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A letter from Marilyn Hansen in Ethiopia

Spring 2014

She lay on the dirt floor with her knees pulled up to her chest. Tears rolled down her cheeks as Kidist thought of her baby, the tiny body still and lifeless as she saw him for the first and last time. For six days Kidist had been in labor, scared, in pain and exhausted because she could not push her baby out. Now three months later she still could not control her body. Urine leaked out of her no matter how she sat, how she lay down, how much she tried to stop it. Kidist’s husband had become disgusted with her condition and walked away from the marriage without a word. Now her sister brought food daily to the door of her tiny hut on the very edge of the village but left quickly because the terrible smell was so powerful. No one else even came near. How could she live like this the rest of her life, Kidist asked herself.

Kidist is 13 years old.

Fistula patient from northern Ethiopia

While Kidist’s story is fiction, it accurately portrays the plight of thousands of women, especially young teenage women, in Ethiopia. When Rich and I arrived in Ethiopia I had no idea what “fistula” meant. That first year I learned that an obstetric fistula is a hole in the tissue between the vagina and the bladder or between the vagina and rectum. Both can happen to the same woman. These tears or holes are nearly always caused by prolonged labor of three or four days, even up to nine days.  When there are complications during labor In Ethiopia there is often no physician or medical help other than a female village elder. No one is present who can perform a caesarean section or other medical procedures in a complicated birth. The baby is stillborn. In Ethiopia this happens to about 18,000 women and girls a year. About half die along with the baby. The other half are left with fistulas.

Although obstetric fistulas are the result of labor complications, the root causes are poverty, malnutrition and early marriage. Girls who grow up malnourished and/or poor have stunted growth and their pelvises are not large enough to accommodate the passage of a baby. In some areas of Ethiopia marriages traditionally occur with a bride as young as 12 or 13 years old. The girls’ pre-adolescent or adolescent bodies are sometimes not physically ready to give birth.

Smiling faces of hope

There is hope. Our second year in Ethiopia I visited the Hamlin Fistula Hospital. Founded in 1974 by Catherine and Reginald Hamlin, it is the largest hospital in the world that treats fistulas exclusively. Walking through the gates of the hospital compound means leaving behind the noise and dirt of the neighborhood and entering a place of peace and beauty. The hospital is a series of small buildings on a slope overlooking a river and hills. Flowers and bushes line the walkways. Trees gracefully overhang the paths. Women walk around with smiles on their faces and small colorful knitted blankets around their shoulders, no two blankets alike. I saw a ward of women and their babies. Women who have been treated for fistulas at this hospital can return when they are pregnant again so that they can safely deliver another baby.

Treatment here costs the patients nothing. Many arrive at the gate after traveling for days, by foot or by public transportation. They arrive with no money and no hope. Their husbands have left them, their families have abandoned them, strangers avoid them. But if the women can find their way to the hospital, the cure rate is 90 percent.

Fistula patient tending chickens at Desta Mender

I later visited a place that furthered my understanding of those women who are the other 10 percent. Desta Mender (“Joy Village”) is a green, flowering oasis with vegetable gardens, a small restaurant, and a dairy and chickens located a few miles outside Addis. This residential community for women with incurable fistulas offers training and support. In this safe environment women learn how to live with their chronic medical condition while acquiring livelihood skills to support themselves.

In addition Desta Mender houses a midwifery school that equips women with knowledge and skills related to pregnancy and childbirth. Midwife graduates return to their home areas, able to provide medical care to local women who experience childbirth complications, significantly reducing the incidence of fistulas. The Hamlin Fistula Hospital in Addis has also established five small hospitals in other parts of Ethiopia so that women with fistulas have a greater chance of reaching a place of help and healing.

Aira Hospital, in western central Ethiopia, is a general hospital that treats obstetric fistulas. This hospital, located in an impoverished area of the country, is owned and operated by the Ethiopian Evangelical Church Mekane Yesus (EECMY), the PC(USA) partner in Ethiopia. In this way EECMY is addressing one of the terrible consequences of poverty in Ethiopia. The PC(USA) has identified poverty, especially regarding women and children, as a critical global issue. This hospital’s treatment of fistulas is an example of the PC(USA) and a global partner both identifying the same important issue and seeking significant ways to tackle it.

Over time my eyes have been opened to a world I had never seen before living in Ethiopia. A world of pain, of rejection, of sorrow and hopelessness. How grateful I am that Christians such as Catherine Hamlin (and her late husband) and denominations such as EECMY are living out their Christian witness, looking forward to the day when every Ethiopian woman who has a fistula can be treated and helped to move forward in her life. And, even more, looking forward to the day when every Ethiopian woman will have adequate medical care so that fistulas will be a condition of the past and never again a reality of the present or the future.

Once again Rich and I are thankful for your partnership with us as we work on your behalf in Ethiopia. We are not in Ethiopia by ourselves. You have come alongside us with your prayers, your encouragement and your financial support. Without you, we could not be here. Please keep supporting us as we minister together.

Here is a link to an op-ed piece in the New York Times featuring Dr. Catherine Hamlin and the Hamlin Fistula Hospital in Addis. Dr. Hamlin has been nominated for the Nobel Peace Prize by the country of Ethiopia.

On a personal note, Rich and I are very grateful for so many of you who have prayed for my health. We have been overwhelmed with the encouragement that you have given and the prayers you have offered. We praise God for what He has done and we thank God for you.


Photos taken from the Hamlin Fistula Ethiopia website.

The 2014 Presbyterian Mission Yearbook for Prayer & Study, p. 133
Read more about Rich and Marilyn Hansen’s ministry
Blog: Meskel Musings

Write to Rich Hansen
Write to Marilyn Hansen
Individuals: Give to E200476 forRich and Marilyn Hansen's sending and support
Congregations: Give toD507537 forRich and Marilyn Hansen's sending and support


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