IMAGINE a 15-year-old girl, pregnant for the first time but unable to deliver the child vaginally. She will spend six days of agonising, obstructed labour, mostly squatting, in an isolated village hut with no hospital or clinic near by, and just a mother-in-law for a midwife. Eventually, the baby dies inside her and shrinks enough to be squeezed out.

But the sadness of the dead baby is only the start of her torture. What happens, if the girl does not die of sepsis, is that the pressure of the baby ruptures the tissues between the vagina and the bladder or rectum so that urine leaks out constantly and her clothes are soaked day and night.

These appalling birth injuries are called fistulae. Within ten days the girl will be incontinent. Reeking of urine and sometimes also faeces, she will probably be thrown out by her husband. She will become an untouchable, an outcast, with scant means of survival other than begging.

In developed societies a woman having a difficult labour will go directly to hospital to have a Caesarean section. In Ethiopia, the world’s poorest country, there is only one doctor per 36,000 of the population and many villages are three days’ walk. Unsurprisingly, 8,500 women a year in Ethiopia suffer fistulae — possibly a million throughout the world.

“If you had 8,000 men with incontinence of urine something would have been done for them,” insists Dr Catherine Hamlin, who founded the world-renowned Fistula Hospital in Addis Ababa with her late husband, Reg, in 1975. “But because they are women, and mostly provincial women, they are second-class citizens in this country. Their plight is so sad: a fistula is a preventable injury.”

Hamlin, a grandmother of 81, is the least strident of women. Tall and upright, she still works as a surgeon and talks in a gentle but matter-of-fact way with lingering traces of her native Australian accent as she describes to me, during a brief visit to England, the tragic medical needs of these women to whom she and her late husband, Reg Hamlin, have devoted their lives.

She has recently co-authored a book, which details some of the most harrowing cases. It is also a compelling account of how ordinary people can make a difference.

“Catherine is not only sweet and kind. She can relate to Ethiopian women, and she gets things done,” says Professor Gordon Williams, a London urologist who goes, at his own expense, four or five times a year to the hospital, sometimes just for a weekend, to operate and to teach Ethiopians his skills. Williams clearly remembers his first visit 16 years ago as a British Council examiner “because it was the first time I had seen a holistic approach to such problems. This wasn’t just a fistula hospital. You saw a total change within days of the girls’ arrival. They started brushing their hair again, knowing they would be cured. They were given new clothes and after the operation were taken by a driver to the bus station. Nobody was ever turned away.”

Catherine Hamlin has always been a committed Christian. She was born into a prosperous family in Sydney. Several ancestors were missionaries and her mother ran a Sunday school. She believes that as a child she had a call from God telling her to “feed my lambs” which inspired her throughout medical school. Reg, a New Zealander, also came from missionary stock. He won a medical scholarship to study in Sydney.

She explains: “These girls cannot understand what is happening. They see it as a punishment, an affliction and don’t associate the condition with their long labour. They have no idea why they are suffering. Several commit suicide.”

One of the many appalling stories she tells is of a woman totally ostracised who had spent nine years never emerging from her darkened hut and surviving on food left once or twice a day. But there are other heart-warming stories of former patients who now work in the hospital. Mamitu, for example, arrived as a teenager with shocking injuries to her bladder, rectum and birth passage. She had no formal education but is now a competent fistula surgeon. Reg taught her.

In 1959 Reg and Catherine answered an advertisement in the BMA’s journal, The Lancet, to set up a school of midwifery in the Princess Tsehai Memorial Hospital in Addis Ababa. Abandoning their successful obstetric and gynaecological practice in Sydney, they accepted a three-year contract and, along with their son Richard, aged six, left for Ethiopia.

“It was all very primitive. There were goats on the plane wandering up the aisle. When we finally landed in an open field there was no one to meet us so we just set off with our bags but we walked in the wrong direction. I remember my husband said, ‘Never mind, Cath, I’ll take you back to Sydney’.”