Labour of love

Medical graduate Anthea Lindquist has taken inspiration for her career from an 85-year-old Australian doctor who has restored health and dignity to thousands of victims of a preventable birthing condition.

The young woman is lying on a mud bench in a village hut with her mother and other village women to encourage her in the birth of her first child.

In this remote region of Ethiopia this is all the help she will get with her labour.

She starts her labour in the morning and thinks the baby should arrive by nightfall. She is in labour all day. Nothing happens. She remains in labour all the next day. Still no baby.

The village medicine man comes in and presses on her abdomen to try to push the baby out, but it won't do any good. The baby's birth has been obstructed. The unborn baby is dead.

In the developed world, the problems posed by obstructed labour were largely overcome in the early 20th century, as trained midwives and hospitals expanded their role and influence.

But in Ethiopia in the early 21st century, few village women will give birth with a trained attendant.

There is only one trained obstetrician for every 160,000 women and five percent of the country's 15 million women of reproductive age will have a labour that will lead to the death or injury of the mother or the baby or both.

The woman eventually pushes the stillborn baby out. She wakes to find the bed soaked and thinks she is bleeding, but she is leaking urine, a condition that has been caused by tissue damage during the labour. A lack of blood to pelvic tissue has caused damage leading to a fistula or hole between the birth canal and the bladder.

Her life is ruined. She has no role in village life. She will not have any more children. Some think she is cursed by God.

Fifty years ago an Australian medical couple Reg and Catherine Hamlin, entered Ethiopia wanting to help women with this preventable and curable condition. They have since treated 30,000 women free of charge and along the way inspired many with their commitment to frontline medicine.

One of them is Anthea Lindquist, a 2008 Monash medical graduate and 2009 Rhodes Scholarship winner.

Anthea first heard of Catherine Hamlin at Sacred Heart College, Geelong and last year she heard her speak at a Melbourne fundraiser.

"Catherine Hamlin has been my long-term hero. After reading about her at school I realised what a passport medicine is. That it gives you so many skills and the knowledge to have an impact. I thought medicine would be the one course that would allow me to fulfill all my ambitions and dreams and allow me to contribute to the community locally and internationally," Anthea said.

"I've grown up in a family and gone to a school with a strong social justice ethic. Dad was a Monash graduate and I grew up with a circle of family friends from his university days. So I had a picture of the sort of people who went to Monash and I haven't been disappointed. I can only say my wishes have been fulfilled."

Anthea sees her career in child and maternal health in Indigenous communities in Australia or in developing countries. She has already spent 12 weeks in two six-week placements in the Northern Territory, one in the troubled community of Wadeye.

She says that while the issues in Aboriginal health are complex and the reality of remote communities confronting and heartbreaking, "we have to keep trying to make it work".

Anthea's approach, like Catherine Hamlin's is a practical one.

"It's preventable, curable. You never come across fistula in developed countries. It's entirely preventable by proper birthing measures. We are incredibly fortunate in medicine to graduate with skills we can take to any community."

The young woman with obstetric fistula has now been taken by aid workers to the Hamlin Fistula hospital in the capital Addis Abba. She will undergo intravaginal surgery and has a good chance of returning to normal life and having more children.

The operation will be free to the woman. Donors in America, the UK and Australia have provided the $US450 to pay for the operation, post-operative care, a new dress and the bus fare home.

The Fistula Hospital has a 93 per cent success rate. The staff restore her dignity as well as repair the fistula.

Anthea will study for a Master in Global Health Science at Oxford in 2010. Later this year she will meet Catherine Hamlin. She hopes to be able to negotiate an obstetrics placement with her at the Hamlin Fistula Hospital to complete the research component of the postgraduate degree.

Visit the Fistula Relief and Aid Fund website