The Hospital By The River

The Hospital By The River‘The fistula patients will break your heart’ were the prescient words a doctor spoke to Drs Reg and Catherine Hamlin soon after they arrived in Addis Ababa, Ethiopia.

Another later said: ‘Nothing can equal the gratitude of the woman who, wearied by constant pain and desperate with the realisation that her very presence is an offence to others, find suddenly that life has been given anew and that she has again become a citizen of the world.’

Both are strikingly true.

The Hamlins, husband-and-wife obstetricians, answered an advertisement for a three-year contract to set up a midwifery school for nurses in Addis Ababa. That was decades ago, with the couple stumbling into what turned out to be their lives’ work.

Struck by the desperate need of so many women suffering from fistulas—that is, roughly speaking, holes in bladders obtained through protracted labour and little medical help—they set up the Hamlin Fistula Hospital and dedicated their lives to helping as many fistula sufferers as possible.

Fistulas are almost unheard of in developed nations, where women are not often married at too young an age, and where they receive good antenatal care and have access to doctors and hospitals during labour.

But they’re wrenchingly common in such places as Ethiopia. Having one has devastating repercussions, with the stench of a woman constantly leaking urine invariably seeing her abandoned by her husband and shunned by the community.

The Hospital By The River is Catherine Hamlin’s memoir (Reg Hamlin passed away around a decade ago). It charts the couple’s and their son Richard’s story as well as the stories of the many staff and fistula sufferers who’ve come entered their lives along the way.

Of which there are many.

The Hamlins came to call these women ‘fistula pilgrims’, with many travelling enormous distances to receive help. The stories both defy description and sound, as you read so many of them throughout the book, depressingly the same.

These women—sometimes girls—are young. They don’t receive antenatal care, and receive little to no help during labour. Complications extend their labour for up to five or six days, after which time the baby is no longer alive. Many eventually deliver a stillborn child and sustain perforations to their bladder and sometimes rectum or uterus. Then, as if the pain of such a labour and of losing a child isn’t enough, they lose their husbands and community standing.

Fistula pilgrims are desperately poor, often having to beg for years to scrounge together the bus fare to get to the hospital or being carried to the hospital by a brother or father. They can’t afford the hospital fees and the Hamlins in the early days found themselves regularly covering costs out of their own salaries.

Many of the women have atrophied limbs from lying curled up on an often foetal position long term. By not moving, they logically try to reduce the leakage and hope it goes away.

All are stoic, proud, and grateful—enduring far more and with more dignity than I can imagine most first world-raised women could. Rarely are they aware the fistula is not their fault and they can for the most part be repaired. One woman suffered a fistula in exile for 40 years before the Hamlins cured her.

A woman from another region who didn’t speak Amharic, the language spoken in Addis Ababa, arrived wearing a sign around her neck in Amharic asking for directions to the hospital. I can’t explain why, but this particular story—and the accompanying image—left me reeling even more than the other tear-inducing stories. I think it was something to do with the humbling, desperate sadness of the sign combined with the ingenuity of it.

Meanwhile one girl endured an eternally long journey to get to the hospital, only to arrive too late one night to be admitted. She tried to hang herself just outside the gates, but was fortunately rescued before she succeeded. She was accepted the next day and her fistula repaired.

‘You’re not leaving are you, doctor?’ a staff member asks Reg at one stage as he readies to depart on a desperately needed holiday.

‘No,’ Replied Reg, ‘but if I don’t have a holiday, I will die.’

‘If you don’t come back, many will die,’ was the staff member’s reply.

At the time the book was written, it cost $300 to cure a fistula patient, a pithy amount I’m ashamed those of us in first-world nations aren’t doing more about.

The Hospital By The River contains more about the Hamlins’ social lives than I had expected. It interested me less than the fistula patients and medical and cultural approaches themselves, but that’s likely my personal preference than any real criticism of the book. Conversational, personal, and anecdote-driven, it’s ultimately easy to read. And the story is, needless to say, endlessly fascinating.

The book was significantly more positive than I’d thought possible too, with Hamlin focusing on the live-changing benefits of the operations and the incredible people who have touched her life rather than the poor education and poverty and stigma invariably surrounding fistulas.

And there are some fantastic fundraising efforts, not least a cheeky letter Reg wrote to the British Petroleum chairman: ‘While you have been drilling holes in the Middle East and making a profit, we have been mending holes in the Horn of Africa and making a loss.’ The chairman subsequently wrote him a personal cheque for around 500 pounds.

My one gripe—and it’s a personal pet hate but a big one—is that Hamlin inserts her religious beliefs into the story a tad too much. Or rather into the fistula patients’ lives. I have no issue with people having faith; I have huge issue with them imposing it on others and especially others who are vulnerable and not in a position to fairly decide whether or not they wish to take the religion on. It reeks, frankly, of whites-in-shining-armour ignorance.

For example, the hospital includes a schoolroom at which patients can receive some education: ‘Some learn to read and write quickly, and how proud they are,’ Hamlin writes. So far so fine. ‘A group of friends and some churches in Australia have devoted money for this work and for buying Bibles that we distribute to all who can read.’ Suddenly not fine. They need to provide books—a variety of books, not books with a convert-you-to-their-religion agenda.

But I digress. If you can stomach the at-times-too-much religious references—which I could, barely—then The Hospital By The River is a worthy read. As Hamlin writes, you can’t help but come to understand that: ‘These girls and women had suffered more than any woman should be called upon to endure. To meet only one was to be profoundly moved and called forth the utmost compassion that the human heart was capable of feeling.’

Learning about the fistula pilgrims, it’s impossible not to be tremendously moved and want to help (the hospital has long been on my list of must-visit places when I eventually make it to Africa).

Hamlin is in her 80s now, still operating weekly and with no plans to retire. But the organisation is clearly aware that they need to plan for a future where Hamlin and her husband’s legacy continue, whether or not she is around. ‘Now I have come to the end of this story of the fistula pilgrims,’ Hamlin writes, ‘a story that I leave others to continue and finish.’

We’ve seen a giant boost in the hospital’s social media and fundraising efforts in the past year or so as they try to transition to this new era, but these chapters aren’t covered in the book, which was written close to the beginning of the noughties.

I’d be interested to see if reprints of the book contain any update (this book has been sitting on my to-be-read pile for years, so it’s possible there’s a more current version out). Or to see Hamlin or the Fistula Hospital write a sequel in the next few years. It’s a book I’d dearly love to read. Either way, the Hamlins’ legacy is profound.

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Fiona Crawford

Fiona Crawford is a freelance writer, editor, blogger, proofreader, and voracious reader. She regularly appears as a book reviewer in Australian BOOKSELLER+PUBLISHER magazine. Fiona is also (unfairly) known as the Book Burglar due to her penchant for buying family members—then permanently borrowing—books she wants to read herself.