“My dream is to eradicate obstetric fistula forever. I won’t do this in my lifetime, but you can in yours.”
Dr Catherine Hamlin
Dr Hamlin passed away on Wednesday 18 March 2020 at her home on the grounds of the Addis Ababa Fistula hospital in Ethiopia where she had lived for 61 years. The RCOG wants to pay tribute to the incredible and inspiring woman Dr Elinor Catherine Hamlin (known as Catherine) was, and to spotlight ways that we can all continue her work and eradicate fistula forever.
Dr Catherine Hamlin moved to Addis Ababa with her husband Reginald in 1959 after seeing an advertisement in the Lancet; what started as a three-year stay in Ethiopia turned into a six-decade mission to transform the lives of women affected by obstetric fistula.
Obstetric fistula is one of the most serious and stigmatising injuries that can occur during childbirth. It is a hole between the birth canal and the bladder or rectum caused by prolonged, obstructed labour without treatment. This causes incontinence of urine and sometimes faeces.
Women are often shunned by their families and communities, unable to work and they often have to live with the condition for years or even decades because they cannot afford or access treatment.
Around two million women in sub-Saharan Africa, Asia, the Arab region, Latin America and the Caribbean are currently living with this injury, and it is estimated that 50,000 to 100,000 new cases develop worldwide each year.
When Dr Hamlin and her husband arrived in Ethiopia there was little to no treatment available for women suffering obstetric fistula. The two drew on manuals and drawings of the fistula repair operation, supplied by colleagues from around the world including textbooks from a Cairo-based Professor Pasha Naguib Marfouz. They began repairing small fistulas ‘which any gynaecologist can fix without much training, and gradually tackled more difficult ones’ (http://www9.who.int/bulletin/volumes/91/10/13-031013/en/)
The techniques the Hamlins used are still practiced around the world today.
They co-founded the Addis Ababa Fistula Hospital in 1974. Today it is a global centre of expertise and trains surgeons from all over the world. This same year Catherine Hamlin was awarded a Fellowship ad eundem by the RCOG for her contributions to gynaecology.
Following Reginald’s death in 1993 Catherine set up the Hamlin Foundation. It is thought that the Foundation has treated more than 35,000 women for obstetric fistula so far.
It was Catherine’s belief that, although treating fistula is important, we must focus on prevention. The establishment of the Hamlin College of Midwives was a step towards this. Through the Foundation she also opened five rural hospitals offering healthcare to women, as well as a facility for long-term care.
The RCOG believes we need to mainstream gynaecological skills into healthcare services and train more healthcare workers on these essential skills. This includes identifying and treating fistula at the earliest opportunity as well as referring women to accessing quality care. In addition, the RCOG has been working with partners in Uganda to improve the management of obstructed labour to prevent women suffering this terrible childbirth injury. Find out more about the RCOG’s work tackling stigma in gynaecology care here and its work in Uganda here.
We heard from some RCOG fellows and members who had been touched by Catherine Hamlin’s strength and selflessness:
“Although Dr Catherine Hamlin and her husband did tremendous work for the women of Ethiopia, the true legacy was that their work spread. Fistula work is now a known public health problem and doctors are now doing fistula work at over 400 sites across Africa and SE Asia. Many of these centres started their work inspired by the lives of Dr Catherine and Reginald Hamlin.”
Dr Andrew Browning AM
“Following my retirement from the NHS, I worked in Ethiopia for 3 years, 2 of which was at Hamlin Fistula Ethiopia as a fistula surgeon, where I got to know Catherine well. We were frequent visitors to each other’s houses and spent many happy evenings together. Her years in Ethiopia encompassed many difficult times, including the fall of Haile Selassie, a personal friend of hers, and the rise and fall of the Derg. She also witnessed the restoration of limited democracy and a rise in the fortunes of the vibrant country she loved. Throughout these times, Catherine fund-raised tirelessly for the Hamlin hospitals, midwifery school and rehabilitation centre, and remained a truly humble person albeit with a will of steel. Even in her 90’s, she climbed the steep stairs through the carefully tended and beautiful garden of her bungalow to attend morning prayers and a ward round. As Richard, her son said, ‘She had one son but 35,000 daughters’.
“A favourite haunt was the ‘Greek Club,’ a small oasis of tennis courts and green in an otherwise relentlessly dust metropolis, which has survived from the time of the Emperor. We spent many happy lunch times on the veranda there. She is now buried with her husband in the Addis Ababa War Graves Cemetery, but her memory will live long in Ethiopia.”
“Dr Hamlin was such an inspirational person and doctor, it was an honour to know her and indeed to be taught to do my first fistula repair with her 20 years ago. As Isaac Newton said ‘If I have seen further, it is by standing on the shoulders of giants.’ There is no doubt that Dr Hamlin was a giant in our speciality and her knowledge, skills and care for some of the most marginalised women in the world will be sorely missed.”
Mr Shane Duffy MB BS DTM&H Dobst MSc MRCOG
“I first met Dr Catherine Hamlin AC in 1995 when I spent 1 month at the Addis Ababa Fistula Hospital for fistula training during 6 months of volunteer work in Ethiopia, mainly in a rural area. I have visited the hospital many times since then. Catherine invited me back in 1997 to be a staff specialist fistula surgeon at the Fistula Hospital for 6 months whilst one of the 2 fistula surgeons was on maternity leave. Dr Hamlin spent a fair bit of time travelling and fundraising but when she was in Addis, we were the only 2 doctors living on site. This gave me the privilege of spending time with her, sharing meals and stories with her. Catherine was great at telling entertaining stories of her life and experiences.
“I remember she would drive around in her very small car, usually avoiding the enormous potholes in the streets of Addis Ababa – she would know where to go to get certain items that she required, for example, she would drive up to a small group of shops and send me out to a certain butcher to obtain a small leg of lamb for dinner.
“I also remember the time when we had to bring a woman back to theatre one evening for post-operative bleeding. Catherine gave the anaesthetic whilst I secured the bleeding. I can still recall Catherine sitting very calmly with a cloth mask over the patient’s face, dripping ether onto the mask.
“There are dozens other stories I can recall but I remember Catherine as an excellent surgeon, a fantastic teacher, an inspiration and a marvellous mentor. She taught me many things about obstetric fistula – outpatient assessment, surgical tips and tricks, post-operative management – and most importantly, she taught me her love for the fistula women.”
Judith Goh AO FRANZCOG PhD CU
“I went to the Addis Ababa Fistula Hospital to do my physiotherapy elective placement in 2007. When I first met Catherine there, she hadn't known about my visit, and immediately invited me to her home the following day for tea and cake. Her home was within the hospital grounds and, like the hospital, was surrounded by beautiful plants and flowers, quite a contrast to the dusty crowded streets just outside. What I remember most about Catherine was her warmth and humility. I had never met anyone who exuded such a loving and gentle presence. She was a very special person and I felt so blessed to have been able to meet her.”
Sophie Barbary (nee Hilton) Physiotherapy BSc (Hons)
You can leave a tribute for Catherine on the Catherine Hamlin Fistula Foundation website.
Photograph: Dr Andrew Browning