The Hospital by the River
Chapter Nine
Our normal work continued at the same pace as before, but as word of our success spread we began to see more and more women suffering from fistulas. What a tragic sight they were. Offensive to smell, dressed in rags, often completely destitute, they would sometimes walk for two or three hundred kilometres to get to Addis Ababa. One girl turned up with her mother after walking for fifteen days. They had no money and nowhere to stay, so we paid for the girl’s admission ourselves and allowed her mother to sleep on the floor beside her bed.
Another young woman arrived after walking for 450 kilometres. She, too, was in rags and had no money. She was a difficult case, with two big holes in her bladder, through which part of the bladder had prolapsed, making it painful for her sit down. She had endured this for ten years. Reg operated on her and after two weeks she was dry. It was an amazing transformation. Before she had been downcast and miserable; now she was reborn as a beautiful, smiling woman, with a look of joy in her eyes. We bought her a new dress to go home in, and she kept holding it up for everyone to see. When it was time for her to leave, we took her to the bus station and gave her the fare. She tried to kiss our feet and said, “God will reward you for all you have done for me.”
Another girl had heard about the hospital in a faraway province where they spoke a different language. Someone had written a sign asking for her to be directed to the hospital and hung it around her neck, and she eventually found her way to us.
At first Reg did the operations and I assisted him. After we had done 22 with only one failure, I felt ready to do my first. Two cousins arrived in outpatients, both dripping urine everywhere under the bench where they sat. Reg did the more difficult one, and I did the other. They recuperated lying in adjacent beds and after three weeks they were both cured.
After the success of these first cases we felt encouraged to do more. Soon the number of arrivals began to place a strain on the hospital facilities. Being desperately poor, the fistula patients were usually unable to pay for their admission. The hospital provided half a dozen free beds, but these were always full, so often we paid their fees out of our own salaries.
Even when they were admitted we would often have to cancel their operations if an emergency case came in needing urgent surgery. Accommodation became a problem, and we found that some women were being turned away by the hospital guards or the porters, who would tell them there were no beds.
They would wait anyway and sometimes sleep in the hospital grounds. Reg started getting up early and searching the compound for any who had been turned away. He would tell them to sit under a certain big spreading tree near the outpatients and to wait for him there. After examining them he would gather the sad little collection and take them to the kitchen for something to eat. The hospital cooks cooperated wholeheartedly with this routine.
Reg was terribly touched by the plight of these poor women. He called them the fistula pilgrims, on account of the tremendous journeys they undertook to get to the capital. He would hear how they had suffered and been rejected, and of their struggle to get to the hospital, how they perhaps had to sell an animal or beg to raise the money, and often, as he listened to their stories, he would have tears in his eyes.
If fistula sufferers turned up at outpatients, the other women would push them to the end of the line because they were so offensive to be near. Reg would go to them and put his arms around them and say, “You’re the most important patient to me today. I’m going to see you first.”
If there were no beds, he would sometimes put them in storerooms or other places that were out of sight, where there was a bit of space. Once the medical director, Dr Asrat, came to us and said, “The private patients are complaining about the smell of urine coming up the stairwell because you’ve got a collection of patients sleeping under the stairs to the private wing.” But he was sympathetic and tried to find room when he could.
These girls and women had suffered more than any woman should be called upon to endure. To meet only one was to be profoundly moved and called forth the utmost compassion that the human heart was capable of feeling. One girl, after making her way to us, arrived so late at night that there was no one to see her. In despair, early next morning she tried to hang herself outside the hospital gates. The guards found her in time and cut her down, and she was subsequently cured.
When they started to come in big numbers, Reg was called to the Ministry of Health to explain this new epidemic of fistulas that had struck Addis Ababa. He explained, “This is not an epidemic, Your Excellency, this has been going on since the beginning of time. We just happen to have done something about it.”
The Ministry was not particularly interested in the plight of the fistula pilgrims. They had so many other problems to contend with that they told us, “They are your problem. You can use the hospital facilities, but we can’t afford to pay their hospital fees.”
If we were only able to raise some money we knew we could help many more. Reg wrote to a reporter friend on The Advertiser back in South Australia to try to generate some interest in a fund. In Addis Ababa the Rotary Club agreed to pay for one bed a month. A committee of local American women, The American Women’s Club, pledged us US$60 a month to pay for patients’ travel expenses and also agreed to supply ten dresses every month for them. It was a start.
Despite the fact that Reg was 51 when we came to Ethiopia, an age when many people would be starting to think about retirement, he was tireless in his enthusiasm. In all of our wanderings about the world he had been looking for something upon which to focus his tremendous energy and compassion. Even working as a medical superintendent in Adelaide had not been enough to satisfy him. He was driven by a need to create something. When Richard was old enough to discuss such things, Reg told him, “Women have a built-in advantage. They’re creating something that’s visible, whereas men can’t create something that’s tangible like that.”
With the fistula pilgrims he found the great cause he had been seeking. He was drawn to them because he loved them. We found that looking after them was never a hardship and never once did we feel we wanted to do something else. We both knew that this was work that God wanted us to do and we were thankful that we so enjoyed doing it.
At the end of the first year in Addis Ababa the three of us went to Kenya for four weeks leave. We had to go to twelve different government departments and prove that we had paid our electricity and water bills, had no overdraft at the bank, did not owe anyone anything, and were not wanted by the police and so on, before they would give us our exit visas.
It was exciting boarding the plane for our first holiday. We booked into the Fairview Hotel in Nairobi, a famous old-fashioned family hotel favoured by British expatriates from Kenya and Rhodesia. These colonials were quite different from the expatriates we were used to in Addis Ababa. They were much more of a rowdy, hard-drinking type who would gather in the bar every evening.
One of the big attractions for us was a cafe at the New Stanley Hotel called the Thorn Tree Cafe, built beside the street with a big tree growing through the middle of it. We drank milkshakes and ate sausage rolls, which we couldn’t get in Addis, and watched an exotic populace of Africans, Europeans and Arabs walking past. Nairobi also gave us the chance to go to the cinema for the first time since leaving Australia. I remember seeing Alec Guiness in Genevieve, a hilarious British comedy about a lot of misadventures with a vintage car. In Addis Ababa we had not felt particularly starved of these Western luxuries, but when we were able to indulge ourselves we realised how much we had missed them.
Our journey from Nairobi to Mombasa was by train, far more enjoyable than a plane trip. We booked a double sleeper so that the three of us could spread out. We hung out of the windows and watched the colourful crowd on the platform, waving to their departing friends, as we slowly gathered speed. Richard, especially, enjoyed the exotic sights - as we passed through Nairobi Game Park with twilight fading, we occasionally saw game. Soon the African night was around us, and we rushed forwards through blackness.
After a gong was sounded we proceeded through swinging carriages to the dining car, where each table was spread with a spotless white starched tablecloth, napkins, silver-plated cutlery and sparkling glasses. The waiters hovered about in white uniforms with red cummerbunds. There was a carnation in a small bracketed vase at one end of the table.
We made many stops during the twelve-hour journey, for the train had to fill up with water. As we lay in our bunks we could hear the shouting and the shunting and occasionally the cry of an animal in the African night.
When we woke the scenery was transformed. Now we could see the hills covered with lush, tropical vegetation. At Mombasa, an old coastal town with a strong Arab flavour, there was an old fort built by the Portuguese, Fort Jesus, and lovely tree-lined streets. We hired a car and drove to the Cosy Cafe where we ate a hearty breakfast, then we set off up the coast for Malindi. When we arrived we drove to a point overlooking the ocean and drank in the view of the sea which we loved so much and missed in Ethiopia.
Our hotel, Lawford’s, was one of the oldest in Kenya. Built by a retired sea captain and named after him, it had bungalows right on the beachfront. Richard was wild with joy when he saw the surf. While we unpacked he raced down towards the water (with strict instructions not to go in) and promptly got lost. We could see no sign of him on the beach and naturally were greatly alarmed. Reg exclaimed, “I’ve brought him all this way to drown him.”
It wasn’t long before he turned up, although it seemed an eternity to us. He had been searching for us among the beach bungalows, but they all looked the same.
With two or three families we would sail out on an Arab dhow to a place called the Coral Gardens, several kilometres out to sea. It took an hour and a half to get there. We would put on face masks, jump into the water and goggle over the reef. We loved looking at the wonderful coral and shoals of brightly coloured fish, wheeling and flashing like shimmering jewels through the blue light. The first time we went we spent about two hours floating face down, just mesmerised. Richard kept saying, “Heaven cannot be more beautiful.” We all got terribly sunburned.
When we were saturated with all this beauty we would collect shells. The hotel kitchen boiled out the little creatures inside, although not with complete success. So we arrived back in Addis Ababa with our luggage reeking of rotting fish.
Every Saturday there was a fishing competition with prizes for the heaviest fish. But the biggest attraction from Reg’s point of view was the surf. We all loved surfing. Reg and Richard would spend hours in the water catching terrific shoots to the beach. Reg, being a strong swimmer, would also go out beyond the waves, do long lengths up and down the beach, then come surfing into shore on a big wave.
This first trip to Kenya and the events I have described became almost a yearly ritual, and we never tired of this routine. We would go to Kenya for our annual holiday for three or four weeks and often met the same people at Lawford’s year in and year out. One old bachelor from up-country in Kenya somewhere said he came to birdwatch. He used to sit on his bungalow verandah with his binoculars, but I think he was really looking at the women. Later, when package tours were beginning, he became an even more avid birdwatcher!
In March of our second year we were able to take a short holiday in Eritrea. We decided to visit Asmara, the capital, then Massawa on the Red Sea coast. March was the cool season for Massawa, which was normally unbearably hot.
Asmara was very like an Italian town - houses with flat roofs and gardens full of poinsettias and jacarandas, palm-lined boulevards, shops full of expensive Italian goods. The streets were free of the beggars that were so common in Addis Ababa.
This feeling of Italy continued at our hotel, the Albergo Italia, where we enjoyed wonderful Italian soup and Red Sea fish. Next day we hired a car and started a spectacular journey down to the coast, winding our way at first down a frightening pass with many hairpin bends, through a landscape of barren mountains and ravines. On many corners crosses had been erected in memory of someone who had fallen over the side.
Towards the bottom of the pass there was a sudden change of scenery. It was now green and lush, with gentler slopes, crops growing on the hillsides and spreading trees in profusion. This was due to the moist breeze blowing off the Red Sea and dropping rain as it hit the mountains.
In the little town of Geda, we visited a well-run mission hospital. The doctors told us that they saw quite a few fistulas but were at a loss to know what to do with them. Later they would send many patients to us.
We continued our descent and, quite suddenly, were at sea-level, where flat desert stretched away into the hazy distance. As we drove along we counted seven bridges over dried up rivers. Evidently they contain water for the few weeks of the Eritrean rainy season, but we saw no sign of even a puddle in any of them.
We were relieved to be out of the mountains as we had been warned of shiftas, or highwaymen. We did not see any but perhaps that was because we were travelling in daylight. We would never travel there at night.
We reached Massawa in late afternoon and found our hotel - an old, Italian-owned wooden building right on the harbour’s edge. It looked over to Massawa Island, where the old Arab town of Massawa is situated. The island is now joined to the mainland by a causeway. On the mainland side stood one of the Emperor’s palaces - a glistening white building. After an easy stroll across the causeway, one plunged into the crowded port area, where many fine Arab buildings were scattered among the more modern Italian ones.
We visited the island port every day and here, as at Malindi, we soon found our favourite spots. There was one special cafe with the tables on the pavement, opposite an evangelical bookshop that had a brothel on one side and a crowded grocery on the other. Our order was always the same - grilled fish with fresh lemon juice followed by Italian creme caramella, Richard’s favourite. Poor child - he was seldom allowed a second helping as we were a bit limited for cash. While we ate we watched the exotic scene before us Ð Arabs in long robes, Italian businessmen, donkeys and street vendors all mingling together amid the harbourside smells.
At the port men were loading into a ship sheep and goats bound for Jedda, Saudi Arabia, for slaughter, as a Muslim will not eat meat that has been handled by a Christian. To the delight of the Muslim stevedores, Richard helped them herd the animals onto cargo nets. Suddenly the net would tighten, and they would lift clear, heads, horns and legs hanging out of the mesh, bleating with fear as they were swung over and lowered into the hold. The head Muslim seemed impressed with Richard despite his religion.
One day we drove 12 kilometres over desert to a sandy beach on the Red Sea, Gorgoson Beach. Along the way we stopped at a well where people were drawing water. As usual Richard plunged into the throng of people, camels and donkeys to help. He loved being part of these exotic goings-on. We stayed a week at Massawa, doing little except swimming and eating, before returning home to Addis.
This also became our holiday routine. In those days there were vague murmurings about Eritrean independence, but no hint of the terrible war that would later erupt with Ethiopia. We would spend a week at Massawa in March and in the rainy season, August and September, we would go to Kenya for the long holidays. Every three years we had return tickets home to Australia and New Zealand.
At the end of our second year in Addis we went down to Malindi as usual. For three weeks we surfed, snorkelled on the reefs and relaxed in the sun. When we returned it seemed as though nearly all the hospital staff were waiting at the airport to meet us. They were amazed at how brown we were. Laughing about our changed colour, they kept saying we were no longer foreigners, and comparing the skin of their arms against ours.
Yeshi and Birru were waiting at home. Although they were both excited to welcome us, they greeted Reg and me in their dignified Ethiopian manner, extending one hand while holding the wrist with the other, and giving a slight bow. They were more relaxed with Richard. It was Meskel time, the ceremony of the finding of the true cross, when the countryside is ablaze with a bright yellow meskel daisy. Yeshi had filled our house with them and had coffee prepared.
The welcome from our eleven fistula patients was touching. As we gave each a small present, their faces lit up with spontaneous joy and, despite our protests, they kissed our hands. Yeshi cooked a big serving of injera and chicken wat, which we all shared. It was deeply touching and it was good to be home.
During the long lazy days on holiday, Reg and I had read the lives of Sylvia Pankhurst and her mother, Emmeline, and marvelled at what fighters for the poor women of England they and Sylvia’s sister had been. Emmeline of course was best known for her tireless battle to obtain the vote for women. She had also started the first antenatal clinics and welfare clinics for women in the East End of London after World War I. The Pankhursts had suffered humiliating treatment at the hands of the authorities for their political activities - solitary confinement and even hard labour. We felt privileged to have Sylvia as a friend.
Two days after we got back Reg and I received an urgent call from Sylvia’s maid, saying that her mistress had become ill. As it was our weekend on duty we went to her home at once. We found her in great pain and quickly realised she was suffering a coronary. We fought to save her, giving her morphia and oxygen, which we had brought from the hospital right next door. Knowing what a great friend of the Emperor she was, we rang the palace straightaway. Two of the princesses came immediately. Her son and daughter-in-law unfortunately were away on a camping trip. We did all we could with our limited ability in such a serious situation. Soon she lapsed into unconsciousness. As I sat beside her, now and then she squeezed my hand until, after about two hours, she died.
The Emperor, Haile Selassie, gave her a state funeral at the Ethiopian Orthodox Holy Trinity Cathedral. Normally only royalty are given that honour, and no foreigner had ever before had their funeral service there. The service was taken in Ge’ez - a language only used for religious occasions, so most people could not understand it. It was attended by every important person in the country. The Emperor himself stood at attention for two hours, without moving, during the service. She was buried in a royal grave just outside the church.
Despite the honours given to her by Ethiopia, Miss Pankhurst had never been decorated by her own country, which I thought was disgraceful.
Next day we were back at work and as busy as ever. We mostly operated together, not only on the fistulas but with other surgery as well. Sometimes I would operate and Reg would assist or vice versa. Even after a busy day Reg usually did an evening round of the labour ward and saw the post-operative patients. I helped Richard with any homework he might have, which was little in the early days, put him to bed with a story and heard his prayers. We had time to sit, perhaps around the fire when the nights were cold, discuss the day’s activities and wonder what the future held. One thing was obvious, the hospital simply did not have the room to cope with the demand we were creating. We wondered - what if we could raise the money to build a special hostel just for the fistula patients, so that they would have somewhere to live while waiting for a bed in the hospital? We knew nothing at all about fundraising on a large scale, but the more we thought about it the more attractive the idea became.