I read with interest Brian Hancock’s article, “Obstetric fistula in Africa: a continuing surgical challenge”1, in April’s edition of The Bulletin. In it he highlights the plight of young African women who have suffered the misfortune of a prolonged obstructed labour, the subsequent delivery of a stillborn child, terrible fistulae as a consequence of ischaemic necrosis to the pelvic organs, and the abandonment by those closest to them due to the total incontinence that results. He outlines how successful fistula surgery, although technically demanding, can bring new life to these unfortunate women.
In his article Mr Hancock mentions the famous Addis Ababa Fistula Hospital that was founded by the Australian Gynaecologists Reginald and Catherine Hamlin. May I commend to interested readers of The Bulletin that they obtain a copy of Catherine Hamlin’s book, “The Hospital by the River: A story of hope”2. Although written for the lay person, the book holds interest for those from a medical background including the history of fistula surgery and the development by Sims in the 19th Century of his speculum and the subsequent first consistently successful reparatory surgery.
Dr Hamlin tells how her late husband, son and she left Australia on a three year contract to set up a midwifery school in Ethiopia, and some 52 years later she is still there having successfully operated on over 25,000 women and opened the Addis Ababa Fistula Hospital! Maybe a warning (and also and inspiration) to idealistic young surgeons who wish to travel to the developing world to gain that extra experience in pathologies that have long since become rarities in the UK?
1. Hancock B. Obstetric fistula in Africa: a continuing surgical challenge. Ann R Coll Surg Engl (Suppl) 2011; 93: 128-130.
2. Hamlin C, Little J. The Hospital by the River: A story of hope. Oxford: Monarch Books; 2009.