Australian surgeon Catherine Hamlin has just celebrated her 90th birthday, and for most people, this would be a good enough reason to slow down.  
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World News Australia
31 Jan 2014 - 5:16 PM  UPDATED 19 Feb 2014 - 12:43 PM

Australian surgeon Catherine Hamlin has just celebrated her 90th birthday, and for most people, this would be a good enough reason to slow down.

(Transcript from World News Australia Radio)

But Dr Hamlin says she will continue her work with women in Ethiopia with the potentially life-threatening medical condition, obstetric fistula.

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When Catherine Hamlin celebrated her 90th birthday, she didn't want gifts or a party.

Instead, she says she wished for her hands to remain steady enough to continue to operate on some of the thousands of women who come to the hospital she and her late husband, Reg, established in the Ethiopian capital, Addis Ababa.

Dr Hamlin says it's not difficult to feel compassion for the women coming to seek help for a painful and potentially life-threatening condition.

"These patients are very touching to people meeting them because of their poverty, because of their needs. And to know that there are young women who would be ruined if they're not repaired, you don't have to have special gifts. If you just see one it draws out your compassion in your heart."

Dr Hamlin's work involves women who have developed a hole, or fistula, near their vaginas after prolonged, obstructed births.

The condition, when untreated, can cause incontinence, as well as severe infection-- and in extreme cases, paralysis.

The work of Dr Hamlin's hospital is supported by a fund-raising group in Australia.

Chief Executive Officer of the group, Lucy Perry, says the condition is debilitating.

"They're in so much pain. They have serious internal injuries but people often forget too, because they're dripping urine, they're incontinent, just the acid in their urine eats away at their skin and their skin breaks down. Just walking is a huge discomfort to them. And just that ability to decide when you go to the toilet is such a basic human dignity that allows you to live your life properly."

Dr Hamlin says obstetric fistulas frequently lead to women being excluded from their community in rural parts of Ethiopia.

"They don't understand what is the cause of this. They think they've been cursed by God and they have no idea that it's due to a mechanical factor. Either the baby's too big or the pelvis is too small and they can't deliver normally. And they don't realise that this was the cause of them being incontinent when the baby comes out."

Dr Hamlin says when she and her husband arrived in Ethiopia as fellow doctors in 1959, they never imagined the condition would end up being the main focus of their lives.

"We happened to have come to Ethiopia. We didn't know anything about fistulas when we came. And we met these patients and we met these patients and we became very much involved straight away with trying to help them and we read all the literature about how to repair them and we contacted doctors in Egypt who were doing these operations. And we had to learn really, how to operate."

Despite being more than 20 years over Australia's retirement age, Dr Hamlin says she has no plans to stop working.

Every day, she walks from her home in Addis Ababa to the hospital, where she still operates on an average of two patients a week.

Other surgeons do many more operations - more than two-thousand a year, and almost all patients are completely cured.

Dr Hamlin says the best 90th birthday presents she can have are donations to help keep her hospital running.

Lucy Perry says even the smallest donations can make a difference.

"Anything from ten dollar packs of slippers for our patients. A ten dollar pack buys five pairs of slippers. Our patients arrive barefoot generally. So anything from small items like that right through to, we need to pay for obstetric fistula surgery, we need to pay for caesareans, we need to pay for accomodation for our long term patients who need training and more integration back into society, right up to $35,000 fully equipped midwifery centres in regional Ethiopia."

The Hamlin organisation once received Australian government funding, but that's stopped.

Now, it relies entirely on public donations to keep the hospital running.

Lucy Perry says it makes planning for the future of the hospital a challenge.

"It has had quite an impact, it was a million dollars a year. Our entire budget to run the hospital and the midwifery college is five million dollars a year so to lose 20 per cent of our income is an enormous amount. But at the same time, I've always said that if I'm doing my job properly, we'll never need to apply for AusAid funding again because we'll have enormous support from the Australian public."

Dr Hamlin says she wants donors to realise that despite the number of operations at her hospital, there are still many women in rural parts in Ethiopia suffering from obstetric fistulas.

"I just love the patients and I feel this tremendous need to awaken the Western world to this need."

Ms Perry says Dr Hamlin needs her patients as much as they need her.

"She said to me once, oh if I stop operating, I'll die. And she's still operating weekly and she's amazing. I've sat with her in theatre a number of times and she has amazing steadiness of hand. She doesn't wear glasses, she sits down to operate and the team around her sit around her. She said to me in theatre once, the day I lose the steadiness is the last day I'll operate."

Dr Hamlin's sister, Ailsa Pottie agrees.

"I think she just loves the work and people say 'oh you know you're wonderful to give up a good career in Australia', as though it's some sort of terrible hardship for her. But she just loves the people and she loves the work, and she's just committed."

But Dr Hamlin does have a plan in place to keep her work going for the women of Ethiopia, when her hands one day do become unsteady.

Lucy Perry explains.

"We have 90 midwives in training at the moment. In time, as we can deploy those midwives out into the countryside, and they can be alongside women in Ethiopia when they give birth, we will be able to reduce the incidence of obstetric fistula. And then we can look towards the future of really putting our effort into general obstetrics and really being able to give to the women of Ethiopia emergency obstetric services when they need them. So that's the vision. Catherine has said to me over the years, she had wanted to achieve that in her lifetime and last time she said that to me she said it won't be in my lifetime, but it might be in your lifetime. And I'm 50 years younger than Catherine so I've got my work cut out for me."

Catherine Hamlin says it is the dedication of her staff that helps the hospital to thrive, and will keep her foundation running for many years to come.

"I've got a good staff that are committed to help and they're inspired to go on with this work and they will keep the hospital going until we're free of fistulas in the countryside."