Nova: A Walk to Beautiful

“It is very difficult,” says Ayehu, “Waiting for food to be thrown in my direction. I don’t mix with people. I live here away from others.” Ayehu suffers from obstetric fistula, in her case a hole between her birth passage and her bladder that causes chronic incontinence. As she explains, she was married at age nine, became pregnant with a child who died in her womb, and then “got this problem.”

In Ethiopia, where Ayehu lives, an estimated 100,000 women are afflicted with untreated fistula, with another 9,000 developing the condition each year, primarily due to insufficient obstetric care, as well as undernourishment, both directly related to poverty. As Ayehu reveals in Mary Olive Smith’s remarkable documentary, A Walk to Beautiful, the draining physical “problem” of fistula is compounded by social and psychological traumas, emerging from tradition, ignorance, and institutional gender oppression. Ayehu, however, does not articulate these concerns per se. Instead, her quietness speaks powerfully, as she reveals at once vulnerability and strength, loneliness and a resilient determination to communicate, to tell her story.

Like too many women in Ethiopia, Ayehu’s life has been nearly unbearably hard. In its 50-minute version, airing 13 May on PBS’ Nova series, A Walk to Beautiful follows three as they seek help at the Addis Ababa Fistula Hospital (the 87-minute original features two other stories). Having spent some 10 years “wetting the bed” and feeling shunned by everyone, including her mother and husband, Ayehu remembers dire moments: “I thought about drinking poison,” she says, but “My family told me not to because my soul would burn in hell.” Encouraged by a similarly affected friend who had successful surgery at the hospital, Ayehu tearfully leaves behind her young daughter and boards a bus for the city.

At the hospital, co-founder Dr. Catherine Hamlin describes her typical patients, women who must work for five or six years to earn the $20 it costs for a bus ticket to Addis Ababa, or who must find it within themselves to resist the condemnations and cruelties of fellow villagers and family members. Hamlin and her late husband arrived in Ethiopia in 1959. “The doctor we were replacing said the fistula patients will break your heart, “she recalls, “And that’s really what they did.” Still, they decided to stay, “drawn to [such patients] because of their suffering, because of their poverty, because of their tremendous need.” As becomes clear in their interactions with patients, Hamlin and her team are also moved by their patients’ incredible courage, their desires to live “a normal life,” to exist without daily pain and humiliation, with futures that include physical mobility and a new sense of community.

As Dr. Ambaye Wolde Michael outs it in the documentary, these desires are complicated by social dictates. “In the country,” she says sadly, “To be a woman is to be able to have a child.” When women are unable to have children because of fistula, they are not only cast off, but they judge themselves deviants and failures, “to be not like any woman.” Hamlin adds that a woman so afflicted will often live the rest of her life in a house apart from the village, where “she will stay until she dies.”

At the hospital, the patients begin to comprehend first that they are not unlike other women, that in fact, they are part of a growing number. Second, they also see that theirs is not a life sentence, that they might be cured (some 93% of the surgeries are successful, though as the documentary shows, some women must return for follow-up or repeat procedures). Wubute, another patient at Addis Ababa, endured labor for five days; she has returned to the hospital, because her first operation was unsuccessful. Tearful as she consults with a doctor, Wubute hangs her head: “I don’t have a mother or no one to look after me,” she cries, “They were repulsed by me.” Her doctor pats her and tries to soothe her, “You can’t think of these things now… tomorrow is another day.” When another doctor tells her they mean to try a new technique, a plug that will allow her to control when she relieves her bladder, she’s skeptical but also grateful that someone is trying to help and that, at last, unable to return to her village, she’s put to work at an orphanage, caring for children who parents have died of HIV-AIDS.

Twenty-year-old Almaz has a double fistula, holes between her birth canal and bladder, and her birth canal and rectum. She remembers that she was abducted by her husband when she was 15, while she was walking to market with her friends. “I gave birth to my baby in less than a year,” she says, “That’s all I had and it died… For three years, the injury to my body affected my life badly.” Two weeks after her surgery, Almaz lies patiently in her bed at the hospital, in a room full of other beds and other patients, all instructed to keep still, connected to catheters, as their sutures heal. When she learns her surgery has worked, Almaz is thrilled: “I am glad God gave us doctors to treat and cure us,” she smiles.

For all its attention to the good work done by the doctors, A Walk to Beautiful maintains focus on the women, letting them speak for themselves, express their hopes and their fears. While on occasion, the camera feels intrusive or the soundtrack too assertive, the film is resolutely respectful of its subjects.