The fistula patient, the fistula surgeon, the woman
"If you have no leg, you can go with a crutch. If you are blind, there is somebody to help you around. For fistula, this is worse. Family, father, brother, mum, they can’t help... I would be ashamed, because when I got up, there might be a smell, I might be leaking and my clothes soaked... I wanted to be alone.” - Mamitu Gashe
Mamitu Gashe came to the hospital as a patient at the age of 14 with terrible obstetric fistula injuries. She was so grateful for the care she received that she decided to dedicate her life to Dr Catherine and Reg Hamlin’s mission - helping other women with a fistula injury. Catherine and Reg saw something special in Mamitu. She went from mopping floors and comforting her fellow patients, to assisting Catherine and Reg in theatre.
Under Reg and Catherine’s skilled guidance and training, Mamitu became one of the most acclaimed fistula surgeons in the world, despite never having had a day’s schooling. In 1989 she won the Gold Medal for surgery from the Royal College of Surgeons in London.
Mamitu began travelling to spread the Hamlin Model of Care in obstetric fistula treatment. Over the next few years she visited Kenya, Tanzania, Uganda, India and the Mercy Ship ‘Anastasis’ to train surgeons in fistula surgery.
Mamitu still lives on the grounds of Hamlin’s Addis Ababa Fistula Hospital and is a much loved matriarch in her own right. She remains dedicated to transforming the lives of women suffering fistula and eradicating this terrible condition once and for all. It is widely acknowledged that almost every fistula surgeon in the world today has been trained by Mamitu Gashe or by someone who was trained by Mamitu
“I see Catherine as the sun who lit up Mamitu when she was so alone and vulnerable as a fistula patient. And then Mamitu shone so brightly herself as a truly extraordinary woman, rescuing thousands of others from the darkness." - Tesfaye Mamo, CEO, Hamlin Fistula Ethiopia.
Healing Lives: Mamitu's story
Healing Lives by Sue Williams reveals the untold tale of Mamitu Gashe, the protégée of Dr Catherine Hamlin, and the inspiring friendship between the two women. Mamitu came to the hospital as a patient in 1962 with a horrific obstetric fistula injury, she went on to become one of the most acclaimed fistula surgeons in the world, despite never having had a day’s schooling. This is a story about the power of passion, giving, and an unlikely friendship, that will capture your heart.
Studying Midwifery During a Pandemic
Studying Midwifery during a pandemic. Like millions of students around the globe, Rahmet’s studies have looked a little different this year; through emails, online discussion boards, and phone calls, the third year midwifery student has been continuing her studies from home during a nation-wide lockdown.
The new normal
In March, following the announcement of the Ethiopian government’s measures to combat the COVID-19 pandemic, the Hamlin College of Midwives closed its campus and sent its 98 students back home to study remotely from their rural communities across Ethiopia. The College enacted a plan for students to continue learning from home. Each cohort has a designated advisor supporting students via phone and email, as well as online learning groups where instructors provide materials and students exchange ideas.
Students studying Midwifery are encouraged to take responsibility for one another despite being physically distant: each cohort has an assigned group leader who is responsible for coordinating group challenges and solving them under the supervision of instructors. The College also facilitates student visits to nearby government clinics for practical observations in addition to their theory work.
Hamlin midwifery student Rahmet is home in Mettu and is studying Midwifery every day; like so many people around the world, working from home is not the same. “Before we left the College, our instructors equipped us with enough materials for each course and we are now studying from home. To be honest, this is the longest time I have spent away from school in my life: I miss my classmates and feel detached from the teaching process,” reveals Rahmet.
For Rahmet, her studies make up part of a packed schedule giving back to her family and her community during a trying time: “Alongside my studies, I spend the day helping my Mum at home, teaching neighbors ways to prevent spreading COVID-19, and visiting the government clinic for practical observation,” says Rahmet.
Rahmet hopes to return to her classes and friends soon. “I can’t wait to re-join college life inside that breathtaking compound when the pandemic is under control,” says Rahmet. The Hamlin College of Midwives is hoping to re-open its campus in late September in time for the new academic year. They’re prepared for an intense few months of extra evening and weekend classes to make up missed classes. Hamlin midwives are the cornerstone of Dr Catherine Hamlin’s vision - ensuring that women in Ethiopia have access to quality health care during pregnancy and birth.
Even in the most difficult of times, our students and midwives in the field are studying and working harder than ever. Because of them, obstetric fistula as well as countless maternal and neo-natal deaths are being prevented, every day. Their work is nothing short of remarkable and it is possible thanks to supporters like you. Thank you.
Learn more about the Hamlin College of Midwives here.
Maternal Health and COVID-19
Maternal health and COVID-19. The COVID-19 pandemic has placed extraordinary strain on health systems across the globe and disrupted essential maternal services. For too many women, access to potential life saving perinatal and postnatal care is a challenge as countries redirect health resources to tackle COVID-19.
The impact of COVID-19 on maternal health
The impact of the pandemic on women in developing countries is compounded: they are often poor, they often live in remote communities distanced from medical resources and they are women. The implementation of lockdowns and travel restrictions, coupled with the closure or repurposing of public health facilities to slow transmission, further distances women from already difficult to access maternal services. Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa, states “Women are disproportionately affected by lockdowns and this is resulting in a reduced access to health services.” Accordingly, perinatal and postnatal care are considered by the WHO as essential medical services that must be maintained during a pandemic to support women’s health.
Although the WHO considers adverse health effects of unattended births outweigh the risk of COVID-19, fear of contracting the virus from health centres is deterring more women from travelling to open facilities to receive medical support from skilled clinical personnel. Reduced access and utilization of essential maternal health services translates into an increased likelihood of obstetric fistula injuries and maternal deaths.
The WHO interim guidelines for COVID-19 estimate a 10% decline in facility based births could result in an additional 28,000 maternal deaths. Many African countries are reporting a gradual decline in deliveries by medical personnel, with assisted births down by 9% in Ethiopia alone.
The UNFPA’s Executive Director Natalia Kanem commented to The Lancet Journal “We’re at a point where people are avoiding health systems for fear of COVID-19, so the role of the midwife, the role of the community health worker… is absolutely essential.”
Maternal health and COVID-19: The importance of midwives
In 2020, the International Year of the Nurse and Midwife, these frontline workers are more important than ever. Midwives are trusted companions of expectant mothers, performing a dual role to achieve safe childbirths and deliver maternal care. They are essential to creating a positive pregnancy experience. Amidst the challenges of COVID-19 midwives are risking their health to deliver care and emotional support to women.
At Hamlin Fistula Ethiopia, Hamlin Midwives are the cornerstone of our vision, to ensure women in rural Ethiopia continue to access quality maternal health care, especially during COVID-19. In communities where there is a Hamlin Midwife, the Hamlin team is determined to ensure that there is not a spike in obstetric fistula cases or maternal death due to lack of skilled medical care. At the same time, Hamlin Midwives and Hamlin’s outreach officers have been supporting the Ethiopian Government’s initiative for community health workers to raise awareness about how to prevent COVID-19 infection. Our midwives are particularly well placed to support this as they speak different regional languages, and the trust the Hamlin team has built up over the years is helping them engage with their communities.
Maternal health and COVID-19: We’re all in this together
Hamlin Fistula Ethiopia is committed to the protection and care of patients during this challenging time. Although “the pandemic has definitely affected the flow of fistula victims to our hospitals”, according to Sister Konjit, the number of women suffering obstetric fistula has likely risen. Our work today is as essential as ever, with the threat of COVID-19 disproportionately affecting women - that’s why Hamlin Fistula Ethiopia is dedicated to providing essential maternal care and restoring dignity to Ethiopian women.
Even in the most difficult of times, our students, midwives and entire Hamlin clinical team are working harder than ever. Because of them, obstetric fistula as well as countless maternal and neo-natal deaths are being prevented.
We won’t stop until fistula is eradicated. Forever.
If you would like to support the work of Hamlin Fistula Ethiopia, click here. Your support is needed now, more than ever. Together we can create hope and lasting change for women.
In the remote village in southern Ethiopia where Buritu grew up, access to basic services such as medical clinics, schools and electricity was unthinkable. Buritu and her family have to walk for hours just to reach the closest market town. Completely illiterate, marriage was the primary objective for Buritu. At age 16 she was married, maintaining a household and working with her husband on the farm.
After giving birth to a healthy daughter, Buritu found herself pregnant again. With no access to qualified medical professionals, Buritu expected to have a home delivery assisted by village elders. Unfortunately, the complications of her labor would cause heartbreaking consequences.
The pain of fistula
After Buritu's labor dragged on painfully, she was taken to the closest government hospital. There, she delivered a stillborn baby through a caesarean section. "At first I was so happy just to stay alive - so was my entire family. I felt the wetness down my legs but thought it might be from the aftermath of the long labor. I hoped it would stop soon but that didn't happen and by the time the doctors told me that I faced a fistula [injury], I felt ashamed of myself and wished that I could die with my baby. I never believed that I would be cured," recalls Buritu.
Buritu hid away in a small hut at her mother's home, suffering the agony of fistula. Buritu was relatively lucky though, as her family supported her through the darkest times. "I am lucky that I have a caring husband. He would spend all day at home washing my clothes, feeding me and taking care of me until we headed to Addis Ababa," Buritu reflects. After three months, she headed to the Addis Ababa Fistula Hospital to get help.
Getting her life back
Buritu arrived at Hamlin's Addis Ababa Fistula Hospital at the beginning of June. After a week of pre-operative rehabilitation and medical attention, Buritu underwent fistula repair surgery. Her injury was cured through a single operation. Buritu's journey went from suffering to hope thanks to the team at Hamlin Fistula Ethiopia.
Today, Buritu is completely dry. "I was not expecting to be cured within such a short period of time. This hospital is unique in that it provides motherly care free of charge and brings back dignity for poor women like myself," says Buritu. She has already returned home, ready to restart her life.
"You gave me my life back, for which I am forever indebted. I can't thank you enough for what you did for me and for many more women like me," reflects Buritu.
Help more women like Buritu get their lives back. Click here to learn how you can help.
Achieving the UN Sustainable Development Goals, thanks to you
Your regular support changes lives
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.
By eradicating fistula, through treatment and prevention, we will move towards a fairer and more just world for all. As a Hamlin Regular Giver, you play an important role in helping us achieve the UN Sustainable Development Goals.
Here's how you are helping achieve the SDGs
Goal 3 - Health and Wellbeing
You are helping to 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 are playing 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 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 are helping to 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. This is thanks to supporters like you!
By being part of our valued Hamlin Regular Giver community, you are taking a huge step towards a fairer and more just world for all.Thank you.
Jallene’s Journey. For years, Jallene needlessly endured the agony of obstetric fistula without any medical attention. Thanks to a new Hamlin Fistula Ethiopia initiative, Jallene was identified by Hamlin-trained health officers and taken to the Addis Ababa Fistula Hospital for treatment. Jallene’s journey is one of sacrifice, suffering and, ultimately, the renewal of hope.
Life before fistula, Jallene's journey
Jallene is from a remote village near Asossa, the capital of the Benishangul-Gumuz region of Ethiopia. Like most of the women in her village, Jallene has spent most of her life farming the same small plot of land along with her family. Their subsistence farming would generate a little money – the sole source of income for the entire family – but life was not easy for Jallene and her five children.
During her sixth pregnancy, Jallene lost her baby; her seventh pregnancy would result in even more tragedy. When Jallene conceived again, she thought her pregnancy would proceed as usual. Living in a remote village meant that access to antenatal care in the city was extremely limited; as with her previous pregnancies, she was unable to visit a clinic. Unlike her previous pregnancies, Jallene experienced a prolonged and obstructed labour.
Jallene tried to deliver at home, to no avail. After two days of pain, she was taken to a nearby government clinic where she eventually delivered a stillborn child. In addition to the anguish of losing a child, Jallene suffered a devastating fistula injury.
The harsh reality of fistula bears out in the numbers. Seven in every ten women in rural Ethiopia give birth without any medical care. Lack of access to a qualified midwife increases the likelihood of a woman experiencing an obstructed labour. Where an obstructed labour is neglected or allowed to continue without intervention, a stress incontinence or an obstetric fistula will develop. A staggering 93% of the women who suffer an obstetric fistula injury give birth to a stillborn baby.
Struggling to live
For many fistula sufferers, the isolation of fistula is as harmful as the physical debilitation of fistula. Jallene’s social support systems crumbled in the wake of her fistula injury. “After this injury, husband abandoned me and I started to struggle to feed my children by myself. It was too difficult: I had to work tirelessly on the farm as well. During those days I had no friends and would never mix at any social gatherings. I just lived alone with my children,” explains Jallene.
Jallene lived with the debilitating pain of fistula – and single-handedly supported her three sons and two daughters – for ten years. It was not until earlier this year that Jallene’s injury was identified and she was brought to the Addis Ababa Fistula Hospital for treatment as part of Hamlin’s Patient Identification Program. It was the first time she had received medical attention since she has suffered the childbirth injury.
The Patient Identification Program trains local health officers to undergo their work with the utmost sensitivity. Hamlin-trained health officers are able to identify obstetric fistula injuries, talk to women with empathy and sensitivity, and offer counselling to women who have suffered in silence for so long. The identified fistula patients are brought to the closest Hamlin Fistula Hospital where they undergo fistula repair surgery and comprehensive, holistic treatment free of charge. The first phase of the program earlier this year identified 24 fistula patients.
A promising future
Upon her arrival at the Addis Ababa Fistula Hospital in May, Jallene underwent heath checks and preoperative physiotherapy. After this, Jallene had surgery to repair her complex fistula injury. She is now using a catheter and able to socialize with other patients. Hamlin medical staff find Jallene’s case to be very promising and believe there to be a good chance that she will be fully cured.
“I regret not knowing about Hamlin and coming at the earliest possible opportunity to experience such joyful dryness. I have no words to explain my gratitude for everybody at the hospital. They have worked so hard with the current pandemic and gave me such motherly care,” reflects Jallene.
Hamlin’s new Patient Identification Program seeks and treat to find the countless women who, like Jallene, have suffered in silence from the indignity of fistula. Jallene's journey went from pain to hope. You can help care for fistula patients like Jallene by donating today.
As a health care worker, woman and mother…
Hamlin regular giver Maggie Robin supports the work of Hamlin Fistula Ethiopia, here’s why…
I first heard about Dr Catherine Hamlin many years ago from my Godmother. She had seen Dr Hamlin speak in person and was inspired to donate to the foundation. Some years later while training as a doctor in women’s health I learned more about the devastating consequences of obstetric fistula. I read “The Hospital by the River” on a family camping holiday and, like many others, I was deeply moved by Catherine’s story and mission. As soon as we arrived home from that holiday, I signed up to become a regular donor.
I was thinking about how the values of the Catherine Hamlin Fistula Foundation resonate with me in multiple ways. As a health care worker, I know that childbirth injuries are both curable and preventable.
As a woman, I am grateful for the health care I have had, and I believe that every woman should be similarly supported and cared for in childbirth, no matter where she lives in the world. As a mother, I want my daughters to have confidence, independence, and a sense of self-worth – the Hamlin Foundation wants this for all women. I was thinking that becoming a regular donor would be a meaningful way to make a difference.
The Catherine Hamlin Fistula Foundation is an organization with a single mission: to end obstetric fistula in Ethiopia. It’s the way they are achieving that mission, however, that is what makes them so special. Hamlin’s holistic approach – treating the whole woman, not just the injury – and their focus on prevention through training midwives, transforms not only the patient’s lives but the lives of their families, their midwives and the communities they serve.
I think that back in 1959 when Catherine & Reg Hamlin first arrived in Ethiopia, no one could have imagined the magnitude of what they would eventually achieve. Without a doubt, their dedication, passion and fundraising efforts are the foundations upon which Hamlin’s facilities stand today. They have transformed the lives of many thousands of women. Through training and employing Ethiopian staff however, they have also built an organization that is now proudly Ethiopian. Despite Catherine & Reg’s passing, their legacy will therefore continue on, delivered predominantly by Ethiopians rather than relying upon international staff, and I love that this makes it a robust and sustainable organization.
While any donation is helpful, an ongoing commitment can achieve more in the long term. In 2019 I was lucky enough to join the Hamlin 17 Day Ethiopian Adventure and visit Hamlin’s facilities, meeting patients, staff, and even Dr Catherine Hamlin herself. This firsthand experience exceeded everything I thought I already knew about the organization and the quality & impact of the work they do. I feel like I have a lifelong relationship with the organization now, and being a regular supporter helps me maintain that connection.
If you want to support an organization that will use your donation as effectively as possible, where it is needed most, to genuinely change lives for the better, then the Catherine Hamlin Fistula Foundation is a wonderful choice.
Hamlin Fistula Ethiopia is on track to achieve its goal of eradicating obstetric fistula in Ethiopia by 2030. They are already looking at ways that they can continue to improve the lives of women and girls beyond this time. This is an organization with not only a strong history and a lasting legacy, but an ambitious vision for the future. Give them your support and just watch what they can achieve!
Become a Hamlin regular giver today!
If you would like to join our amazing community of committed supporters, click here. A monthly gift of $45 will fund a standard fistula operation in one year. Become a Hamlin regular giver today!
Thank you to our regular givers, you are amazing!
Regular givers - you are helping to change lives every day. Your monthly donations provide Hamlin Fistula Ethiopia with a reliable and sustainable income which helps us plan well into the future - that means the world to us.
You are part of a committed community of people who are determined to eradicate obstetric fistula. Forever. Your support restores women’s lives.
Click here to read an interview with Hamlin Regular Giver, Maggie.
How your monthly donations help…
Treatment: Your gift helps to provide fistula surgery to restore women’s lives. The Hamlin clinical team deliver the world’s best practice surgery.
Prevention: Your gift supports the training of local midwives who prevent fistula and ensure more women have access to quality health care.
Rehabilitation & Reintegration: Your gift helps to provide rehabilitation and reintegration programs to recovering patients, healing their bodies and minds.
Regular givers make the world go round. Join today!
If you would like to join our amazing community of committed Hamlin regular givers, click here. A monthly gift of $45 will fund a standard fistula operation in one year.