pregnancy

After 8 days in labour, 16-year-old Mamitu was close to death. Then she met Dr. Catherine Hamlin.

This article deals with infant loss and depression and won’t be suitable for all readers.

Sixteen-year-old Mamitu Gashe is at home in her hut in the remote highlands of Ethiopia when her labour starts. She doubles over in pain and someone is dispatched to send for her mother and sister.

She spends the whole of that night in agony from the contractions that are coming more frequently and more violently with every passing hour, but keeps telling herself that it won’t be long before her baby arrives. But by the time the dawn light streaks the sky, there’s still no sign that the baby is any closer to being born. 

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She’s pleased, however, that her family are now there to help. ‘Stay strong,’ her mother tells her, giving her some hot sweet tea. ‘It can’t be too much time left now.’

Mamitu smiles weakly, but, for the first time, starts to wonder if there’s something wrong. 

Her husband of two years is pacing around outside, constantly asking for news. But another day passes. Then another night. Then another day, and another night. 

By the third day, Mamitu’s eyes are rolling in her head from the constant pain. Her mother and sister try to persuade her to eat something, but Mamitu refuses. They try to pour some cool water into her mouth, but it trickles down her chin. She’s too weak by now even to swallow.

On the fourth day, Mamitu’s mother, growing increasingly alarmed, calls for the traditional birth attendant to come to tend to her daughter. 

After two hours, an elderly woman hobbles into the tukul, takes one look at Mamitu and lifts the blanket off the young girl, lying shivering on the ground, delirious and confused.    

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She pulls Mamitu’s legs apart and shakes her head. She can see part of the baby’s head protruding, but it’s absolutely lifeless. ‘It’s dead,’ she says bleakly. ‘There’s nothing you can do now. We need to get it out.’ 

Mamitu feels a sudden searing pain and hot tears burn her eyes, but she is too exhausted even to scream. 

For the next three days, she remains lying in the hut, all the while slipping in and out of consciousness. 

‘I just didn’t know what was happening,’ she says. ‘I think I was in shock. I thought I might die. I was in so much pain, I actually wanted to die.’

At one point, she realises the ground beneath her is damp, and she must have passed urine. Her body doesn’t seem able to do anything; she has no control over any of her functions. 

She starts crying and doesn’t stop. ‘My mother told me not to worry, that I’d be all right,’ Mamitu says. ‘But I could see in her face how worried she was. I could see that even she didn’t believe her words.’

But the situation soon grows even worse. 

Mamitu’s body begins again to pass urine and faeces. 

Whenever she falls asleep, she wakes to discover a wet and dirty patch underneath her. When she tries to sit up, she can see her legs are shiny with urine, and there’s a terrible smell around her. 

She’s horrified. She doesn’t understand what’s happening. And she seems powerless to stop it.

She stops drinking and eating in the hope that the problem will go away. It doesn’t. Instead, she just grows weaker and weaker with each passing day. She feels totally, utterly overwhelmed by despair.

Finally, she suggests they go to the Ethiopian capital Addis Ababa, to one of the major hospitals. It’s a startling suggestion from a young girl who doesn’t even really know what a hospital is, far less a city, and who’s never been to school to learn about either. 

But her father, husband and relative fashion a stretcher from eucalyptus branches and carry her for 12 hours through the night down the treacherous face of the mountain, to the nearest road. From there, they lift her onto the bus to Addis.

By the time Mamitu arrives at hospital, she’s close to death. 

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There, she’s met by iconic Australian doctor Catherine Hamlin, and her husband Reg, who arrived in the country three years before. 

Mamitu’s never seen a European before and, in her delirium, she thinks they must be angels.

She feels a pair of arms lifting her up and cradling her like a baby. 

Then the man and woman carry her inside and put her down on a bed. 

They ask, through a nurse who interprets for them, if they can examine her. Mamitu nods dumbly and feels her clothes being lifted up and her legs gently eased apart. 

She can hear them talking, but doesn’t know what they are saying. She has her eyes closed tight, willing herself not to cry. 

So much rests on this: the whole of the rest of her life.

Eventually, she feels another sheet and a blanket being put over her. She opens her eyes and sees Dr Reg and Dr Catherine smiling at her. 

They talk to the nurse, who addresses Mamitu. ‘Dr Reg says you are safe now,’ she says. 

‘You do not need to worry any more. They say you are a very special girl and they will take good care of you. They will be able to cure you.’ 

Mamitu flinches. Has she heard right?

The nurse is laughing. ‘Yes, my sister. They say they will cure you. You will not leak any more. You will feel much better. You will be able to go back to your village, to your husband and to your life.’ 

Mamitu makes a huge effort to sit up. Then Dr Reg leans forward, touches her forehead and gathers her in his arm in a massive hug. 

When he lets her go, Dr Catherine embraces her too. Mamitu holds them each as if she’ll never let them go. 

They are angels from God to be sure. God has decided to help her by giving her these faranjis [foreigners].

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The terrible childbirth injuries Catherine and Reg Hamlin find that Mamitu has, after a much fuller examination, are the worst the two doctors have so far encountered. 

The baby’s head, during the protracted labour, rubbed on the tissues around her pelvis and has torn holes - or fistulas - in both her bladder and rectum, causing her to leak uncontrollably.  

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But, already, she’s captured their hearts. The way she looked at them, so trusting and hopeful, they were both so close to tears. 

The young girl must have been through hell, but she had obviously been so determined to seek help, they simply don’t know how she survived. 

‘To know Mamitu is to love her,’ says nurse-midwife Ruth Kennedy who worked at the hospital for many years. ‘She’s always been like a little girl. There’s such an innocence about her that’s she’s never lost – despite everything she went through. She’s so sweet and lovely. You can see why the Hamlins fell for her.’ 

Catherine is determined to do everything she can for Mamitu, but she knows it won’t be easy. 

She and Reg have never tried to repair such extensive damage before. 

They’ve only been operating on fistula patients for two years and, while they’re refining their techniques all the time, they realise this case is going to prove particularly challenging. 

It’s likely it will need a series of operations to repair Mamitu, but they’re determined to keep operating for as long as it takes. And Mamitu, as they already realise, is a remarkably courageous individual. 

Their patient gradually regains her strength and undergoes operation after operation to repair her broken body. 

Mamitu is so grateful for their care, she wonders how she can somehow repay them, and starts by slipping out of bed at the hospital to mop the floors. 

Then she starts changing and making beds, and drawing up a roster of chores for the other patients who want to help too. 

She also greets the frightened new patients and reassures them that Catherine and Reg will treat them and cure them. 

When her husband visits, she sends him away and tells him to find another wife. She knows now she will be unable to bear children, and wants him to be happy while she has found a place helping at the hospital. 

Catherine looks on in wonderment. 

‘We are so proud of you,’ she tells Mamitu one day. ‘You had such faith in us from the very beginning, and you were willing to do everything we asked of you, even when we knew you were in so much pain, and the surgeries weren’t as successful as we hoped. You never lost that faith. You endured all the pain, the difficulties and the disappointments with such grace. We could never have asked for more. We would be so proud to call you our daughter.’ 

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Mamitu is now positively beaming as the nurse translates their words. She looks at Reg and Catherine’s faces. 

‘That would be wonderful,’ she replies, her voice cracking with emotion. ‘That would be wonderful. I would be honoured to call you Emaye [Mother] and Abaye [Father], my second parents.’ 

*** 

In 1975 Mamitu also supports Catherine and Reg in setting up their own Addis Ababa Fistula Hospital, dedicated to helping women with fistula injuries, and funded mostly by Australian, New Zealand and British donors, and charities. 

She then helps out in the operating theatre, then starts assisting with their operations.

At the age of 40, in 1987, she starts operating on her own. Outsiders are stunned to find that one of the hospital’s top surgeons is actually a former patient with no education, who can’t read or write or speak English.

‘Her fingers are dexterous, and her handing of the tissues gentle and careful,’ says Catherine. ‘I was also pleased to have her assist me and still want her help at any difficult operation. Her ability… is superb.’

Mamitu’s fame begins to spread. 

In 1989, a delegation from the famed Royal College of Surgeons in England visit the hospital and the president of the college, renowned colorectal surgeon Sir Ian Todd asks to meet Mamitu and watch her operate. 

The next day, he presents Catherine, Reg and Mamitu with one of international medicine’s highest honours, the esteemed Honorary Gold Medal of the Royal College of Surgeons.

The three continue their work helping some of the poorest, most desperate, women on earth, giving them their lives back after they’ve been devastated by their fistula, with their husbands often leaving them in disgust at their constant smell and dirt, their families abandoning them, and their villages banishing them. 

Today, an estimated 60,000 have been treated, and cured, by the Hamlins’ hospital and clinics. 

When Reg passes away in 1993, Mamitu’s support helps Catherine continue her life’s work, and the two women work side-by-side for many years. 

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They build another new hospital in 1995 and their friendship grows ever stronger, with Mamitu still regarding Catherine as her second mother, and Catherine, who has one son, seeing Mamitu as her daughter.

The pair are inseparable, with Mamitu even visiting Australia with Catherine. ‘You’d see Mamitu and Catherine walking together,’ says Catherine’s niece Alison Morgan.

‘It’s just this incredible picture of love and care.’ 

Obstetrician and gynaecologist Dr Andrew Browning, who worked at the Hamlin hospital, admires the two women’s friendship. 

‘They are from such different backgrounds,’ he says. ‘Catherine can be bossy, and forceful, but Mamitu just smiles at that ... I think Mamitu feels indebted to her, and Catherine loves her very much and has a great admiration and respect for her. Between the two, there’s a very deep love and concern and friendship.’  

The pair were only finally separated in March 2020, when Catherine Hamlin, aged 96, died after a short illness. Mamitu, now 74, is determined, however, to continue her legacy, and has returned to the operating theatre to carry on the work.

The CEO of Hamlin Fistula Ethiopia Tesfaye Mamo regards Mamitu’s life as a remarkable tale of tragedy, courage, spirit, strength and success. 

‘I see Catherine as the sun who lit up Mamitu when she was so alone and vulnerable as a fistula patient,’ says Tesfaye. ‘And then Mamitu shone so brightly herself as a truly extraordinary woman, rescuing thousands of others from the darkness.’ 

This is an edited extract from Healing Lives, the heart-warming story of a friendship that saved so many women’s lives, by Sue Williams, published by Pan Macmillan, is now on sale (subs out October 13).

The Catherine Hamlin Fistula Foundation, hamlin.org.au, Phone (02) 9440 7001.

Feature Image: Supplied.

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