ƒthere must be men and women of compassion and determination so that childbirth for all women can always be safe and babies and mothers saved ...

Acceptance speech – Catherine Hamlin

The speech was read by Annette Bennett, Dean of the Hamlin College of Midwives.

To have been the recipient of this most prestigious honor – the Right Livelihood Award – has filled me with gratitude and thankfulness. Chiefly because it recognized the plight of many thousands. Perhaps millions of forgotten young women and girls throughout the developing countries of the world – woman who in the most important moment of their lives, giving birth to a child – are without any skilled help when a difficulty arises.

Childbirth should be a joyful occasion, when a new baby enters the world. But it can go wrong. We in Ethiopia have seen and are every day aware of this tragic condition that can result when labor is not straight forward and when it is obstructed. The most dreaded complication caused by obstructed labor that any obstetrician may encounter is a vaginal fistula, which results when the baby cannot pass through the bony pelvis of the mother, or when the baby is lying in the uterus in an abnormal position – both these conditions are responsible for an obstructed labor.

I want you to imagine the plight of a young woman living in a remote village in this vast and beautiful country of Ethiopia. She begins her labor with some natural anxiety and fear especially if it is her first baby. But she is unaware that she is one of the unfortunate 5% of all women in the world who experience obstructed labor. So day after day she lies in her small tukul (a mud house) in this remote village – with perhaps her mother in attendance and a few village women. Her suffering and anxiety is intense. Finally, when the baby is dead inside her uterus it is able to be expelled as a stillbirth. She is relieved that her ordeal is over. Sad that her baby is dead but glad that she has survived. However, soon she wishes she too was dead as her child. Now she finds herself incontinent of body waste – her urine soaking her couch, and often bowel contents as well! Her plight is unimaginable to us who live in the affluent countries of the world. But this has not always been so. Obstetric Vaginal Fistulae were only eradicated in America at the end of the 19th century and in England and Europe in 1920! Now only occurring in the countries of the world where poverty exists and where there are few doctors, midwives, hospitals, or even roads and bridges to allow access to a health facility when this condition of obstructed labor is encountered.

This is a preventable injury – prevented now in the west but common in every poor country where there is not a skilled attendant to intervene, either by a Caesarian Section operation, or by some skilled manipulation. All can be prevented, and yet in this enlightened 21st century when huge advances have been made in medicine when old people live longer when many diseases can be cured and broken bodies mended! there are millions of beautiful young women that we have completely neglected to our shame. This need not be. But there must be men and women of compassion and determination so that childbirth for all women can always be safe and babies and mothers saved – from death for the baby and for a life of a living death for the mother.

I am here today to plead for these tragic patients and to let the world know that they exist. My late husband and I became aware of them soon after we began to work in Ethiopia in 1959 – planning to help in a country short of doctors and at that time with no medical faculty in the university. – But soon we met the fistula sufferers, who broke our hearts, overwhelming us with their stories, with their endurance, and their enormous needs – arriving at this general hospital – The Princess Tsehay Memorial Hospital with nothing in this world but faith and hope and urine soaked clothes – it was impossible not to be touched, and to give them that 3rd great attribute mentioned by St. Paul – love. Finally to build them their own haven, a hospital dedicated to this one medical condition, where no longer they would be ostracized, lonely and without hope, often abandoned by husband, cared for perhaps by a mother who loves her daughter, managing to care for her in some hut or shelter but away for the other family members because she is offensive – now one of the outcasts of society, losing everything that makes her happy! Alone, Abandoned, she exists without friends and without hope.

Now at last they have hope, because we have heard their cry – responding by establishing hospitals for them. The first and the main one in Addis Ababa opened in 1974, which my husband worked hard to establish and finance, succeeding beyond our dreams, which now is greatly expanded, with 5 new smaller hospitals built in the provinces – these will enable us to perhaps cure 4000 woman annually. But the WHO estimates that there are 6-7000 new cases every year in Ethiopia alone! So at last we are concentrating on the prevention of such injuries.

Midwifery I believe is the answer – to put a well trained midwife in every village would soon eradicate obstetric fistulae! This you did in the late 1870’s because you were concerned by the high number of maternal deaths in Sweden at that time. Thus halving this rate in about 6 months! So we established our college for midwives 3 years ago. Our curriculum has been approved and praised! We aim to only take 12th grade students from the country high schools, give them a 3 year course, graduating them with a bachelors degree, a promise from each to work in their own countryside area for 5 years, then perhaps they will progress with further training, becoming tutors themselves and spread the numbers throughout this country of 80 million people.

This dream is coming true, our first graduate midwives will be deployed next September, to their own areas, where they grew up, where they will be accepted and where they will now live and work as midwives – two together in a house they will share, so they will not be lonely or over worked, an ante-natal clinic and a health center not too far away – with a doctor or a health officer to be able to do a caesarian Section when needed. The Ministry of Health is training these health officers in emergency surgery, but need help for this. Perhaps obstetricians from the west could go for a few months to train these health officers and country doctors.

Ideas flood my mind, the task is huge, but I know with the help of an Almighty God and one who is love, we can succeed.

I finish with two quotations – one from my husband:

“A mother is a family’s richest possession, a being of priceless worth.”

The second is from the Bible, written on my husband’s memorial in our hospital grounds – words spoken by our Lord Jesus Christ and recorded by St. Mathew. “In as much as you have done it for the least of these, you have done it for me.”

Thank you.

Catherine Hamlin
Hamlin Fistula International
P O Box 3609
Addis Ababa

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