Abstract
This book is a well-written autobiographical account of the work that Dr Hamlin and her husband began. Starting with the paucity of literature on fistula repair and a fair amount of improvisation, the 2 surgeons became the world's leading experts in repair of vesicovaginal and rectovaginal fistulas. They opened the Addis Ababa Fistula Hospital in 1974, which has become a major teaching institution for surgeons around the world, and over the course of their careers they have successfully treated over 20 000 girls and women for this malady.
The state of medicine in developed nations is so advanced that when one hears of vaginal fistula injuries caused by labor of several day's duration, the first thoughts are often to wonder how it could happen in this modern world. Yet it does happen frequently in places that are not as well developed as others. Ethiopia is such a place. In 1959, Reginald and Catherine Hamlin, gynecologists from Australia, went to Ethiopia to volunteer their services to help establish a school of midwifery. What they found was completely unexpected. Fistula injuries, as they are known in developed countries, are usually a complication of surgery or a cancer. The Hamlins, however, found that many Ethiopian girls and women had fistula injuries related to complicated birthing, all of which could have been prevented with trained obstetric care during the delivery process.
The usual scenario is of a girl of about 15 years of age who has been wed according to tradition of the community. When she becomes pregnant at such a young age, the resulting cephalopelvic disproportion prevents delivery without some form of assistance, whether by caesarean section or other means of obstetric intervention. With the obstructed labor well underway, the fetal head presses on the pelvic tissues and causes ischemic damage. After 2 or 3 days of such strain, the baby dies, yet the contractions of the uterus persist. Finally, the infant's body macerates enough for delivery, yet the young mother has lost more than her first baby. The next day she awakes to find herself soaking in her own urine, a problem that will never heal. Soon she is isolated, left to suffer alone, feeling that she has been cursed for reasons that she will never understand.
While living in Ethiopia, the Hamlins became well acquainted with Emperor Haile Selassie and his family and later survived the 17-year reign of terror by Colonel Mengistu. The book details these relationships as well as the life adjustments that the Hamlins made in a foreign land. The story is full of hope and faith and is truly inspiring. Since the death of Dr Reginald Hamlin in 1993, the work has only continued to grow. The hospital has become a leading teaching institution in this area of medicine. It also has developed a program that reaches throughout Ethiopia in an effort to locate some of these girls and women who have become lost in their seclusion. Dr Catherine Hamlin was nominated for the Nobel Peace Prize in 1999 and has continued faithfully to make known to the world the plight of girls and women in these situations who are victims of such a potentiallydevastating injury.
The Hospital by the River is a very captivating book and well worth reading. Although it is a bestseller in Australia, it is not readily available in the United States. However, it can be obtained through the publisher or online via several Australian bookstores. At the time of this writing, the publisher has no plans for widespread distribution outside Australia. The book is very informative about a subject that is all but unknown in the modern hospitals to which most of us are accustomed. The suffering caused by vaginal fistula injuries is unfortunate because it could be prevented, yet this book can spread the message that help is available to instigate change and provide a better tomorrow for so many girls and women in the third world.