John Dickson:
Let’s focus on your specialty. Let’s go as, um. Visceral as you like. I mean, it’s commonplace for you, but some of my listeners might go, what? 

Andrew Browning:
Well, I must say I spoke at a boys school not so long ago, and one of the boys fainted when I, and um, it turned out that, um, he was, um, Australia’s, um, boxing champion for his age group. And so, yeah, I can, um, say that I knocked out a boxing champion without playing a punch. That’s good knowledge for his next opponent.

John Dickson:
Just say the words, yes. Fistula, obstetric, fistula, and …

Andrew Browning:
He’s down on the ground. He’s out for the count. 

John Dickson:
Tell me what is an obstetric fistula?

Andrew Browning:
So, I’m what’s called a fistula surgeon. I’m a gynecologist. An obstetric fistula is a birth injury. The word fistula in Latin just means pipe or a hole. So it’s a hole that women get from a long, difficult labor.

John Dickson (Studio)

That’s Dr Andrew Browning, an Australian-trained obstetrician and gynaecologist. He’s spent 17 years as a surgeon in Ethiopia and Tanzania. And he’s written a book called A Doctor in Africa about his experiences as a Christian missionary doctor – we’ll talk about the “missionary” title in a moment. I should warn you that the descriptions of obstetric fistula get pretty graphic. 

Andrew Browning:
So anywhere in the world, about 5% of women will get into what’s called obstructed labor when they have their baby. So baby’s gotta come through the mother’s pelvis, um, to be delivered. And it’s usually the head first. Sometimes it’s the bottom first. Some other times it’s the shoulder first, all sorts of presentations. But most of the time the head comes out first. Um, and if the bed baby’s head’s too big for the mother’s pelvis. It’ll get stuck or maybe the head’s coming out in a different angle so it gets stuck. So one in 20 women when they’re in labor, that will happen too. So, um, ordinarily you’ll find that in labor, the midwife looking after you in the hospital, in Australia, uh, she’ll diagnose that the lay baby’s getting stuck. She’ll call the doctor. You’ll have a cesarean on operation to have your baby fine. But most of the women I treat, almost all the women I treat, haven’t had access to a hospital. There’s simply no hospitals. They’re too far or they’re too poor to access it. So they deliver in their village and home. And as a result, in one area where we work, one in 12 women will actually die in their lifetime having a baby. Um, if you get it stuck in labor, if this obstructed labor, then you stay in labor. And the ladies I treat have been in labor for 3, 5, 7, 10 days. If they survive and often they don’t, the child inside almost always dies. And after the child dies, sorry for getting descriptive, the intracerebral pressure decreases in the head. Um, the skull bones collapse, so the diameter of the head decreases. They can eventually deliver a stillborn child. They’re usually unconscious at that stage. It takes them on average two days to regain consciousness on the floor of their heart. And when they do regain consciousness, they find that they’re leaking uncontrollably from their bladder and sometimes their bowel as well. The long labor, the baby’s head’s pressed against the bones of the mother’s pelvis, so all the tissues between are crushed and has its blood supply cut off. So there the tissues of the bladder, birth canal, rectum, birth canal, all those tissues and the crows we call it, they, the blood supplies cut off, they die. So after they deliver their child, all those dead tissues come away and they’re left with a fistula or a big hole between the bladder, birth canal, rectum, birth canal, sometimes 10 centimeters in diameter. Huge hole. Sometimes the whole birth canal’s destroyed. Urethra is destroyed. Bowels destroyed. Everything’s destroyed. So they leak, they smell, they’re ashamed, usually divorced. The, the husband won’t have them back in their house. Um. Might be looked after by their mother. The mother won’t be able to look after them in their house, so they might build a little lean to, [00:16:00] and I’ve had patients in locked away in little lean tos for 12 years. Not going out at all in 12 years. Um, yeah, smelling and just leaking urine and feces on that is the t.

John Dickson:
Because they’re considered damaged goods now? Or is it simply that they smell or is it some other cultural thing?

Andrew Browning:
All, all of the above, right? Uh, they think they’re cursed. Um, other people will think they’ve done something wrong. They’re cursed. Um, but more that they’re ashamed. They’re ashamed of the smell. So they’ll self hide away and other people will mock them. When they come close to them, they’ll be ridiculed. So they, they hide away. 40% have thought about or attempted suicide, uh, with this condition. And if they don’t get surgical treatment, uh, they’ll live like that for the rest of their lives. And we think there’s about 2 million patients they hide away. So it’s difficult to know the number. Uh, but they think there’s about 2 million of these patients in Africa still waiting for treatment.

John Dickson:
So tell me mate about Dot Thompson. You’re six years old and you hear this missionary nurse. Tell us what you remember of what she said and what impact it had. 

Andrew Browning:
Yeah, so I was a little 6-year-old boy growing up in a Christian household, Sunday school every Sunday down in the Southern Highlands Barrel. And, um. We would have, uh, missionaries come to speak to us, um, at the church when they were home on home leave. And my father was a great supporter of missionaries. And, um, I remember as a, a child also packing boxes of sutures and all sort, he was a, he was a surgeon as well, um, sutures on our land room floor and even brought them to youth groups to send off to various missionaries. So missionary, the, and missionary endeavor, I guess, was very much part of my upbringing and. And part of going to Sunday school when the missionaries were visiting, uh, our church, which we would support them, um, we’d, they’d speak to us. And so I remember listening to Doc Thompson sitting on this bare wooden floor in a freezing cold winter. In barrel, uh, drafted wooden floor of gaps between the floors and, um, listening to dot speak of, uh, Africa, you know, the heat, uh, the dust, the, uh, the animals, the tribes, people, spears, bows and arrows and, um, the need there. And just as a, a 6-year-old boy, my imagination was, you know, sparked, I guess you think, wow, this sounds very exciting. And so I’m gonna be a missionary too.

John Dickson (Studio)

Fast forward and Andrew is a young medical student looking for a placement at an overseas hospital for further training. He chose Dot Thompson’s mission hospital – Murgwanza – in the far north-west of Tanzania. It was 1993 and in the weeks before he planned to leave, Andrew started hearing the news of hundreds of thousands of refugees flooding into Western Tanzania, fleeing ethnic violence in Burundi between the Hutus and Tutsis. Over 100,000 people were killed – a terrible prelude to what came just a few months later, the Rwandan genocide, when over 800,000 people – mostly Tutsi, but also moderate Hutus – were killed in 100 days of terror. Two million fled. Murgwanza Hospital was built by Australian missionaries from the Church Missionary Society in the 1930s, close to the border of Rwanda and Burundi. It became a primary receiving hospital during the genocide. 

Andrew Browning:
So I was there at the end of 93, beginning of 94, just at the beginning of the genocide. Wow. So genocide actually started in Burundi, uh, in 93, and then 94 exploded in Rwanda. So I was there at the end of 93 and, uh, beginning of 94. Uh, and so yes, we had tens of thousands of Tutsi refugees come across the, the border from Burundi. 

John Dickson:
Any with injuries or deaths?

Andrew Browning:
Yeah, all sorts of horrible things. Thousands, tens of thousands. And, um, the, um, the Red Cross was there, um, setting up camps. And so I was, they asked me to come along to the camps and so I would, as a medical student, um, I was in the camps with one Burundian doctor for the whole camp. And, you know, as a medical student, what do you know? I mean, very little. Um, but it was marvelous to be able to. You know, we had at one point there were six people a day dying in the camp from Ry. Um, but you could save them just by putting up a drip and um, yeah, we’d bring the really sick ones back to the hospital. Yeah. And there was machete injuries and I mean, there was one. Uh, Hutu guy that fled as well, and he was found by the tootsies. He was just, you know, butchered and just awful, awful stories and just of suffering and of, uh, he really saw the worst in humanity. Um, but in that context, uh, in, yeah, just and seeing the need and what you could do to relieve some suffering, just with simple things. As a, as a doctor, I thought, yeah, this is the way, uh, I want to live my life. 

John Dickson (Studio)

Indeed, and that’s exactly how he has lived his life. But it’s been a long and winding road. Andrew’s aunt, Valerie Browning, is an Australian nurse who has spent the last 40 years among the nomads of Ethiopia’s Afar region, the hottest inhabited place on earth. Early in his medical training, Andrew spent time working with “Aunt Val” – and it proved a turning point. While there, he heard about another Aussie medical legend, Dr Catherine Hamlin, who, with her husband Reg, established a hospital in Addis Ababa to treat women suffering from obstetric fistulas. Seeing the impact that a relatively simple surgical procedure could have on women’s lives, Andrew returned to Australia, completed his specialist training, and then headed back to Africa to work with Dr Hamlin. Over the last twenty years or so, he has worked in different parts of Africa. But today he is back in Ethiopia, where the journey began, working alongside his Aunt Val through the Barbara May Foundation, named after Valerie’s inspirational mother and Andrew’s grandmother. But whatever the country, whatever the organisation, Andrew has one mission: to see women’s lives transformed.

John Dickson:
Tell me. A story of the impact such a thing has had on someone you, you’ve encountered?

Andrew Browning:
I, uh, I could tell you thousands of, of stories, John. Um, but one I had recently is not only a story of the impact on her, but it’s the impact that these women have had on me as well, and other people around them. I mean, some of these women are absolutely remarkable in their strength. So this story is the story of tensor. She’s a lady I met earlier this year in South Sudan. She was married as a teenager, or she grew up in a, an arid area in the northern part of South Sudan. And as a teenager, her father sent her away to a village, to a man that she’d never met before. Village she’s never been to before. About 200 kilometers away from her village. She was married to that man and, uh, had seven children. Three died. Uh, she had four children. She, uh, got pregnant with her eighth. Pregnancy and it came time to deliver that child, and she did what she did for the previous seven pregnancies and she just went to labor in her little hut in the village, there’s no hospitals anywhere near nearby, no health professionals. So she delivered all the other self seven children with no help or even pain relief. Something happened in this labor. Labor, she got into obstructed labor. And after two days of labor, um, she knew something was wrong because the seven previous deliveries took less than a day. So at the end of two days, she knew something was wrong and that she would have to get help. So the nearest hospital she knew about, uh, was a full day’s walk away when you’re in good health. So she took her eldest son and started walking. She walked for about five hours and the long labor. Not only affects the tissues in your, your pelvis, it also affects the tissues in your, the, the nerves to your legs. Um, and it started to crush the nerves to her legs and her legs were getting weaker, uh, to the point that she could no longer stand and she fell into a ditch. Uh, her son waved down a, a vehicle called a, we call them Bud Judge. It’s a three wheel vehicle that was driving past. He took pity on her and they helped her into the Bud Judge, and they started driving to the hospital. So the roads very rocky, and these three wheel vehicles are very unstable. So it flipped. She was thrown from the vehicle. Um, the driver was injured so he couldn’t drive. They passed, flagged down someone else who was able to drive. They righted the vehicle, took the drive around her and her son in the bud Judge to the hospital. They arrived. She’d now been in labor for three days. It was too late for the baby. The baby had already died from the long labor. The baby simply can’t survive such a long labor. And, um, they operated to save a life. Um, uh, but she sustained a fistula, uh, a big eight centimeter hole from the bladder to the birth canal. So she leaked, she smelt, the husband didn’t want her back, so she stayed and begged on the street of that town, um, object of ridicule, uh, for 18 months.  She, um. Was then found by another missionary, actually from Australia, uh, who was living and working with her family in, um, in the northern area of South Sudan. And, uh, taken to her hospital was fed and made strong and she knew that we were treating these patients in Juba. Um, and so she was flown down to us with MAF another mission organization. Yeah. Um, and because there’s conflicts in South Sudan that the roads were blocked, so they have to fly over the conflict to get to us. I was only in South Sudan at the beginning of the year, just for one week. Um, and so we had 46 patients to operate in the wick. Uh, when Tensor arrived, she had quite severe malaria, so we couldn’t operate. We treated her for her malaria quite aggressively, and prayed that she would be better to operate before I left. And she was, so we took her to theater on the last day of theater, of, of operating, and, um, we operate under spinal anesthetics. So she’s, um, awake during the operation and tensor, bless her, she singing very peacefully and calmly as we operate. And the, um, the anesthetist, um, starts singing with her and so does my assistant surgeon start singing with her. And they’re all singing in Dinka or newer, sorry, I can’t remember which language. And I’m the only white fellow and I have no idea what they’re, they’re singing and I say, oh, what, what’s she singing? And they say, she’s singing Jesus. There is no one like you. And so I spoil the atmosphere and join in and um, but it was really such a rare moment. I’ve had a few moments in my life just of mutual praise and adoration of God with people from all around the world. It was a beautiful, beautiful moment. 

John Dickson:
So that’s one woman. Do you have any idea how many women you’ve operated on?

Andrew Browning:
Uh, roughly yes. I’ve been involved in the care of about 16 and a half, maybe even 17,000 women now. Uh, been the, the lead surgeon for about eight and a half thousand, maybe getting, approaching 9,000 now. I haven’t added it up for a while, but, um, yeah, so a lot. I can’t remember them all, but I can remember quite a number of them.

John Dickson:
And what, what’s the effect when they. You know, walk out of the hospital, um, with, with, with the fistula, you know, sonar.

Andrew Browning:
Oh, um, sometimes it is just delightful. I mean, I’ve had, could, uh, tell you so many delightful stories. There’s one lady I had in Tanzania. She’d been living with a fistula in isolation for 50 years. Uh, the way she lived is she had a cow. And, um, I mean, numerous cows over those 50 years. And that would give her some little income and, you know, no one would go near her. Um, but she was cured. And when she was discharged, she was so delighted. She said, I’m gonna go home. I’m gonna celebrate by with my village, by killing my cow and feeding everyone. So, um, so she, her only possession of cows, she was. That was the end of the cow. And um, yeah, she was gonna celebrate with the whole village and, and be with them and feed with them. 

John Dickson:
So does it usually restore them socially?

Andrew Browning:
If they’re cured, yeah. Yes. So we did, uh, we’ve done lots of research on fistula, patients, depression scales, you all sorts of things, and the impact on treatment. And, um, yes, if they’re cured and the majority, thankfully are, uh, they go back to, you know, they’re very resilient people. They reintegrate, they go back to work. Um, sometimes there’s. Still, you know, post-traumatic stress syndrome, but largely they’re, they’re very resilient people and they reintegrate back into their societies.

John Dickson:
Some listeners will go Missionary doctor, what? Uh, I don’t understand. Do, do, do you walk around with a big cross? What I mean, what is a missionary doctor?

Andrew Browning:
Well, a missionary doctor is just, well, a missionary is just someone who will take. Your work.

John Dickson:
So just a doctor who doesn’t make money

Andrew Browning:
Well, there’s probably some of those in Australia. I haven’t come across them, but some of them. But um, yeah, you don’t make any money. You, um, you live by faith and you are working in a different culture, so you’re going away from your own culture into, um, yeah, called by God and to share his love and compassion and to work for his glory in a, in a different location, usually a different culture. So you’re working in a different language. You, you’re not paid. Uh, so we live by faith for those 17 years that we lived abroad. Um, I’m back in Australia now, but still working in that sort of mission capacity, uh, that I don’t work in Australia really. I just travel backwards and forth to Africa and raised money in Australia for our hospitals and charities and so forth. And, um, yeah, so missionary doctors, you know, we live by faith. We help the poorest of the poor that couldn’t afford anything and, and serve them in the name of Christ.

John Dickson (Studio)

Some listeners might still be sceptical: “Those sneaky Christians using healthcare as a way of evangelising.”  We really need to do a whole episode on missionaries—because there’s so much to say … some of it mea culpa … some of it level-setting. One of the best kept secrets of history is that Christians invented the public hospital — free medical care — in the mid-300s AD. It had nothing to do with converting people, and everything to do with the early Christian belief that Jesus healed people as a core part of his ministry, so, even if we can’t miraculously heal on the scale that He did, we use our resources to mend what’s broken in the world. That tradition continued into the modern world, long before there was any government or secular organisational interest in global health. Andrew says, locals are nowhere near as cynical about missionaries as Western critics are. 

 

Andrew Browning:
Wherever I’ve been in Africa, missionaries have a, a wonderful reputation. Oh, there’s some, you know, exceptions to the rule, of course. But as soon as you say that you are with a mission, the attitude from the locals will change. ’cause they know that you are there to love them, to serve them, to be with them. And it’s the missionaries to stay with ’em through the difficult times. They, they learn their language, they help them, they educate them in whatever they treat them. They teach ’em to be doctors, they teach them to be nurses. They teach them to read. I mean, most of the languages in Africa have been put into writing ’cause of the missionary endeavor. So, I mean, missionaries went. Compelled by the love of Christ for Humanity. I mean, they, as Christians, we believe that all people are made in God’s image. And uh, everyone has, you know, something of that image of God in them. Sometimes it’s hard to see, but it’s, but sometimes, yeah, but they do. And, uh, we know that God sacrificially loved every single one of them. And yeah, when I, when I pray the Lord’s Prayer, when you pray, um. Thy kingdom come on earth as it is in heaven. I mean, yeah, God did love the world to give his son to, to people around the world and yeah, he wants to see them saved and have a life with him. This broken, suffering, fallen world that we are in, um, yeah, it is not the way it’s meant to be. Mm-hmm. And God has done. Well, his bit to save it, which is, which is gonna be renewed one day. We’re living in the kind of an In Between time, aren’t we? But, um, the, but you know, uh, in the meantime, his, his church, his body is doing a lot to relieve that suffering. And in across Africa, about 50% of healthcare is provided by the church. It’s extraordinary. Yeah. Yeah. And I mean, when you say about imperialistic attitudes. If it’s, it’s difficult to think, to say politely, but aid, government aid always comes with strings attached. Yeah, you, we’ll give you this money, but you will do X, y, Z. Mm-hmm. And um, and often it’s against the cultures of that country. Uh, and you know, Africans are actually a good friend of mine. He was a professor of, um, political science at, um, university in Tanzania. He said, look, we just don’t want these people’s money. We would rather have our own culture and do what we think is right in our own country than be dictated to by and bought by the these people. Yeah. So take your money and go And other country, I mean some leaders are, you know, saying that now it’s, look, we’re not gonna have your agenda. Yeah. Um, yeah. So. Christians, they’re, they’ve been with the people loving the people, serving the people. Um, sometimes imperfectly, oftentimes imperfectly. But, um, when the locals, anyone sees that they’re loved by people, it makes all, all the difference. But when you are dictated to, will give you money if you do this, it’s a totally different relationship, isn’t it?

John Dickson:
And missionaries don’t do that with the faith. It’s ’cause some people might think, oh yeah, it’s just like governments. You say to people, become a Christian and I’ll give you this sort.

Andrew Browning:
I’ve never seen that. I mean, if a hospital was like that, it wouldn’t be a Christian hospital. Amen. Yeah.

John Dickson:
That’s all amazing. Some of my listeners who aren’t sure what to make of the Christian faith might be listening to us thinking. Why does that bloke do that? What’s the reason? And for sure some of ’em will be thinking, is he trying to purge some guilt, earn points to get into heaven? It seems the only logical explanation, why do I do it?

Andrew Browning:
Yeah, yeah. Um, yeah, it’s love isn’t it? I think, and, and lemme tell you one story before I answer that more. Uh, fully is a story from a patient. I’ve learned so much from my patients more than I’ve given to them. I’m, I’m sure it was from a lady I was working in Ethiopia. It was from Somalia, and, uh, she had a dreadful fistula and had traveled by camel for weeks across desert, uh, to get to Saba in the hope of a cure. But her injuries were so severe, um, that nothing could be done. So I tried ’cause as a surgeon you wanna try, but as I was operating, I, I realized this is hope. There’s almost no bladder left. Uh, no urethral left, no birth canal. Did what I could really, nothing could be done. So we cared for her though. And, um, after the operation, after she had recovered, I took her with a translator and I said, look, there’s really nothing we can do to make you normal again. Um, we can help you live with this injury. We can give you pads, we can look after you, um, but we can’t make you normal again. And, um, yeah, she just looked at me and, um, she said, you know, you, you’ve done something to me. You’ve looked after me. Um, all my own people have neglected me. They ridiculed me. They wouldn’t allow me near them. And, um, but you, you’re not from my language. You’re not from my religion. You’re not from my culture. You’re not from my skin color. You’re not from my gender, but you’ve put your arm around me. You’ve helped me off the bed. You’ve tried to help me by doing an operation. You’ve cared for me, you’ve loved me, and that’s enough. And that’s, I think true, isn’t it? I mean, there’s a wonderful verse in the Bible that love never fails. All our knowledge, all our tongues, our prophecy, whatever will pass away. But um, you know, when completeness comes, when we see Jesus again, all those things will pass away. We’ll know him fully, but the things that will remain are faith, hope, and love. And the greatest of those is love. And I’ve found that over and over, uh, in my life, that showing love, um, changes people. Good. And, um, and what is the source of that love? Um, it has to be, you can love best when you are loved yourself. I think. And you know, as a 14-year-old, I realized that Jesus did die for me. The creator of the world, the creator of the universe. You’re so interested in me that he shed his blood on the cross for me, but it didn’t stop that he rose so I could still know him. And to have that transformative. Be aware of that transformative love just changes you. And so you don’t care about material possessions. They all pass away. I mean, I could have earned a lot of money here. I had a big house, a boat. I’m not interested in boats. I get sick on them, but I, holidays and all sorts of things. But um, yeah, you’re not interested in that anymore. You are interested in loving people because God loves them too. And, um, when you see these people, they’re broken. Uh, they’re at the lowest of the low. They’re rejected. No one will come near them. They stink. Um, but just to hold their hand to, to help them, to show them that they are loved and valuable. I mean, that’s, yeah, wonderful. And there’s many, not to say that my life has been easy. We’ve been through a lot of personal suffering as a family, uh, individual suffering, danger, illness. Without food, without electricity, without water. All those things we’ve faced over and over. Um, and there’s times that you just scream out saying, God, get me outta here. Get me somewhere comfortable. But, um, then you have a glimpse of God and all sorts of ways and other people around you, and that gives you the strength. To keep going. And so, yes. I mean, when I look at people doing this work in the developing world, I generalize and I kinda split them into three groups. There’s the people that work for the big organizations like the UN and Wolf Food Program, that sort of thing. There’s people that come over with all sorts of altruistic ideals, um, wanna save the world, want to do something that’s impactful. And then there’s the Christians that are coming ’cause they feel called by God and strengthened by God to serve. And just neglect their needs to, to serve others, un people. Uh, they,  the big, sorry, um, don’t wanna signal them out, but the big NGOs, the only time I see them, uh, really is if I’m ever upgraded to business class and the airport lands, they had lived very comfortable lives. It’s a very privileged career, a very comfortable career. Big salaries. It’s, it’s an industry, it’s a career. And, uh, yeah, I don’t really see them on the ground. Um, the altruistic people. Some exceptions of course, but generally they might last two years and then they’re burnt out. But the people that stay with the people love the people, learn the language, be through all the hardships, sacrifice. They’re the ones that have their faith in God and wanna share that love with those around them. So, um, yeah, why do I do it? Yeah. There’s all sorts of passages in the Bible. Like the rich young ruler, he, um, wanted to do things, what can I do to inherit eternal life? That’s, that’s nonsense. Um, it’s what God has done for us in giving his life for us on the cross, isn’t it? That’s, that gives us life and hope and gives us the strength, uh, to do this work.

John Dickson:
Andrew Brown, thank you so much.

Undeceptions theme

John Dickson (Studio)

Hey, Andrew would never ask me to do this, but if you were moved by what you heard in this episode, please check out the Barbara May Foundation, which makes the work of Andrew and his amazing Aunt Val possible. They are doing amazing work in this important medical field — and they’re training the next generation of local medical professionals, both in Ethiopia and elsewhere in Africa. You can find more info in the show notes, or just head to barbaramayfoundation.com.