Addis Ababa Fistula Hospital

Addis Ababa Fistula Hospital (also known as "AAFH" and "Hamlin Fistula Hospital") and its regional Hamlin Fistula Centres provide comprehensive care for women who suffer from incontinence, physical impairment, shame and marginalisation as a result of an obstetric fistula. The hospital was created by the Australian obstetrician and gynaecologists Catherine Hamlin and her husband Reginald Hamlin to care for women with childbirth injuries and has been in operation since 1974. It is in Addis Ababa, the capital of Ethiopia. It is the only hospital of its kind in the world dedicated exclusively to women with obstetric fistula (a condition common in the developing world where the maternal health provisions are poor), and it treats all patients free of charge. Patients undergo surgical repair by Ethiopian and expatriate surgeons trained at the hospital's main facility in Addis Ababa. Around 93% of these patients are repaired successfully.
In addition to the main hospital in Ethiopia's capital, Dr. Hamlin has opened five hospitals in the Ethiopian cities of Bahir Dar, Mekele, Yirgalem, Harrar and Metu. All 6 hospitals provide a safe birthing facility where former patients who fall pregnant can have a caesarian section. The hospital is a global centre of expertise in fistula repair, and it trains surgeons from around the world with 28 surgeons trained between 2015–2018. Hamlin says that they have "now treated 55,000 [women] and these are like ambassadors all over the countryside". Patients come to hear of the hospital primarily by word of mouth. In 2008, when the fourth clinic was opened Dr Hamlin travelled the world to raise awareness of the effect of the condition on women in Ethiopia.
The hospitals aim to cure 4000 women annually, but Hamlin cited the World Health Organisation's estimate that there are 6000-7000 cases a year in Ethiopia alone.
Since its inception visitors and supporters from all over the world have visited the hospital to see the patients and the work of the hospital. Many of them have gone on to become fundraisers for the organisation so all the patients receive free treatment.
The Catherine Hamlin Fistula Foundation (formerly the Hamlin Fistula Ethiopia (Australia)) was established in Australia to support the work of the fistula hospitals and eradicate obstetric fistula.
Founding.
In 1958, Catherine and Reginald Hamlin answered an advertisement in "The Lancet" for an obstetrician and gynaecologist to establish a midwifery school at the Princess Tsehay Hospital in Addis Ababa. They arrived in Addis Ababa in 1959 on a three-year contract with the Ethiopian government but only about 10 midwives had been trained before the government closed the midwifery school. The Hamlins had never seen an obstetric fistula before and, seeing many cases arrive at the school, decided to create a dedicated hospital.
Obstetric fistula was virtually eradicated in the developed world by the 20th century due to improved obstetric techniques such as Caesarean section. According to UNFPA in Ethiopia 353 mothers die for every 100,000 births, in Uganda it is 343 an in Australia it is 6. The Hamlins resorted to studying the works of earlier fistula surgeons such as Dr. J. Marion Sims (the father of modern gynaecology) and from doctors who were operating in places such as Egypt. The Hamlins refined the surgical technique to close an obstetric fistula while continuing to treat a broad range of obstetric cases.
Word of mouth is the primary method of patients discovering the hospital, going from 30 patients in the first year to 300 patients in the second. Offered treatments include physiotherapy, stress incontinence management, specific treatment for stoma patients, psychological counselling, extended medical care and general education. About 55,000 patients have been treated to repair the internal damage from obstetric fistula.
Development.
In 1998, the hospital was extensively refurbished and enlarged. Today Addis Ababa Fistula Hospital can accommodate up to 140 patients and four operations can be performed simultaneously in the theatre. Five fistula centres have been established in the regional towns of Bahir Dar, Mekelle, Harar and Yirgalem and Metu and the Hamlin Fistula hospitals are staffed by over 550 Ethiopians.
The growing network of Hamlin Fistula Hospitals and the midwifery college are supported largely by private donors in Australia, the UK and the United States. The largest of the dedicated support organisations is the Fistula Foundation, located in San Jose, California. Money is also provided by World Vision, the Catherine Hamlin Fistula Foundation, the England-based Ethiopiaid and funds paid into an endowment by the Australian Government.
The Hamlin College of Midwives was established to ensure that there is a skilled birth attendant available to provide maternal health care (pre-, intro- and post-natal). Dr Hamlin believes that midwifery is the answer to the problem. In 2006 she established a school of midwifery with the aim of putting a trained midwife in every village in Ethiopia. The college follows the curriculum of the International Confederation of midwives, including the precondition that students conduct at least 40 deliveries before they graduate. The Midwifery college is on land adjacent to Desta Mender ("Village of Joy"), where women with long-term injuries caused by obstructed labour reside, about 17 km from Addis Ababa. The first students graduated in 2011 and, as of 2018, 125 midwives have graduated with a Bachelor of Science degree in Midwifery. All have committed to working as a Hamlin midwife for a minimum of 4 years. The midwives are being deployed in pairs near medical centres. There are currently (2018) 48 Hamlin Midwifery clinics in rural health centres staffed by Hamlin midwives. In 2017 Hamlin midwives delivered over 22,500 babies and no cases of fistula occurred in these births.
Due to the development of the five regional Hamlin Fistula Centers, some of the women who suffer the long-term effects of obstetric fistula are able to move back to their homes and receive ongoing medical care from one of the outreach centres. Additionally, some women have established small, successful businesses that have enabled them to move out of Desta Mender to nearby towns and return to receive medical care or visit friends.
Oprah Winfrey Show.
In January 2004, Catherine Hamlin appeared on "The Oprah Winfrey Show" to discuss the 50 years of free reconstructive surgery that she has been providing to over 25,000 patients. After Hamlin's visit to the show, thousands of viewers were compelled to act due to her sheer selflessness. The Fistula Foundation, which supports Dr. Hamlin's hospital, received more than $3 million in donations. Oprah Winfrey was so impressed by Dr. Hamlin's actions that she visited the hospital in Ethiopia to tape the second episode in December 2005. The funding received by the hospital following this exposure led to the building a brand new facility with classrooms, examination rooms, housing for residents who travel to the hospital for treatment and a small apartment for the on-call doctors for Desta Mender.