高清福利片

*The following content may be distressing for some readers.聽

It鈥檚 a not an uncommon scenario. A woman in the delivery ward finds her baby isn鈥檛 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鈥檚 birth canal so a caesarean procedure is organised. Soon the child is resting safely in its mother鈥檚 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 鈥榳hat then?鈥� 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鈥檛 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:

鈥淪he 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鈥檛 get there regardless.

鈥淪he 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.

鈥淒uring labour, the baby鈥檚 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鈥檛 let her in the family house. She must live alone in a small backyard hut.

鈥淭his story is not unusual. I鈥檝e heard tens of thousands like it.鈥�

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鈥檚 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.

鈥淭here's still refinements in the surgery techniques to improve their outcome,鈥� Browning says in his soothing, radio-ready voice. 鈥淲e鈥檝e 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.鈥�

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

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.

鈥淚'm not a preacher or an evangelist or whatever,鈥� he says. 鈥淚'm a surgeon and I love doing surgery. I serve God with the skills he鈥檚 given me."

In a way, Browning鈥檚 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鈥檛 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, 鈥淪he鈥檚 tiny. She could have been a jockey.鈥�

Working with his Aunt, he became aware of the late and lauded Dr Catherine Hamlin who was running the world鈥檚 only fistula specific hospital in Addis Ababa, Ethiopia. Hamlin offered Browning a job and later he started her organisation鈥檚 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 so he could build his own in other locations.

鈥淚n those environments, there are needs that the government can鈥檛 meet, so you have the chance to do things of true value,鈥� he says. 鈥淲omen are dying in labour, you need to do something about it. Or the kids aren't being educated, so build a school.鈥�

Indeed, Browning鈥檚 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.

鈥淲hen we lived in northern Ethiopia, you could only buy potato and cabbage. Then carrots, which were new,鈥� Browning remembers. 鈥淔or meat, you鈥檇 buy a live goat or sheep and slaughter it at home because that was the culture. Then you鈥檇 hope the electricity didn鈥檛 fail, which it did a lot, so the fridge wouldn鈥檛 work.鈥�

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.

鈥淚 walked past a bus stop near here a while ago,鈥� he says. 鈥淚 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.鈥�

Asked about what he still needs to do, Browning laughs dryly, 鈥淭here鈥檚 the need for a few thousand maternity units across Africa so women don't have to die during labour or get a fistula. We鈥檝e built three.鈥�

Written by George Dodd.聽