Imagine life ostracized from your community, returned to your family by your husband. Your crime? To have spent six days in labor delivering a stillborn child, the result of which has left you doubly incontinent so body fluids drip constantly, eating your flesh, causing boils and excruciating pain, making you a rotting, stinking outcast. Not only is this the fate of women who suffer from obstetric fistula in the developing world, an all but forgotten tragedy, but the women are also considered cursed.
It only takes USD100 to go to one of the four fistula centers located around Ethiopia, a country the size of France and Spain combined, but it can take a farmer 7-10 years to save that much, and public transportation is not an option for a reeking female. Instead women live in hell for a condition that has all but been eliminated in the developed world. The last fistula hospital in the United States closed in 1895. (Yes, 1895).
Ethiopia has the highest obstetric fistula rate in sub-Saharan Africa, a childbirth injury caused when the pressure of the baby's head crushes soft tissue leaving an opening between the birth canal, the bladder or rectum, often because the women is malnourished, too young and has lived a life of hardship.
It was not surprising then that when Reginald and Catherine Hamlin arrived in Ethiopia 50 years ago, they were astounded by what they found. The Hamlins had never seen an obstetric fistula before. "To us they were an academic rarity," Catherine wrote in her book The Hospital by the River.
In 1959 two obstetric gynecologists answered an ad in the prestigious British medical journal The Lancet to work at the Princess Tsehay Memorial Hospital in Addis Ababa as a husband and wife team to train physicians and midwives.
The Hamlins soon changed direction and pioneered techniques for a condition that previously had no treatment. At 85, and 35,000 women later, Dr Hamlin still operates once a week at the Addis Ababa Fistula Hospital which she and her husband, who died in 1993, established, an oasis of calm, beauty, hope and inspiration, run on international donations, including from Oprah Winfrey who has a center named after her.
I met Dr Hamlin in Addis this week. She had just come from surgery and invited me into the reception, the tukul, rather than talk in the middle of the garden where we had met Mamietu Gashe just back from the US having received another honorary degree. More than 40 years ago she had been a patient, now she is a practical surgeon training gynecologists, having completed 1,300 successful operations.
There are many of these stories. More than 98 percent of the women who come are cured. They return to their villages, find another husband, get pregnant and many return to the hospital to deliver their babies.
While at the hospital the women receive training on micro-finance, mathematics, nutrition, legal affairs, all necessary skills in a subsistence economy where 99 percent of women are illiterate. About 1.3 percent of the women have a chronic condition and won't be sent back. Instead some train and become nursing aids. Nothing and no one goes to waste. The hospital believes in the holistic approach.
The surprising thing is that the men here love their wives, and often have to divorce them for practical reasons - they need someone to raise the children, look after the house. "Men are sweet to their wives," says Dr Hamlin, thin and tall in her white doctor's coat in the temperate Addis morning. "They don't desert their wives because they want to but because they have to. I have had men come to me and say 'I want her to be cured because I love her.'"
The picture I take of Dr Hamlin is of her standing beside a painting by and Ethiopian artist. The broken, leaking pots represent the women, some as young as 13, although child marriage is not a major issue in this part of the country. A couple of the eight dogs, who are 'on the staff' roamed around.
And in the 50 years what had changed for the rural women, many of whom have to walk for two days just to get to a main road? "Only that there are more cases as the population has increased," she says.