Hamlin, Elinor Catherine

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MB BS 1946 MD honoris causa 2005 FRCOG (Eng) ad eundem FRANZCOG (Aust) FRCS (Eng) Honorary FACS (America) Honorary

Catherine Hamlin, with her late husband Reginald, co-founded the Addis Ababa Fistula Hospital in Ethiopia in 1974. This hospital has now treated more than 26,000 girls suffering from fistulas and other birth injuries.

After graduating from the Faculty of Medicine, Catherine became House Surgeon at St Joseph’s and St George’s Hospitals. In 1948, she was appointed Senior Resident Medical Officer at the Crown Street Women’s Hospital, where she remained until 1953. There she met and married Dr Reginald Hamlin. Together, in 1958, they answered an advertisement for an obstetrician and gynaecologist to establish a Midwifery School in the General Hospital in Addis Ababa. Initially, they went to Addis Ababa for three years. However, the Hamlins soon became aware of the plight of hundreds of ‘fistula women’.

Catherine described the cause of the fistula as being: the agonising journeys to hospital faced by many patients from remote areas, including a typical two-day walk to the nearest road followed by lengthy travel by bus; a labour of four, six or even 10 days followed by a stillbirth; and the devastating injuries caused by obstructed labour. These are patients who are the unfortunate 5 per cent of all labouring women who suffer an obstructed labour.

[The Hamlins] were profoundly affected by their serious needs, and decided to stay in Addis Ababa and do something to help them. They were inspired by an American surgeon who in the 1850s demonstrated that these injuries could be cured. They were able to develop this delicate surgical technique to successfully repair fistulae caused by obstructed childbirth in 93 per cent of cases.

A fistula waiting hostel was built in the grounds of the Princess Tsehai Hospital to house patients, while waiting for a bed in the hospital. In the first year, fistula repairs were carried out on 32 women. By the third year 300 women had been healed. They perfected their surgical procedure. Each operation takes from about one to three hours to perform. As word spread that a cure for this condition was possible more and more patients arrived for surgery. There were not enough beds at the Princess Tsehai Hospital to treat them. The Hamlins decided that they must find a hospital for these “outcast” women, something that would be a sanctuary and a haven, where they would be welcomed and restored. The “Hamlin Fistula Research and Welfare Trust” was registered in Ethiopia. Land for the Hospital was purchased.

The first ward of the Addis Ababa Fistula Hospital was opened in 1974. Because the patients were so poor, treatment had to be given free of charge.[1]

When Reg Hamlin OBE died in 1993, Catherine pledged to continue the work they had begun together. Without his physical support however, there was a need for additional doctors.

An increasing number of patients were coming for surgery and the hospital buildings needed to be upgraded and extended. A house for a new resident doctor was built. The Princess Anne Ward, the pathology laboratory and the library were also built. A more intensive program to train doctors and nurses in fistula surgery was commenced. Because of the extreme difficulty patients have to reach Addis Ababa, a mobile Medical Team was established, to travel to remote areas of Ethiopia, and to do fistula operations in regional hospitals. A Land Rover was donated by Rotary Clubs in Australia. The Fistula Hospital building complex was restructured and major extensions were made. A new operating theatre, an X-ray room and physiotherapy centre was built. Accommodation for resident nurses and for overseas doctors in training, were constructed. A bore for water was sunk. This project was funded by the Australian Government, AusAID, and other generous donors in Australia and New Zealand. At a later date an additional 30-bed ward was built in the grounds of the Addis Ababa Fistula Hospital, also funded by Australia.[1]

At the degree ceremony at which Catherine received her Doctor of Medicine, University Chancellor Justice Kim Santow paid tribute to the Hamlins for devoting their lives to alleviating the suffering of Ethiopian women. The Vice-Chancellor, Professor Gavin Brown, said that “the Hamlins did not simply cure their patients, they cared for them”. But the dual nature of her work, both heartbreaking and inspirational, was best conveyed by Catherine herself:

Patients are still arriving daily, each one deserving the utmost compassion the human heart is capable of…They arrive with nothing but faith and hope and urine-soaked clothes.

When the young women have been treated, they either need to stay for further rehabilitation or are free to return home. Catherine describes this moment:

We don’t just say to them now you are cured, just go out the gate and you will be alright. They wouldn’t know where to go. They wouldn’t have money to get home. So twice a week we take them in our vehicles, in our Land Rover or a 4-wheel drive, up to the market area where the buses leave and we pay their fares back to their village. Not only do they have a new dress and perhaps a new headscarf, but they have a card which they carry which describes the operation which we have done and we tell them that this is a very precious card. You keep it safely and when you are pregnant again you must get to a hospital and take this card with you as soon as you feel the baby walking around in your stomach. You will be looked after possibly needing a Caesarian Section, to give you a live baby.[1]

According to Catherine, around 99 per cent of fistulae cases can be cured by surgery. But without access to treatment, many of the women are treated as pariahs in their home villages; unable to control the flow of urine or faeces, they are usually abandoned by their husbands and treated as outcasts in their own communities. To help the women for whom surgery does not provide a solution, their team has built the village Desta Mender on 60 acres of land, given by the Ethiopian Government. Says Catherine:

Fortunately, it is only about half a percent of all the patients that we see that have this terrible injury where the bladder is irreparably injured, and so we have built this village especially for them. It is a beautiful place, with ten women to every house”.[1]<

Catherine is confident about the future even though patient numbers are still increasing: “Our hope is that one day every woman will be able to have a safe delivery and a live birth.”[1]

Citation: Mellor, Lise (2008) Hamlin, Elinor Catherine. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.