© SARAH HENDERSON
Patient Etaferaw Zelalem at Hamlin Hospital.
Note: PhotoServe presents the words of photojournalist Sarah Henderson and her mission to document the work of Hamlin Fistula Hospital in Ethiopia, while working with the NGO digital-storytelling group SalaamGarage. SalaamGarage works to get under reported stories out to the world digitally and traditionally, with the hope for impacting social change, along with creating a new paradigm for self-monitored or personal responsibility.
My iPhone alarm rings. It’s 5:30AM. I’m in a cold hotel room 9,000 miles from home. Amidst hazy remnants of melatonin, I hear dreamy echoes of religious chanting in Amharic bouncing off the surrounding hills. My dreams had been a wrestling match of anxiety. My focus clears as I realize what I am doing here. I had ventured into the “cradle of humanity”… Addis Ababa, Ethiopia, with a group of 12 photojournalists, on a self-imposed mission to document the good works of Hamlin Fistula International, a medical NGO dedicated to relieving a maternal health crisis here. My concerns though are egocentric. Are my camera batteries charged, what access will I have today, what about the light, where's my ibuprofen? Would I finally be able to connect to the internet? The foreign sounds from my window remind me that I’m here to do "worthwhile" work, to cast light on what the United Nations sees as a key Millennium Development Goal (MDG) focus-- maternal health. This is my chance to utilize my photography to possibly manifest a “butterfly effect’’ of change. At breakfast, the word is that the founder, Dr. Catherine Hamlin, will not be available for a portrait. Is this the first of a series of setbacks that every documentarian can expect? I’m starting to wonder what I’m doing across the world after all?
A few blocks away at the Hamlin Fistula Hospital , an incredibly frail woman, Etaferaw Zelalem is also waking up. Her goals for the day seem simple though painful. She is learning how to walk again. Her last walk had been seven years before, in her northern village of the Bahir Dar region, hundreds of miles away. Etaferaw had become pregnant at just 13 years of age and she was unable to deliver her baby after ten days of obstructed labor without medical care. Isolated and uneducated, and shunned by her family and villagers, she and her family were unable to afford a bus ride to get to care. It turns out transportation is quite expensive and surprisingly rare to see cars on rural highways. For seven years Etaferaw had been living with constant leaking from her uterus and rectum until a NGO rescued her by chance and rushed her to Hamlin in Addis − proving that my issues are nothing in comparison.
Etaferaw’s story may not have been the story I set out to tell, but that’s one thing I’ve learned as a photographer and filmmaker, be awake to opportunities outside your preconceived notions. Hamlin's work with prevention of fistula through developing a midwifery school and provision of rural medical outreach to women is noble. Focusing on Etaferaw's story could potentially inspire others to get involved and help save Ethiopian women from such a long, painful journey of loss and isolation. If I could, along with my group's work, spread our photos and stories around the United States and beyond borders, maybe it will help Hamlin fund training for many needed midwives to work in the mini rural hospitals where most of the estimated 88 million people live in Ethiopia. I had to believe that our group could cumulatively do more "good" together than as individual storytellers. I started to readjust my expectations of doing any amazing stories or photography in Ethiopia, given that I hadn't given myself a buffer of time and resources to stay the extra two to three weeks I'd need to do really "good" photography or get to the stories I was interested in doing. That and just getting through a day of Amharic was fascinating though intense, as was making sense of their beautiful and ancient language. We relied heavily upon the generosity of Hamlin for hospital translation and communication with key patients. Otherwise we were lucky to have a ground tour guide, Sefiw of Dinknesh, who helped us connect with many Ethiopian people after our work with Hamlin.
Etaferaw really got me thinking while at Hamlin. Upon my first meeting with her, I was struck by how incredibly slight and weak she looked. It was clear she was in great pain though she didn't want me to know this it seemed. At first Etaferaw was shy in front of the camera but after spending more time together, she opened up and was proud to be "someone" to be seen and not hidden away. She gathered the strength to show me that she could stand without her walker. And despite her shame of having had an acute double fistula, she had finally made it to Hamlin, which she expressed as being very happy about-- a place that strives to provide excellent medical and holistic or humanistic care to women and at no cost to them if they can make it there.*
I was starting to understand that maybe Etaferaw was someone I was supposed to meet. I wished that I knew Amharic past my sphere of around ten words by that time. So it came down to connecting through photography and facial expressions. I was glad that our group had a Fuji Instamatix camera to help make those connections by actually giving patients like Etaferaw a portrait of herself standing without a walker. I was guessing it was the only portrait she had of herself.
We can get so hung up on our tasks at hand, the results we expect, when really all of that is trivial. If my camera can’t see around my ego, then there will be false images to show. The photography will end up being another pile of pretty or interesting travel pictures, hanging in a show or lost in my studio, gathering dust with no home, no audience, and no purpose. By doing a group photo media/NGO project, such as with SalaamGarage and Hamlin Fistula, we can act with the support of our peers and partners. Collectively we can self-publish photos and stories through blogs; do offline events such as shows and lectures; spread news of project progress through social media like Facebook and Kickstarter and partnering with do it yourself (or DIY) publishing companies such as Blurb, creators of the Blurb for Good book project.
So the people we meet along the way in our journeys, as well as the photos we give away rather than take, can quite possibly help us grow as photographers in the long run, if not in the short run. And though I struggled with doing the group photography approach in a confining and conservative medical setting with limited access, I felt it was vital to do such a trip and put myself to a new photography challenge. With all of the negative things going on in the world, however small of a good thing we can do with our work, it is better than not doing anything at all. I hope to raise more awareness and funds for Hamlin in order to further develop their post-op and therapy programs such as the Physiotherapy program. If Etaferaw and others like her can walk again, they can have a life again.
When I asked Etaferaw, "What are your dreams for a life outside of Hamlin?" (Realizing what a typically American thing to ask "what's next?” I still asked.) She replied in Amharic through Sister Azeb Befekadu, Hamlin's Physiotherapy Manager and my translator, "God willing that I can walk again. Then I can think about dreams.”
Since returning from Ethiopia in December 2010, I'm truly beginning to understand and better appreciate the accomplishments of Hamlin Hospital and its founders Dr. Catherine Hamlin and her late husband, Dr. Reginald Hamlin. It's mind boggling to think about the incredible commitment that's required to wade through treating thousands of cases of fistula (now an average of 3,000 per year) with relatively streamlined yet taxed medical and administrative staff. Since 2005, the Hamlins have opened up a handful of small rural mini clinics, and in 2009 opened up the Hamlin College of Midwives, located at the Desta Mender campus in Addis. The work toward eradicating obstetric fistula in Ethiopia has accelerated in pace in recent years, which can be partially attributed to the advent and spread of news stories through the Internet. With more global awareness, the ability to raise funds has grown quickly toward prevention initiatives since the early 2000s. All of which has helped attract photographers like me to join the maternal health movement in Ethiopia-- also to help pave the road for empowerment of next generations of women.
Thanks to SalaamGarage and their work to develop partnerships with Hamlin, Blurb and my fellow photographers who have volunteered their time, passion and talents. Thanks to Blurb for donating their design and publishing services so our group could affordably participate in a Blurb for Good book project. All book profits go directly to Hamlin-- helping them eradicate obstetric fistula, for the better health of Ethiopian women and their families.
For more information on the Hamlin Fistula Hospital, their care and need for midwives and to help support their cause, see their USA site. Transportation is a problem for most Hamlin patients as it is hard to get to and from ER medical care, especially for many rural Ethiopians who may make an average of $1 a day. There is a lack of road infrastructure and transport service, which affects access to emergency obstetric care service and contributes to the occurrence of obstructed labor, uterine rupture, sepsis and death. To read more about fistula patients and transport service for emergency obstetric care, see the writings of Dr. Mulu Muleta.
See Sarah Henderson’s work with Hamlin Hospital in the new book Hamlin Fistula & SalaamGarage. Also, see her Web site for more of her photography, creative direction, videography and production on many other projects at www.sirenapictures.com and her video documentary, There is No Finish Line, on Olympic champion marathon runner Joan Benoit-Samuelson.