20-0411期
The AD in the Lancet called for a gynecologist to set up a midwifery school for nurses in Ethiopia. In the end they got two for the price of one—Catherine, who had grown up in a wealthy Sydney family, and her husband, Reg, from New Zealand. She was reminded of her homeland as soon as she saw the rugged, biblical landscape. It looked a bit like New South Wales, with its armies of gum trees arrayed along steep hillsides as in the Blue Mountains. She liked the lemony light of early morning when she would start the day with a cup of tea on her veranda and a passage from the Bible. But in other ways it wasn’t like home at all.
《Lancet》刊登了一则广告，寻求一位妇科医生前往Ethiopia，建立产科医院。最后，买一送一，他们得到两位医生，一位是出生于Sydney，家境殷实的Catherine；另一位，则是他的丈夫，Reg，他来自New Zealand。看到这崎岖不平、如同圣景梦境般的风景时，她思念起了自己的故土。和New South Wales如出一辙，蓝山（Blue Mountains）[1]之下，沿着陡峭的山间，那里桉树林立。她贪恋清晨，那如同柠檬般光泽的阳光落尽走廊，茶香弥漫，她将圣经轻启。但在其他方面，这里和她的故土相去甚远。
No one was there to meet the couple when, with their six-year-old son, Richard, they stepped off the dusty flight from Djibouti, where their ship had docked. The telegram announcing their arrival in Addis Ababa was not delivered until two weeks after they got there. Ethiopia had more pressing needs too, it turned out, than either midwifery or teaching.
他们的船在Djibouti靠岸，舟车劳顿，辗转至此，却没有人去接见这对夫妇，彼时他们还带着自己六岁的儿子Richard。他们通过电报告知了Addis Ababa他们的到来，但是直到两周后他们抵达最后的目的地，都没有收到。事实上， Ethiopia当时还有比助产医疗更为迫切的需求。
Each day, when the hospital gates swung open, she found them there, the young women who believed she might be their last hope. Some had been carried for hundreds of kilometres on the back of their fathers or mothers, others had spent years saving for the bus fare. One arrived at night and, finding the gate shut, tried to hang herself. In the morning the guards cut her down; Dr Hamlin operated, and cured her.
每一天，当医院的门打开，她看着她们，她们相信Hamlin是她们最后的救命稻草。她们中，一些被父母背着，不远千里来此寻医；一些为了省下路费流经数年。其中一个，晚上到达的时候，发现大门紧闭便自寻短见。早上的时候，门卫将她解救下来，Hamlin为其做了手术，她得以康复。
“others had spent years saving for the bus fare”这句的翻译应该是：为车费花光多年的积蓄。
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. 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.
她们都有严重的内部损伤，19世纪以来，这在Europe, America 或者 Australia是从来没有的。营养不良使得Ethiopian的女孩身形很小，这些都是地方性疾病。Ethiopian东正教鼓励童婚从而保持女性的贞洁，由于缺乏产科护理，他们的主张只会使事情变得更糟，在乡下尤为恶劣。她们八九岁订婚，在十几岁的时候就怀孕。当她们分娩的时候，除了wogesha（开草药的乡村赤脚医生），她们得不到任何人的帮助，而这样的事情一直在发生。她们常常需要五六天才能生产，分娩除了蹲着推，她们无能为力。如果孩子不幸夭折，其母亲最后分娩是因为胎儿死后变小了。
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. 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.
后来她发现，产妇醒来会发生更可怕的事情：她的床已经湿透而且发臭了。过长的分娩过程会使她的膀胱和直肠破裂，使身体受到严重的伤害。粪便和尿液从她的身体中泄露出来。不久，她的丈夫便会离她而去，她的家庭和村庄都会抛下她。而她躺在床上，下巴紧贴着腿，蜷成一团，试图防止他们流出来，羞耻感将一直伴随着她。
The Hamlins would sit up late into the night in their little mud-built 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. Of the two of them, he was the conventional one, doing things the way they had always been done. She was the more flexible, ever prepared to experiment, radically cutting away scar tissue, for example, or trying out a technique known as the Martius fat-pad graft in which a piece of fat partly cut from the side of the vagina was used to repair the bladder—and create a reinforcement between the bladder muscle and the skin of the vagina, offering protection in a future pregnancy. When she wrote to Heinrich Martius of her success after doing the surgery hundreds of times, he replied: “I’m glad you’re curing these women with my operation. I’ve only done 26.” Her small hands, wearing surgical scrubs during the week and white gloves for church on Sundays, were perfect for suturing within the small confined spaces of women’s bodies.
在医院空地搭起土房里，Hamlin夫妇研究妇科瘘管病[2]的历史，常常熬至深夜。这种损伤过去有过记载，最早的记录是在1550年。他们回顾了治疗手段的演变进程，又重新阅读了Marion Sims[3]的个人传记，这位医生在1850年治好了有相似损伤的美国女奴。夫妇两人，Reg比较保守，会遵照以前的方法。而Catherine则相对灵活，更愿意尝试，她将损伤的组织完全切除。比如，尝试一种称为Martius[4]脂肪垫移植技术，从阴道的一侧切下脂肪组织修复膀胱，在膀胱肌肉组织和阴道表面建立一种强化，它将为未来再次怀孕提供保护。在进行了数百次的外科手术之后，她将自己的成功经验告知Heinrich Martius，他回信：”我非常高兴你使用我的方法治好了这些女人们，我自己才做了26例。”她那双小巧的手，平常都套着外科手套，只有礼拜日在教堂的时候，她才戴着白手套。对于女性身体这样小而有限的空间，她这双手再合适不过了。
Some patients were too far gone, and died. But many recovered and went home—always in a new dress that she gave them for the journey. Others made a life in the hospital as assistants to the nurses, like Enatanesh Demisse whose urethra Dr Hamlin rebuilt using muscle taken from her leg, or Lete Birhan, who was not only incontinent when she arrived, but also paralysed from the waist down having been knocked over by a car. Once treated by the doctor, Lete, in her wheelchair, became a stalwart of the hospital’s physiotherapy department.
很多病人病得太重过世了。但她们中也有很多人都康复了——总以一个全新的面貌度过她们的余生。还有人在医院留下来了，成为了护士们的助手，就像Enatanesh Demisse，当时她的尿道就是Hamlin用她腿上的肌肉重建的；亦或Lete Birhan，当她来的时候出了车祸，不仅失禁了，腰部以下已经瘫痪。当她被医生治好之后，她坐在轮椅上，成了理疗科最佳代言人。
Oprah signs a cheque
Soon the hospital was curing more than 90% of its patients. Surgeons came from around the world to see her work. Having delivered several of the imperial princesses, she asked the emperor for land so the hospital could expand. In 1993, when Reg died, she found herself, at almost 70, taking on yet more tasks. The hospital had survived the Derg, which overthrew the emperor in 1974, and the famine that stalked the country. By then she had treated more than 25,000 fistula cases. To help it grow she taught herself to speak to crowds of people and to ask for money. She told Oprah Winfrey, whom she’d never heard of before flying to Chicago to appear on her television show in 2004, that she was a professional beggar. Oprah signed her a personal cheque for $450,000, a year’s running expenses for the hospital.
不久，这家医院能够治愈的病人超过90%。全世界的外科医生在此观摩她的手术。在接生几个王室公主之后，她向国王请求一片属地来扩建医院。1993年，她的丈夫Reg去世，彼时她意识到她已近古稀，肩上的担子也更重了。1974年，Derg[5]推翻了国王，饿殍遍野，但医院在这场动荡中得以幸存。当时她已经治愈了25000例妇科瘘管病，为了壮大她的事业，她亲自发表演讲筹钱。她告诉Oprah Winfrey[6]，2004年她去Chicago参加电视节目秀，之前从来没有听说过Oprah Winfrey，彼时她是一个高学历乞丐，Oprah Winfrey为她签下$450,000支票，那是医院一整年的费用。
She was still operating when she was 92, stopping only when she could no longer stand without her sticks to make that first incision. She even built the midwifery school the original Lancet ad had called for. She did all this, she told Oprah, because she believed that was what God wanted her to do. She was not a missionary doctor, but a doctor who was a Christian. She loved the spirituality of the Ethiopians and was not rigid about where she herself worshipped, moving from church to church wherever she liked the message or the minister. She thought of herself as an ordinary woman. The Ethiopians called her Emaye, Amharic for mother. They thought of her as a saint. ■
鲐背之年的她仍然在做手术，直到双脚无法站稳手术台之日，她才封刀。她甚至建起了最初《Lancet》所要求的妇产科医院。这些她都一一遵照，将其悉数告知Oprah，她相信，是上帝指引她来做这些事。她不是传教者医生，而是作为皈依的信徒，救死扶伤的医者来到这里。她在一座座教堂之间辗转，她信奉主的旨意和牧师，她钟情于Ethiopian精神，对此从不掩饰自己的崇拜。而她一直都把自己当做一个普普通通的女性。但Ethiopian的人们将她尊为Emaye，Amharic语意为“母亲”。她是人们心目中的圣人。
读后感：
文章很是可爱，开头一句“买一送一”就让我忍俊不禁，不带任何不敬，而这是这是一篇讣告我似乎不应该，但当我看到这个慈祥的老妇人，就像这篇讣告的封面照片那样，带着微笑和洁白如圣光。Hamlin夫妇奉献毕生精力救死扶伤，文章回顾了Hamlin的一生。无可争议，她是一个圣人。
身为凡人，无非是谋生活，人之为肉身，无法永恒，但是却可以被人铭记，口口相传，镌刻历史。毕竟不是任何人都有这样的勇气和境界，起于人，高于人。在这个被上帝遗忘，又被上帝眷顾的地方，她如同天使降临。
最近的时节让我想了很多，在这个特殊的节点，医生是最可爱的人，这个职业是自带使命的，若说这篇文章对我的启发，我不敢说，但多了一种认同和敬重。某种角度，它是一种圣职赋予一个凡人。古有希波克拉底誓言，现有医学生誓言，仅仅是“健康所系，性命相托”就足以令人动容潸然。亦或孙思邈《大医精诚》，夫大医之体，欲得澄神内视，望之俨然，宽裕汪汪，不皎不昧。
《肖申克的救赎》中一句，“A strong man can save himself, a great man can save another. ”。
——强者自救，圣者渡人。
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蓝山国家公园（Blue Mountains National Park）坐落在新南威尔士州境内，距离悉尼97公里。蓝山国家公园属于大蓝山地区（The Greater Blue Mountains Area），该区域拥有7个国家公园，在2000年被列入世界遗产名录。蓝山山脉国家公园占地近2000平方千米，以格罗斯河谷为中心，峰峦陡峭，涧谷深邃。山上生长着各种桉树，满目翠蓝。入秋，叶间丹黄，景色更美。桉树为常绿乔木，树干挺拔，木质坚硬，含有油质，可提取挥发油。其挥发的气体在空气中经阳光折射呈现蓝光，因而得名蓝山。 ↩
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这里指的是vesicovaginal fistula，妇科瘘管病，又称产科瘘管病是女性分娩时难产阴道和膀胱及直肠之间的组织被撕裂导致的生殖道与泌尿系统或者肠道之间形成的异常通道，继而引起持续遗尿、遗便的一种损伤性疾病。
Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the bladder (vesica) and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.In addition to the medical sequela from these fistulas, they often have a profound effect on the patient's emotional well-being. ↩ -
James Marion Sims (January 25, 1813 – November 13, 1883) was an American physician and a pioneer in the field of surgery, known as the "father of modern gynaecology". His most significant work was the development of a surgical technique for the repair of vesicovaginal fistula, a severe complication of obstructed childbirth.He is also remembered for inventing Sims' speculum, Sims' sigmoid catheter, and the Sims' position. However, "one would be hard pressed to find a more controversial figure in the history of medicine." ↩
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Martius fat-pad：A fat pad (aka haversian gland) is a mass of closely packed fat cells surrounded by fibrous tissue septa. They may be extensively supplied with capillaries and nerve endings. The fat pad of the labia majora, which can be used as a graft, often as a so-called "Martius labial fat pad graft", which can be used, for example, in urethrolysis. The labia majora (singular: labium majus) are two prominent longitudinal cutaneous folds that extend downward and backward from the mons pubis to the perineum. Together with the labia minora they form the labia of the vulva. The labia majora are homologous to the male scrotum ↩
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Derg(阿姆哈拉语的意思是委员会)是由Mengistu（门格斯图）领导的血腥的G，在上世纪70年代末和80年代统治着埃塞俄比亚，在1974年9月时候的政变推翻了海尔·塞拉西皇帝。在长达17年的统治期间，Mengistu的政府对自己的人民犯下了许多暴行，以武力、恐吓和大屠杀为统治手段。没有履行在迎接G意识形态时所宣称的那样给国家带来进步，而是让它陷入可怕的经济状况，许多人都会记得上世纪80年代经常发生的饥荒。由武装部队、警察和地方军队组成的委员会于1974年6月正式成立，由一群军官在维持着法律和秩序。在随后的几个月里，情况逐渐恶化，并没有像最初提议的那样建立一个君主立宪制国家，Derg废黜并囚禁了海尔塞拉西皇帝以攫取全部权力。
1974年9月，Derg将自己改名为临时军事行政委员会，并由Mengistu Haile Mariam担任主席，并在此过程中铲除了所有忠于前皇帝的成员。
1975年5月，君主政体正式废除，马克思列宁主义宣布为这个国家的意识形态。
详见：https://www.sohu.com/a/233172499_251423 ↩ -
当今世界上最具影响力的女性之一，她的成就是多方面的：通过控股哈普娱乐集团的股份，掌握了超过10亿美元的个人财富；主持的电视谈话节目《奥普拉脱口秀》，平均每周吸引3300万名观众，并连续16年排在同类节目的首位。2009年11月20日，据国外媒体报道，在播出了23年之后，脱口秀女王奥普拉·温弗瑞的节目《奥普拉脱口秀》于2011年9月9日结束。 ↩
