An illiterate surgeon raised barefoot in the mountains of Ethiopia grew up to become the ‘future of African medicine’ – and she still can’t read or write.
Mamitu Gashe was 16 when she went into labour with her first child in a mud hut in her highland village in 1963.
She spent four days in excruciating pain before her baby son died inside her, causing an obstetric fistula – a devastating injury sustained during traumatic childbirth which leaves women incontinent, uncontrollably leaking urine and faeces for what is often the rest of their lives.
Fate brought her to the capital, Addis Ababa, where she was treated by legendary Australian doctor Catherine Hamlin – a woman who would become her mentor, surrogate mother and lifelong friend.
Eternally indebted for her second chance at life, Mamitu, now 73, learned to operate on fistulas by placing her hands over the great Sydney surgeon’s and tracing her intricate incisions as she worked to save the women once described as ’20th-century lepers’.
Through drought, famine and murderous regimes, Dr Hamlin devoted her days to this cause before her death at the age of 96 on March 18, 2020.
Seven months later, her grieving protégé and constant companion of 57 years is returning to theatre to continue the legacy of the woman who saved her from what would have otherwise been a life of social ostracism, homelessness and prostitution – the heartbreaking result of inadequate healthcare in the developing world.
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Side by side for 57 years: Legendary Australian obstetrician Dr Catherine Hamlin (left) and her patient-turned-protégé Mamitu Gashe (right), who has been hailed as the ‘future of African medicine’ – despite being unable to read or write
Tens of thousands of women have been given second chances at life by the tireless work started by the Hamlins (right) and continued by Mamitu Gashe (left)
British author Sue Williams was travelling across Ethiopia in 2017 when she received permission to interview Catherine Hamlin at her famous fistula hospital in Addis Ababa.
There she met Mamitu, a timid yet intriguing woman acting as Dr Hamlin’s carer who ‘kept scurrying away’ when Ms Williams tried to talk to her.
‘I wondered what her story was. It took a bit of persuading but eventually she trusted me enough and said she was ready to talk about her life,’ Ms Williams told Daily Mail Australia.
That story would have been very different had Dr Hamlin and her Kiwi husband Reg not accepted job offers to launch a midwifery school in Ethiopia in 1959.
When they arrived, they were shocked to discover scores of young girls with fistulas – a horrific condition unheard of in the Western world since the early 1800s but still commonplace across sub-Saharan Africa and southeast Asia today.
It is perhaps the most devastating and degrading condition a woman can face.
Through drought, famine and murderous regimes, Dr Hamlin (pictured with Mamitu) devoted her days to this cause before her death at the age of 96 on March 18, 2020
Fistulas are tiny holes which develop between the vagina and bladder, and sometimes between the vagina and rectum, after days of obstructed labour without modern medical intervention like Caesarean sections or vacuum extractions.
During this protracted labour, the mother’s contractions continually push the baby’s head against her pelvis, cutting off bloody supply to the tissue which creates holes that cause continuous and uncontrollable incontinence.
The mother usually delivers a stillborn baby before discovering she is leaking urine and sometimes faeces through her vagina. The smell is unbearable.
Husbands frequently abandon wives who constantly soil themselves and are – more often than not – unable to carry more children, such is the severity of their injuries.
Mamitu’s were so extreme that even 10 surgeries could not fully repair the damage, leaving her barren and partially incontinent for the rest of her life.
After arriving in Ethiopia in 1959, Catherine and Reg Hamlin (centre) were shocked to find scores of young girls with fistulas – a condition unheard of in the Western world since the early 1800s, but still common across sub-Saharan Africa today
Mamitu (pictured on a visit to Australia with Dr Hamlin) has devoted her life to helping women
Still, her husband was one of the rare few who begged her to return to their village so they could live together.
But Mamitu felt her future was at the hospital, helping Dr Hamlin tend to others enduring the same torment.
‘He stood by her and pleaded with her to come home, but because she couldn’t have kids she didn’t want to hold him back or change his mind,’ Ms Williams said.
‘She said, “you’re like a brother to me now”, go on with your life and find a new wife and family.
‘It was really courageous of her to do that, selfless. He was a really good guy.’
Shortcomings in Ethiopia’s infrastructure continue to compound the problem for women with fistulas.
Lack of access to clean running water makes it almost impossible to keep clean, causing communities and even their own families to shun them.
It leaves most no choice but to live in caves in the countryside or to beg homeless on the streets of ramshackle cities, where many turn to prostitution for survival.
Some commit suicide while others live out their days crippled with post-traumatic stress disorder and depression from the loss of their babies, husbands, homes and dignity.
Pariahs and social outcasts, Reg Hamlin famously described fistula sufferers as the ’20th century equivalent of lepers’. His wife Catherine called their plight a ‘nightmare’.
‘These are beautiful young women in the prime of their lives,’ she told Ms Williams in her book, ‘Healing Lives’.
‘They go into labour, but instead of having a lovely baby, they end up with a dead child and the nightmare afterwards of leaking.’
Compelled to intervene, the Hamlins poured over old medical journals for guidance and set about curing patients at the Princess Tsehai Hospital. Mamitu helped by making beds.
Mamitu (background, overseeing a fistula operation) is part of unique group affectionately known as ‘barefoot surgeons’, non-medically qualified practitioners who are changing the face of African medicine without any formal training
An obstetric fistula is a life-altering injury sustained in childbirth that leaves women incontinent.
It occurs when a mother has a prolonged, obstructed labour, but cannot access a hospital for emergency medical care like a Caesarean section.
The woman often labours in excruciating pain for days and tragically, her baby usually dies.
During this protracted labour, the mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bone become compressed, restricting the normal flow of blood.
Without adequate blood supply, sections of tissue quickly die, leaving holes – known as ‘fistulae’ – between the mother’s vagina and her bladder or rectum. It is these holes that cause incontinence.
If untreated, the woman will uncontrollably leak urine, stool, or sometimes both, for the rest of her life.
While fistula injuries were eradicated in the Western world in the early 1800s, they remain commonplace in the developing world, particularly across sub-Saharan Africa, southeast Asia and parts of the Pacific.
Source: Fistula Foundation
As news spread of the foreign doctors who worked ‘miracles’, more fistula sufferers flooded the capital in the hope of a second chance.
It wasn’t long before Catherine noticed something special in her kind, dedicated and razor sharp assistant who could empathise better than anyone with the frightening ordeal her patients were facing.
The Hamlins allowed Mamitu to watch during surgery, then encouraged her to assist by sponging blood, cutting wires and sewing wounds.
Later, she would rest her hands on theirs, memorising every step as they guided her through intricate incisions.
‘People talked about how gentle she was. She had a real affinity with surgery and was so passionate about it,’ Ms Williams said.
‘She had great eyesight and could see tiny little openings that needed to be repaired without using instruments.’
In 1975 the Hamlins opened the Addis Ababa Fistula Hospital, the world’s only medical facility offering free repair surgery to impoverished women after childbirth.
More than 30,000 women of all religions and backgrounds have been admitted to the hospital since it opened, free of charge.
Mamitu has helped many of them.
‘It was gratitude [to the Hamlins] for giving her her life back, because it was worthless before,’ she said.
Fistulas continue to blight Africa, Asia and other parts of the developing world wherever women have limited access to doctors and emergency care services.
In Ethiopia, a dearth of cars, public transport and drivable roads prevents expectant mothers from reaching hospitals before complications arise.
Even today, women from provincial villages live with their injuries for decades, though many have been saved by the tireless work started by the Hamlins and continued by Mamitu.
Mamitu and Reg Hamlin in Addis Ababa, where she found her purpose curing women with fistulas after her own ordeal
More than 30,000 women of all religions and backgrounds have been admitted to the Addis Ababa Fistula Hospital since it opened in 1975, receiving care free of charge from Catherine Hamlin (left) and her assistants including Mamitu (right)
Today she is part of a unique group affectionately known as ‘barefoot surgeons’, non-medically qualified practitioners who are changing the face of African medicine without any formal training.
Surgeons like Mamitu typically specialise in one area which they have painstakingly learned through observation and natural skill.
Their efforts are increasingly recognised by the international medical community as a vital component of healthcare provision in some of the most vulnerable and poverty-stricken places on earth.
In 1989, Mamitu was awarded the Gold Medal for surgery from London’s Royal College of Surgeons.
She was ranked number 32 on the BBC’s ‘100 Women’ list in 2018, in the illustrious company of world leaders, industry trailblazers and everyday heroes.
‘There will never be training for doctors in Africa like we have in Europe or Australia, so people like Mamitu are regarded as the future of medicine in the developing world,’ Ms Williams said.
It was for this reason that the head of the Addis Ababa Fistula Hospital persuaded her to return to work after seven months in mourning for her ‘mother’, Dr Hamlin.
Aged 73, Mamitu is returning to surgery to honour the work of her mentor, surrogate mother and lifelong friend, Dr Hamlin
‘She was a bit lost after Catherine died. Mamitu only speaks a little English and Catherine struggled with Amharic [the local language], but they’d been together so long, they often didn’t need to speak,’ Ms Williams said.
‘She just wants to help other women like her. They’re gorgeous women, it’s so sad to see them coming in desperate, ashamed, crying. The difference when they leave is really incredible.’
Every woman cured at the Fistula Hospital leaves with a new dress to take back to her village, a symbol of rebirth and celebration of the new chapter they are about to begin.
‘They are reborn because without surgery, their lives were over. I feel so privileged to have witnessed it all,’ Ms Williams said.
As Dr Hamlin once noted: ‘These women have suffered more than any woman should be called upon to endure. To meet only one is to be profoundly moved and calls forth the utmost compassion that the human heart is capable of feeling.’
Healing Lives by Sue Williams is published by Pan Macmillan Australia and is on sale now in paperback for $34.99 and eBook format for $14.99.