Beyond Surgery: Injury, Healing, and Religion at an Ethiopian Hospital by Anita Hannig (review)

Since the 1960s, much of the focus on maternal health in Ethiopia from international NGOs and the media has been on obstetric fistula, an obstetric injury caused by prolonged labor and lack of timely access to emergency obstetric health care. Obstetric fistula, which can range in severity from mild urinary incontinence to total fecal and urinary incontinence, is almost always framed as causing social and familial exclusion, leading to a lifetime of stigma, suffering, and abandonment for those who suffer from it. This positioning of women with obstetric fistula as social pariahs marks much of the fundraising and advocacy work promoted by medical NGOs, international journalists, and hospitals dedicated to the treatment of obstetric fistula—entities with considerable privilege in directing the narrative about this affliction. Anita Hannig offers an alternative to this hegemonic narrative in her ethnography Beyond Surgery: Injury, Healing, and Religion at an Ethiopian Hospital.

Based on fourteen months of fieldwork in two institutions—the Bahir Dar obstetric fistula hospital in Addis Ababa and Desta Mendir, a rehabilitation center for women with permanent obstetric fistula or stomas, both founded by the Hamlins—Hannig’s research delves into the affective, social, and religious experience of obstetric fistula in Ethiopia within the oldest and most famous obstetric fistula institutions. Her work repudiates accepted truths about women with obstetric fistula as almost universally abandoned by their husbands, families, and communities, and instead provides a nuanced and careful window into the lasting and profound ties of care and kinship that provide the foundation from which women may access institutional care for their fistulas.

The book is divided into three parts, each with two chapters. Part I examines the lives of Bahir Dar and Desta Mendir patients prior to arriving at the hospital for treatment. In Chapter 1, Hannig provides an in-depth introduction to Amhara practices of care, kinship, and community. In contrast to commonly circulated presentations of Amhara women with fistula as abandoned pariahs, Hannig demonstrates how the commitment to caring for family and friends is a key value in Amharic culture, and her ethno-graphic components show that women with obstetric fistula remain tightly embedded in networks of care after their injury. This chapter also pushes back against the most commonly cited cause of obstetric fistula—child marriage. By providing a more accurate understanding of child marriage as it is actually practiced, Hannig emphasizes that letting go of racist and stereotypical narratives about obstetric fistula reveals the actual cause of obstetric fistula: poor maternal-health infrastructure and lack of access to emergency obstetric care.

In Chapter 2, Hannig provides an overview of orthodox Christianity and examines the ways in which orthodox Christian beliefs about purity, bodily integrity, and closure influence how women with obstetric fistula understand and navigate their injuries. As Hannig demonstrates, these beliefs guide women’s interactions with their communities and with the divine, and orthodox Christian women with obstetric fistula are engaged in constant calculations and recalibrations to align their bodies with their souls’ needs for divine connection. However, Hannig also argues that orthodox Christianity provides a number of ways that even women whose injuries render them unable to be pure or ritually and physically clean may still participate in rituals and practices to bring them closer to God and maintain a connection to the community. Just as kinship networks and cultural values serve to help women with fistula remain a part of their communities, so too do orthodox Christian practices allow for them to remain a part of religious life.

Chapter 3 traces the historical and ideological underpinnings of the Hamlin fistula hospitals through archival materials of funding requests and the history of Protestant Christianity in Ethiopia. Hannig argues that fistula treatment is embedded in Protestant salvation narratives that emerged, in part, due to the Hamlins’ backgrounds in missionary work. A key thread in this chapter is Hannig’s examination of the historical use of medicine and...