A teenage Ethiopian girl says goodbye to her husband in the morning as he goes off to work. She tells him when he gets home that night they might have a baby. She’s started to get pains. She lies in her hut all day, but nothing happens. The next day too, there is still no baby.

In Ethiopia, women are often deprived of food or water during their labour. The girl becomes dehydrated, perhaps slipping into a semi-coma as she labours for another two days. Still no baby. In and out of her home are her mother and maybe a traditional birth attendant (TBAs), who are in some of the Ethiopian villages – they have some training, but not enough to understand or tell the girl what’s going on.

After two days of strong labour, an unborn baby will usually die; the placenta starts to separate and the baby is cut off from oxygen. The girl can feel that the baby has stopped moving. She knows it is dead. Once the baby dies, it gets smaller within the woman and it’s scull bones get soft. Finally, the young girl is able to deliver the stillborn.

If she doesn’t die from septicaemia, a common occurrence when a stillborn remains in the body for too long, the girl – exhausted – sleeps. She wakes up to the horror of finding her bed soaked in urine. She remains in this state not knowing it is not temporary. She thinks that if she keeps very still, it will dry up.

Her husband comes home and asks why she doesn’t get up. He’s not cruel, but he can’t manage now that she’s leaking urine. The girl is given back to her parents, back to her old village, where no one understands what has happened to her. She can’t control the leaking. She’s placed somewhere to live on her own – a little shack somewhere away from the main village. Hidden.

Catherine Hamlin in Ethiopia. Credit: Hamlin Fistula Ethiopia (Australia)

This story, told by Dr Catherine Hamlin to Eternity, could be the story of any of the 36,000 young women who have arrived on the doorstep at her hospital in Ethiopia. They have developed an obstetric fistula, caused by lack of blood to the tissues of the vagina and bladder (and sometimes, the rectum) during prolonged, obstructed labour, leaving a hole through which urine and faeces pass uncontrollably.

According to Hamlin, five per cent of all women have an obstructed labour, whether they’re Ethiopian or Australian. The difference is, in Australia help is readily available to correct the position of the baby or to have a caesarean. Ethiopian women aren’t so lucky.

“A lot of the women,” Catherine told Eternity, “have crippling injuries when they get to us. They’ve remained in bed curled up thinking the urine will dry if they lay still. One girl not too long ago came to us, carried by others, with her knees up to her chin – she’d been lying in that position so long, her joints had become stiff.”

Hamlin’s work has been called saint-like. The New York Times crowned her the new Mother Theresa, a title Hamlin says is “rather embarrassing”.

“I do have influence there [in Ethiopia], because I’ve been there so long. And I do genuinely feel love for every patient. A little peasant girl is precious in God’s sight, and so they’re precious in my sight too.”

Catherine Hamlin comes from a mission-focused family. “I had a great aunt who started a mission in the Solomon Islands. Another one went to China.” But she is uncomfortable with those who would call her a missionary. “I don’t actually do a lot of mission work, but I hope I live a life that shows that I love the patients and that they would recognise that I have a Christian faith.”

For 53 years, Dr Hamlin has been working as a gynaecologist and obstetrician in Ethiopia. With her husband Reg, who died in 1993, she founded the Addis Ababa Fistula Hospital, which has now spread to five outposts around Ethiopia.

For the past year however Dr Hamlin’s work has been overshadowed in Australia by internal conflict and a stand-off with the hospital’s Australian Trust – Hamlin Fistula Australia.

Labelled, as these things often are, an “unholy row” over a “hardline Christian approach” in the formal running of the hospital and the Trusts who fund the work around the world, the genesis of the conflict is an ‘ethos’ document purportedly written to secure the Christian heritage of the hospital.

According to Dr Hamlin’s son Richard the ethos document – which outlines Catherine Hamlin’s personal faith and quotes Reg Hamlin’s “guiding text” from the Book of Matthew (“If you do it for the least of these, my brethren, you do it for me”) – was never meant to be a public document. Richard Hamlin is also a trustee of Hamlin Fistula International.

“As far back as 2009,” Richard said, “some of the senior management in the hospital spoke to one of our Dutch partner trusts, basically saying that unless they could align themselves with the ethos document, they could no longer be partners, but only funders or donors.”

The verbal statement, according to Richard Hamlin, was again repeated in 2011, by which time the Dutch Trust expressed its discomfort.

“They said, ‘We can’t have your mother’s spiritual views imposed on our trust.’ They said, in their country, to have a focus that is exclusively and explicitly Christian in articles of association will mean they can’t function and will make it difficult for them to raise funds for the hospital.”

“It seemed to them like an attempt to ‘Christian-ise’ their Trust, which was from its inception ecumenical or multi-faith.”

The fallout from the release of the Christian ethos document to the international support Trusts saw the dismissal of the chairman of the Ethiopian board, with several senior management personnel resigning also. In April this year, the Australian Trust was caught up in the dispute, reportedly backing the former Ethiopian board.

Doug Marr, executive officer of Hamlin Fistula Australia, has been reluctant to give media interviews, but told the ABC back in April that the Australian Trust had “concerns about” Richard Hamlin and his activities on the board. The Hamlin’s say the Australian Trust (HFA) stopped raising funds in June 2011 in Australia for Hamlin Fistula Ethiopia. Doug Marr has told the media the Trust continues to send money to the Ethiopian hospital when requested through the proper proposal structures.

Richard Hamlin says HFA has turned the dispute into a personality issue, now with little to do with the “use or misuse” of the Christian ethos document.

Catherine Hamlin has now withdrawn permission for Hamlin Fistula Australia to use her name, and has asked that the Australian trust hand over $14 million of donated money to the new charity – Hamlin Fistula Ethiopia (Australia). She is in Australia this month to launch the new charity, gather support and assure her Australian supporters of the work that continues to be done by the hospital in Ethiopia.

Hamlin Fistula Ethiopia, and its overseas Trusts, is not the first organisation to struggle with the question of Christian heritage.

In Driven by Purpose published this year, authors Stephen Judd, Anne Robinson and Felicity Errington discuss the “elephant in the room” for religious charities: whether to play up or down the “faith-factor”.

“Motivation,” they write, “and the role of faith within Christian charities does matter… If motivation is not clearly articulated and understood, then it is wide open to being radically misrepresented. It matters because a healthy sense of identity, purpose and ownership is essential for healthy relationships between charities, their communities and government.”

While both Catherine Hamlin and her son Richard have been careful to distance themselves from the notion of the hospital being a “Christian charity” while in Australia this month, there is still a sense of uncertainty about how Dr Hamlin’s faith will be remembered in the work of the hospital in the future.

In Catherine’s Gift by John Little, published in 2010 as a follow up to the bestselling story of the Hamlin’s in Ethiopia, Catherine’s concern for the Christian heritage of the organisation is obvious.

“She worries that as the hospital expands it may lose the Christian spirit that has guided it so far,” writes Little. “It’s not something that can be formalised in a written charter. It’s an indefinable way of doing things – a Christ-like approach, if you like – that is a reflection of Catherine Hamlin’s entire approach to life. She thinks it’s the most important resource they have.”

Quoting Catherine, the book goes on: “We must say that we’re a Christian organisation here, John. That’s why we’ve prospered. God has been behind the work. He’s the one that’s been sustaining all these trusts and so on…We must keep Him at the head of our work and must remain nominally Christian at any rate. We’re not a mission hospital. We have Muslims on the staff. But we don’t want to forget that. That’s really important in our charter – that we’re trying to show our Lord’s compassion for these people.”

At 88 years old, Catherine Hamlin’s faith is strong and evident in the way she speaks.

“It’s your love for God that counts. I think that is something we must spread. I feel this is the main reason I’m there [in Ethiopia], to show the love of Jesus to my patients.”

But she won’t be at the hospital forever. Former CEO of the Ethiopian hospital, Mark Bennett from Australia, was asked to resign from his position at the hospital earlier this year over his involvement in the distribution of the Christian ethos document to the hospital’s partner Trusts. He says the reference to the hospital being God’s work has been removed from the organisation’s mission statement, which he described as “disappointing.”

“We are not a Christian hospital, but there are many Christians who work for us,” Dr Hamlin says.

She doesn’t like to think of the ethos document as simply an historical record of the faith of the founders of the hospital.

“Certainly not,” said Dr Hamlin. “We’ve got many Christian people on staff. We have little prayers nearly every morning – I walk up to the wards, and we pray together. It is a wonderful thing.”

But organisation is not prepared to enshrine that faith in a formal sense for the ongoing operation of the hospital. Rather, Catherine feels confident that the Christian foundation of the hospital will live in the actions of the Christian staff that continue to be attracted to the hospital.

“Our patients feel loved and accepted. The spirit is certainly a Christian spirit in our hospital.”

When John Little wrote in 2010, he did so almost prophetically. “I don’t envy Catherine having to guide the way into the future. The little hospital that she and Reg nursed into life is growing up fast. Managing it through the next stage of development is going to need wisdom and strength. Catherine’s wisdom is undoubted; it’s her stamina that I worry about.”

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For more information about Catherine Hamlin’s new charity Hamlin Fistula Ethiopia (Australia) click here.

Hamlin Fistula Australia has released a statement this month on the current circumstances for funds donated to the hospital in Ethiopia. You can read that statement here.