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Beyond Surgery 

Injury, healing, and religion at an Ethiopian hospital.

Perhaps you have heard about the horrific plight of women in Ethiopia and other African countries who developed tears in their bladder or rectum after prolonged labor. You may hear that these women, child brides who were too small to give birth, are ejected from their homes as pariahs, lonely in their huts at the edges of their villages, leaking urine or feces, shunned by their communities. You’ll hear this story from NGOs working to raise money and save these women from their plight.

This story is what drove Anita Hannig ’04, an anthropologist at Brandeis University, to investigate the phenomenon. She bought into this tragic narrative—until she discovered how wrong it is. It took time to build trust, but when she did, she was able to speak with many fistula sufferers in rural Ethiopia and spend time in their communities and the hospitals and institutions designed to save them. 

Hannig uncovered an even more insidious truth. In her book Beyond Surgery: Injury, Healing, and Religion at an Ethiopian Hospital, Hannig details how the prevailing narrative gives no agency to these women, misrepresents the strength and caring of their culture, mixes in irrelevant tropes of child marriages and genital mutilation, and feeds into damaging notions of cultural primitivism.

In this beautifully written, careful, and evocative book, Hannig relates how the Protestant underpinnings of the first fistula hospitals led to notions of uncleanliness and ungodliness, and how this religious view resulted in the belief that fistula surgery would save obstetric fistula sufferers. In fact, many surgeries are often needed to cure the injuries, and sometimes surgery is not at all effective. In addition, although living with fistula is difficult, these women take part in the religious life of their communities and are not shunned; Hannig writes about how they are “remade in the face of misfortune.”

In the final part of her book about the mission of those who treat fistula sufferers, Hannig speaks about how the helpers try to “civilize” these women, believing that lack of education creates the problem. Hannig makes a powerful case that the problem lies in the helpers’ biases, and that the most critical issues at hand—poverty and lack of access to health care—remain unaddressed. After reading this book, I am left hoping that Hannig’s powerful work will serve to illuminate this situation in a more public way, further respect for the women and their culture, and help usher in necessary change. 

— Reviewed by Nadine Fiedler ’89

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