2020年经济学人 产科医师凯瑟琳·哈姆林(2)（在线收听）

They all had terrible internal injuries, such as had not been seen in Europe, America or Australia since the 19th century. Here these were endemic, owing to the malnutrition that meant the bodies of Ethiopian girls remained small. The attitude of the Ethiopian Orthodox church which encouraged child marriage—to keep girls virtuous, they insisted—only made things worse, as did the lack of obstetric care, especially in rural areas. Betrothed at eight or nine, girls would find themselves pregnant in their early teens.

他们都患有严重的内伤，这种情况自19世纪以来在欧洲、美国或澳大利亚从未发生过。在埃塞俄比亚，由于营养不良，女孩的身体仍然很小，在这里这是很常见的情况。埃塞俄比亚东正教鼓励童婚的态度-他们坚持认为这可以保持女孩的贞洁-还有产科护理的缺失，都使事情变得更糟，尤其是在农村地区。女孩们在八九岁就和人订婚，然后在十几岁的时候就怀孕了。

When they went into labour, sometimes with no one to help but a wogesha, a village doctor offering a potion made of herbs, it went on and on. There was nothing to do but squat and push, often for five or six days. If the fetus did not survive, the only reason the mother could eventually deliver was because babies get smaller when they are dead. But then, as she discovered, the mother wakes up to an even greater horror: her bed is soaked and stinks. Her protracted labour has left her so badly injured that her vagina has ruptured, her bladder is shredded, her rectum torn. Urine and faeces leak out of her without cease. Soon, her husband leaves her.

当他们要分娩的时候，有时除了一名“沃格沙”之外没有任何人帮忙，“沃格沙”是提供草药制成的药剂的乡村医生，就这样循环往复。他们除了蹲坐着往外推之外，常常会持续五六天，别无他法。如果胎儿没有存活下来，母亲最终能够分娩的唯一原因是婴儿死后会变小。但是，当她醒来的时候，她发现了一件更可怕的事情：她的床又湿又臭。长期的分娩使她严重受伤，阴道破裂，膀胱破裂，直肠撕裂。尿和粪便不停地从她身上漏出来。不久，她的丈夫就会离开她。

Her family and her village community turn their backs on her. She lies on her bed, her legs drawn up to her chin to try to stem the flow; shame is her only company. The Hamlins would sit up late into the night in their little mudbuilt house in the hospital grounds, studying the history of obstetric fistula, as these injuries were known, which was first written about in 1550bc. They went over the evolution of the treatment, rereading the autobiography of Marion Sims, who, in the 1850s had treated similar injuries among American slave women.

她的家人和她所在的村庄都背弃了她。她躺在床上，两腿抵着下巴，试图阻止水流；陪着她的只有羞耻。哈姆林一家常常在医院空地上的泥房里熬到深夜，研究产科瘘管病的历史，这些损伤就是产科瘘管病，它最早记录于公元前1550年。他们回顾了其治疗方法的演变过程，重读了马里昂·西姆斯的自传。在19世纪50年代，西姆斯曾治疗过患类似伤病的美国奴隶妇女。