I watched an extraordinary documentary last night, right on my computer. A Walk To Beautiful, set in Ethiopia, has special meaning for me because it tells the story of childbirth injury and the resultant fistula, and because the Hamlins--pioneers of the surgical repair of fistula--were my professors in medical school. You could hardly live in Addis Ababa and not be moved by the suffering of women with fistula, or not know of the Hamlins' legacy. Not surprisingly, the story of fistula is very much at the center of my novel, Cutting for Stone (Knopf) which takes place in Ethiopia and America.
Reginald Hamlin passed away some years back but Catherine Hamlin is very much a presence, The two of them built the Addis Ababa Fistula Hospital in 1974. Catherine Hamlin tells the story of their lives together and their legacy in a wonderful memoir called The Hospital by the River: A Story of Hope. On my last visit to Ethiopia in 2004, I got to visit the hospital (which was built after I left). Alas, I didn't get to meet Dr. Hamlin, who was away, but we corresponded. In her last letter she said she was halfway through Cutting for Stone and enjoying it. I am waiting the final verdict.
The incredible cinematography makes A Walk to Beautiful almost like a poem; there is a tenderness on display that seems to emanate from the camera. There is also great sensitivity to the women whose stories are being told--never did I have a sense of the subjects being exploited. This is particularly important because the story of fistula repair dates to Marion Sims in 1845 (even though women have suffered with fistula since recorded history); Marion Sims's story is heroic, at least by his account, and yet shameful when we look at it now. His surgical success occurred on the backs of patients who were slaves, cast out by their owners because of the incontinence caused by the fistula. Sims operated on the same three slave women multiple times, until he perfected a technique which is similar to what is used today. His accounts imply the three women consented to his surgery, but how can anyone in bondage truly give informed consent? We have little record of the women's account of the experience.
Ultimately, fistula is a reflection of a failed infrastructure and societal failure; the medical disaster is a side effect. It is largely a rural story. It begins with child marriage--girls who are not fully grown being given to grown men. Rickets and malnutrition contribute to a narrow pelvis and when pregnancy occurs, the baby often cannot come out--its head is bigger than the pelvic circumference. The prolonged trauma --days of futile labor--results in death to the baby and often to the mother. If she survives, her bladder and bowel, which were pinned between the bony baby's skull and the bony pelvis are scarred and sometimes torn so that the contents are continuously dribbling into the vagina. The resources to do a Cesarean sections quickly would avert this catastrophe. And that requires good roads, transportation,and health clinics where obstetrical problems can be managed.
It is striking to me that in south India, where I also trained in medicine, fistula which was once common is now rare--the infrastructure--roads and clinics--allows quicker access to medical care and extraction of the baby.
I hope you'll click the link and watch A Walk To Beautiful. In these times when we are wrestling with healthcare reform, this documentary is a breath of fresh air. It reminds us how much we take for granted.