Alone and Ashamed
By NICHOLAS D. KRISTOF
May 16, 2003

ADDIS ABABA, Ethiopia
We in journalism tend to write about scoundrels, but today let me instead hail a saint for our age.

Dr. Catherine Hamlin, 79, is an Australian gynecologist who has spent the last 44 years in Addis Ababa, quietly toiling in impossible conditions to achieve the unimaginable. She has helped 24,000 women overcome obstetric fistulas, a condition almost unknown in the West but indescribably hideous for millions of sufferers in the poorest countries in the world.

It typically occurs when a teenage girl cannot deliver a baby because it is too big for her pelvis. After several days of labor without access to a doctor, the baby dies and the girl is left with a hole between her bladder, vagina and sometimes rectum. The result is that urine and sometimes feces drip constantly down her legs. In some cases, she is also left lame from nerve damage.

Women with fistulas stink and leave a trail of urine behind them. They are often abandoned by their husbands and driven out by other villagers.

Take Mahabouba Mohammed, whom I met here in Addis Ababa. She had been sold into virtual slavery at the age of 8, raped by her master at 12 and then sent out into the bush at 13 to deliver the baby on her own. After a long labor, she delivered the dead baby herself but suffered crippling internal injuries, including a fistula.

Ms. Mohammed crawled back to the village, but the baby's father was horrified by her smell. He confined her in a faraway hut and removed the door — so that hyenas, attracted by the odor, would tear her apart at night.

This girl fought off the hyenas and crawled for a day to reach an American missionary, who eventually brought her to the Addis Ababa Fistula Hospital that Dr. Hamlin heads. Dr. Hamlin was able to repair her fistula, and now Ms. Mohammed is a confident young nurse's aide at the hospital here.

These tales are common. Dr. Hamlin's hospital treats 2,500 women annually in Ethiopia, but each year 8,500 Ethiopian women develop new fistulas. In Nigeria, the Ministry of Women's Affairs estimates that some 800,000 women have unrepaired fistulas. In most countries, no one bothers to estimate the number of sufferers.

"These are the women most to be pitied in the world," said Dr. Hamlin. "They're alone in the world, ashamed of their injuries. For lepers, or AIDS victims, there are organizations that help. But nobody knows about these women or helps them."

Last year President Bush, upset by abortions in China, cut off all $34 million in U.S. funds to the U.N. Population Fund, which sponsors programs to prevent fistulas. That was unconscionable, yet my point today is not to complain again about that, but to hail those like Dr. Hamlin who have stepped up to the plate. Dr. Hamlin is known even to cynical aid workers as a saint and has been mentioned for a Nobel Peace Prize, which she richly deserves (her hospital's Web site is www.fistulahospital.org).

Meanwhile, two American women began the "34 Million Friends" campaign last year to get people to donate $1 each to make up the money that President Bush cut. They've just reached the $1 million mark — the first half of which will go to preventing and treating fistulas in 13 countries (see www.unfpa.org).

Then there's the tireless Dr. Lewis Wall, an American who has repaired fistulas across Africa and is now begging for funds to build a fistula hospital in West Africa (see www.wfmic.org).

I know why most African governments have done nothing to help fistula sufferers: those women are the poorest, most stigmatized, voiceless people on the continent. But since it is difficult to imagine a more important women's issue in the third world than maternal health, I don't understand why most feminist organizations in the West have never shown interest in these women either.

Perhaps it's because Westerners can't conceive of the horror of obstetric fistulas (Americans haven't commonly suffered fistulas since the 19th century, when a fistula hospital stood on the site of today's Waldorf-Astoria Hotel in Manhattan). Or perhaps the issue doesn't galvanize women's groups because fistulas relate to a traditional child-bearing role.

But talk to the shy, despondent outcasts who are reborn in the Fistula Hospital here — and you'll realize there is no higher mission, and that Dr. Hamlin is the new Mother Teresa of our age.

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