Building hospitals and hope for African women with obstetric fistula

*The following content may be distressing for some readers. 

It’s a not an uncommon scenario. A woman in the delivery ward finds her baby isn’t coming as quickly as it should. The doctor assesses the situation and realises that the baby is actually too big to pass through the mother’s birth canal so a caesarean procedure is organised. Soon the child is resting safely in its mother’s arms.

Now switch the location of this story to rural Ethiopia, or indeed many developing areas around the world: no hospital, no doctor, no way of doing a caesarean. What happens to that too large baby and its mother then?

As a 26 year old junior doctor coming from Sydney, Andrew Browning went to Ethiopia in 1996 and saw first-hand the ‘what then?’ being lived out by thousands of women, often shunned by their communities and their loved ones. The condition is obstetric fistula and it strikes up to 100,000 women around the developing world every year.

The name itself is unsettling, but it doesn’t prepare you for its reality, described here by Browning using the story of one of his own patients. And a warning, this is not an easy read:

“She was married when she was 14 or 15, which is normal for her village. She is pregnant pretty quickly with the nearest hospital being 120 kilometres away, but with no money, roads or transport she couldn’t get there regardless.

“She goes into labour and it lasts for days with her desperate, illiterate husband unable to help. Inevitably, the baby dies within her and collapses enough to be delivered. After the birth, she is unconscious for two days, waking up to find her bowel and bladder leaking uncontrollably through her vagina.

“During labour, the baby’s head was pressed against her pelvis, and all the tissues between the bladder, vagina and rectum died, leaving a hole, or fistula, connecting them all. The smell and mess she makes cause her husband to divorce her and her mother won’t let her in the family house. She must live alone in a small backyard hut.

“This story is not unusual. I’ve heard tens of thousands like it.”

First visiting Africa as a student doctor in 1993, Browning had a baptism of fire at a desperate Tanzanian border hospital where he first saw how much had to be done with so little, especially when it was suddenly flooded by refugees escaping the start of the Rwandan genocide.

Feeling a strong sense of mission, he returned to Ethiopia in 1996 and decided to stay. Browning has now spent 17 years living in Ethiopia and Tanzania and is a world authority on obstetric fistula. He’s built three hospitals in Africa dedicated to its treatment and prevention, and trained hundreds of doctors to do the often tricky surgery. Those doctors now work everywhere from Sierra Leone to Afghanistan and Nepal.

“There's still refinements in the surgery techniques to improve their outcome,” Browning says in his soothing, radio-ready voice. “We’ve made great strides in the making of new vaginas and urethras that were destroyed in labour. The cure rate has gone from fifty to almost 90 percent.”

Indeed, the young woman, whose terrible story he told, is one of many successes. “I caught up with her about a year or two after her operation, and she’s so happy to be well. She’s back at school and building a new life for herself.”

The first qualities you might notice in Browning are his intelligence and a gentle inquisitiveness. Then a sense of calm that he attributes to his strong, Christian faith, shared with his wife and many in his extended family which includes a number of clergymen and medical professionals working with a philanthropic intent.

“I'm not a preacher or an evangelist or whatever,” he says. “I'm a surgeon and I love doing surgery. I serve God with the skills he’s given me."

In a way, Browning’s arrival in Africa was set in train when he was just six years old. A missionary nurse told his Sydney Sunday school class about her time there, and the sense of work needing to be done stayed with him, though he wouldn’t be the first of his family to go to Africa.

When Browning refers to Aunt Val, she is Valerie Browning AM who has spent more than thirty years living and working with the Afar people of Ethiopia. Her influence has been transformative for the 1.5 million Afar, in everything from education to health care, even dam building. Though Browning notes, “She’s tiny. She could have been a jockey.”

Working with his Aunt, he became aware of the late and lauded Dr Catherine Hamlin who was running the world’s only fistula specific hospital in Addis Ababa, Ethiopia. Hamlin offered Browning a job and later he started her organisation’s first regional fistula hospital where he and two Ethiopian nurses operated on up to 700 fistula patients annually.

Knowing more hospitals were desperately needed beyond Ethiopia, Browning set up a foundation so he could build his own in other locations.

“In those environments, there are needs that the government can’t meet, so you have the chance to do things of true value,” he says. “Women are dying in labour, you need to do something about it. Or the kids aren't being educated, so build a school.”

Indeed, Browning’s wife, Stephanie, built two schools so their two sons, and the children of other people around them, could have an assured education. Having lived with a Tanzanian family during her own schooling years she was a white person fluent and accent-perfect in Swahili, which certainly helped her navigate the obstacles. And living in Africa can present obstacles.

“When we lived in northern Ethiopia, you could only buy potato and cabbage. Then carrots, which were new,” Browning remembers. “For meat, you’d buy a live goat or sheep and slaughter it at home because that was the culture. Then you’d hope the electricity didn’t fail, which it did a lot, so the fridge wouldn’t work.”

On the day Browning tells SAM his story, he is on a park bench near Royal Prince Alfred Hospital, and a long way from his Tanzanian home. A couple of years ago, he and his wife moved their family back to the New South Wales Central Coast, where they have family connections, so their sons could finish high school here.

The boys, who were raised in the active and freewheeling environment of African children, are still adjusting to the more technology-centric interests of their Australian school friends.

After the move back to Australia, Browning would commute between the two countries, but the global pandemic put paid to that. From Australia he still administrates his hospitals and fundraises on their behalf, but he very much misses his work, the people and the sheer, chaotic energy of Africa, where the streets are full of noise and interaction.

“I walked past a bus stop near here a while ago,” he says. “I wanted to take a photo to send home because everyone was lined up in a straight line looking at their phones. My African friends would have laughed their heads off.”

Asked about what he still needs to do, Browning laughs dryly, “There’s the need for a few thousand maternity units across Africa so women don't have to die during labour or get a fistula. We’ve built three.”

Written by George Dodd.