlin Midwives – is one of the three pillars of Hamlin Fistula Ethiopia’s work. In FY19 alone, Hamlin midwives delivered 30,004 babies! 

Advocating for the needs of midwives 

Working alongside other organizations such as the International Confederation of Midwives and the United Nations Population Fund, the WHO seeks to use the International Year of the Nurse and the Midwife to campaign for “increased investments in the nursing and midwifery workforce” in light of the significant challenges that nurses and midwives often face. 

Dr Tedros Adhanom Ghebreyesus, WHO Director-General and long-time supporter of Dr Catherine Hamlin and Hamlin Fistula Ethiopia, reflected on the importance of the initiative, saying, “nurses and midwives are the backbone of every health system: in 2020 we’re calling on all countries to invest in nurses and midwives as part of their commitment to health for all.” 

The WHO initiative has even garnered royal support from the Queen’s daughter, Princess Anne, who is the patron of the Royal College of Midwives. In a letter to the College, Princess Anne wrote: “I wanted to take this opportunity on the eve of the International Year of the Midwife in 2020 to express my profound admiration for the incredible and important work that you do; the value of which cannot be underestimated.”        

Midwives: the key to eradicating fistula 

For Catherine, the essentiality of nurses and midwives in preventing obstetric fistula from occurring cannot be underscored; for this reason, Catherine established the Hamlin College of Midwives in 2007. Speaking on the value of training more midwives, Catherine said: “to be able to train dedicated young doctors and midwives is marvelous for me and my loyal staff, especially as they become enthusiastic about helping these poor women. It gives me confidence that the eradication of obstetric fistula can be achieved.” 

As 2020 continues to unfold, keep an eye out for more news from the Hamlin College of Midwives and the work of Hamlin Midwives in Hamlin-supported Midwifery Clinics. 

Depression and Fistula - the Harsh Reality

The heartbreaking reality of an obstetric fistula injury for women in sub-Saharan Africa is that its consequences go far beyond the physical damage caused by the traumatic childbirth. For women suffering from fistula, the constant leakage of urine and/or feces leads to inescapable stigmatization within their communities that often results in social isolation. 

Due to myths and misunderstandings surrounding the causes of fistula injuries, women will often be outcast by their husbands and families, further adding to their distress. With no apparent means of supporting themselves, these poor women will endure a terrible quality of life, frequently suffering from depression. 

Hamlin Fistula Ethiopia has long recognized the tragic psychosocial implications of a fistula, and through the Rehabilitation and Reintegration Program is successfully addressing many of these issues. A series of recent studies has shed further light on the psychological aspects of fistula injuries, underscoring the need for a holistic approach to treating fistula. 

The extent of depression amongst fistula sufferers 

That depression is an inherent consequence of fistula would be of no surprise to those working in the field or those familiar with the heartrending circumstances of Hamlin patients. A recent study undertaken by Mount Kenya University and published in the International Journal of Sciences has found various psychological effects associated with fistula. 

The main such effects reported by the 190 women participating in the study survey were sadness (33%), social withdrawal (28%) and loss of self-worth (23%). An additional study, published in BMC Psychiatry and conducted on 306 women in Ethiopia, determined that 97% of women with urinary incontinence showed depressive symptoms whilst 100% of those with both urinary and fecal incontinence showed such symptoms. This is a truly alarming figure. 

The study also found that depression was more prevalent among rural than urban women and among divorced than married women. Various other reports have estimated that fistula results in divorce for 50% of women suffering from this condition. For those who remain married, 77% of women will not discuss their problem with their husband. These figures paint a picture of an isolating life for fistula patients, deplete of hope for a better future. 

Surgery - repairing more than just physical injuries 

The team at Hamlin Fistula Ethiopia is performing miraculous work in repairing the injuries of fistula sufferers. Such surgeries not only repair the physical injuries but, according to recent evidence, mend emotional scars too. 

In February of this year a team from the University of South Africa’s Addis Ababa campus published a study on the effects of fistula repair on the severity of depression and anxiety for women in Ethiopia. The results were extraordinary – the prevalence of depression reduced from 91% of participants prior to surgery (with 11% having severe depression) to 27% of participants post-surgery. Similarly, anxiety was prevalent in 79% of participants prior to surgery, reducing to 26% of participants after surgical repair of their fistula. Interestingly, the study found a correlation between the severity of leaking and the persistence of depression and anxiety symptoms at follow-up. 

This suggests that women who endure more prolonged and more significant traumatic experiences may require more than surgery to improve their mental wellbeing and reclaim their lives. 

Rebuilding a life 

Although fistula surgery may repair a woman’s physical and emotional wounds, reintegration back into the community will remain a difficult challenge for many. A 2016 journal report in BMC Pregnancy and Childbirth summarized the main concerns of fistula patients in Malawi both before and after restorative surgery. The greatest concerns of women prior to surgery included the ‘fear of death during surgery, having an irreparable fistula and marital discord’. ‘Urinary leakage, difficulties conceiving and general negative thoughts’ also presented as pressing issues. 

Following surgery, these concerns evolved to surround relationship challenges predominantly, as well as persisting financial challenges and the need for additional surgery. Thus, it is apparent that the medical complications of a fistula are only half the story. It is necessary to help women regain their sense of worth and rebuild their lives. In fact, the authors of the aforementioned study of women in Kenya recommended that fistula victims receive counselling services alongside vocational training to aid in their recovery and their return to community. This is where Hamlin’s Rehabilitation and Reintegration Program fulfils such a vital purpose. 

Hamlin's pioneering and holistic approach to recovery 

Hamlin Fistula Ethiopia recognizes that after suffering so much, fistula patients need to regain their dignity. At Desta Mender, meaning ‘Joy Village’ in Amharic, this is exactly what occurs. This peaceful and purpose-built recovery center allows long-term fistula patients to continue to heal through a comprehensive Rehabilitation and Reintegration Program. Amongst friends who share an understanding of what it means to have endured fistula, women find themselves immersed in a caring community. In response to the significant psychological effects of a fistula, women at Desta Mender are offered counselling, helping them to better understand their injuries and the subsequent trauma. 

The program also offers literacy and numeracy classes and vocational skills training. This affords fistula patients the confidence and expertise necessary to become independent members of their communities and is central to them regaining a sense of self-worth. In fact, the Malawi study revealed that for 75% of women, improved income-earning ability positively contributed to their quality of life post-surgery.     

Read about the incredible progress made by former fistula patients. 

Rebuilding a meaningful life and regaining a positive outlook after enduring so much is a remarkable achievement that speaks volumes of the courage of women who arrive at Hamlin. It is also testament to the tireless efforts of the team at Hamlin Fistula Ethiopia and the incredible compassion of Dr Catherine Hamlin. 

Catherine has always sought to understand her patients for the person that they are - each an incredible individual with her own story, her own suffering and her own hopeful future ahead. 

Please consider supporting the truly life-changing work of the Hamlin Rehabilitation and Reintegration Program and help alleviate the emotional turmoil endured by fistula patients in Ethiopia.  

Author: Natalie Stals, medical student interning at Catherine Hamlin Fistula Foundation

Help finish what Catherine started

Make a tax deductible donation to help eradicate fistula. Forever.
Donate Now
dr hamlin | Catherine Hamlin Fistula Foundation (USA) | Working to eradicate obstetric fistula. Forever.