14 August 2010

The Believers

I’m sitting in the back seat of an old blue and white Russian Lada, looking through the drizzle flecked window at some wet goats standing in mud on the side of the road. The morning is gray and smells of petrol and exhaust and I have a headache from a bad night’s sleep.

The day before I’d showed up at the Addis Ababa Fistula Hospital and asked to speak to its 84-year-old founder, Catherine Hamlin. I didn’t have an appointment, and was ambivalent about whether or not she would see me. I’d been travelling non-stop for three months, living out of a suitcase, eating with strangers. I felt dislocated and lost, weary of ideas, weary of writing.

But the hospital public relations manager, Feven, told me to come back in the morning at 9 o’clock and we could meet.

Now I’m stuck in traffic, and my driver, Fikadu, is creeping along the street like a snail. It’s okay, though. I need the time. Looking out the window—a crumbling church, an open market, masses of Ethiopians darting in and out of traffic—I try to think of questions for Dr. Hamlin. Usually, I have a list prepared for the people I interview. The questions have a logical, linear progression.

But when I think about Dr. Hamlin, my questions feel irrelevant, like abstractions (does aid work?) compared to her concrete reality (yes—these women were sick and now they are healed).

And when I arrive, ten minutes late, my mind, and notebook, are completely blank.


Feven tells me to have a seat while she fetches Catherine. I pick up a brochure, flip through it absently, then set it down and look out the open window. The morning air is cool and smells of eucalyptus. Nurses dressed in white walk along a corridor next to the admissions office, which, like the surgery and recovery ward, is nestled on a hillside among trees and flowers.

Then I see Dr. Hamlin, tall and conspicuous in a long white lab coat, walking slowly with a cane, Feven’s hand in hers.

Catherine Hamlin and her husband came to Ethiopia in 1959, after answering an advertisement in the Lancet Medical Journal, seeking an obstetrician and gynecologist to establish a Midwifery School at the Princess Tsehay Hospital in the Ethiopian capital of Addis Ababa. Fifteen years later, they established the Fistula Hospital, a place where women with horrendous injuries from childbirth*, women who have been abandoned, cast away to the margins, can come and be cared for, and in many cases made well again.

Dr. Hamlin's face is deeply lined and rosy, and as we sit down to talk, she tells me about the hospital, which provides fistula repair surgery to about 2,500 patients each year, and cures over 90 percent of them. They also care for fifty long-term patients, who are not able to be cured, and train local health workers and specialists. All services are provided free of charge.

In the opening pages of her book, The Hospital by the River, Hamlin says that she came to Ethiopia as an answer to the calling of God. Has her faith changed in the fifty years she’s lived in Addis?

—No, she says. There has always been good and evil in the world.

Do you ever get discouraged, I ask? Why did you stay when so many others have left?

—I was excited, she says. I was curing people.


One night in Nairobi, a friend and I had dinner with a young woman just arrived in Kenya to do research for her PhD. It was her first time in Africa, and in between bites of teriyaki chicken, she told us about the angst she was feeling, questioning the purpose and utility of development. Is it arrogant to come to a place you know nothing about and study it? Is it just another form of colonialism?

—Colonialism is underrated, my friend, M, interjected with a grin. The young woman laughed uncomfortably and shifted in her chair.

I frowned at M and asked her: What is the most defining thing about your first few weeks here? What do you feel most acutely?

She said: Guilt.


—Go easy on the newbie, I told M later in the car. I’ve been here a year, and I’m still pretty sure colonialism is NOT under-rated.

—I know, I know, he smiled, hurtling like a rocket through Westlands roundabout. But you can get lost in the debates forever. I wouldn’t be here if I didn’t think my job was important.

M works in conflict resolution and has lived in Kenya for three years. His job is to think about and work with groups most consider beyond the pale, outcasts.

—I choose to be here. I signed a contract. I know my work isn’t perfect. But I have to do the best I can with what I have.


Back in Addis, I’m sipping a macchiato with Owen Barder, head of aidinfo.org, an initiative promoting aid transparency.

He is, as usual, like loose electricity, overflowing with ideas and optimism. Where does this fierce belief in the power of shared information to change things for the better come from?

—I’m a hacker, he says, leaning over the table conspiratorially. I was shaped by the idea that information should be shared.

He tells me about a meeting he attended in Paris, in which donors who give about half of the world’s aid agreed to publish data more quickly, and in a common, open format, so that it is readily accessible, comparable, and easy to find.

Owen’s ambitions are massive. He wants to fundamentally realign incentives in the aid business, to change it from the inside out. How is a meeting in Paris going to do that?

—This is work, he says, undeterred. It’s slow and incremental. Over time, low key technical and technocratic changes will change the system dynamics, and hence the whole trajectory of the aid system.


It is easy, in the development business, to get caught up in words and ideas, to be mesmerized by doubt and uncertainty. But we must move on. People like Owen and Catherine and M believe in the work they are doing, not because they are under any illusions about its limits, but because they get up each morning and do the work. Because they try. Their dreams and hopes are grounded in responsibility.


As our interview draws to a close, I tell Dr. Hamlin: I don't want to leave! Your work is amazing!

She smiles: "They keep coming, though, year after year." The Fistula Hopsital gives women their lives back, but it does not solve the underlying problem of poverty and lack of access to basic health services that brings them there in the first place.

"But we're working on it," Hamlin says. She and her colleagues recently opened four mini-fistula hospitals throughout Ethiopia where prevention education programs are being delivered to communities and traditional birth attendants are being trained. They have plans for much more.

Outside, in the crisp morning air, Feven chides Catherine gently for being up and about so soon after hip surgery a few months ago. Catherine takes her hand: “There’s work to be done.”

*Obstetric fistula is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth. A woman with obstetric fistula will suffer from incontinence and extreme social stigma.


  1. I love this Lindsay. Thank you. The faith does not change nor does the vision that was given and the excitement at saving a childs life, giving a family their mother back well it will always be exciting. As exciting as only a God this big can make it. - David Waines EQUIP Liberia