The Edinburgh surgeon who treated my bowel cancer also saves lives in Africa

Mhairi Collie at home in Edinburgh

Imagine you are a girl like one of those whom Edinburgh surgeon Mhairi Collie treated in Madagascar this summer. You’re 15 or 16, and pregnant, but when it comes to giving birth, things go wrong. There’s no hospital, no doctor you can afford, so you just sit waiting in your hut.

Within a day, the baby’s dead. Within a week, on top of the heartbreak and trauma, you’ll have life-altering injuries caused during labour. You’ll be incontinent, unable to work, possibly hidden away as an embarrassment to your family, probably abandoned by your husband. In the absence of running water or sanitary pads, your life will become an odorous hell, with fistulas leaking for the rest of your life.

“When I first heard about women who suffer like this,” she tells me, “I had no idea what numbers were involved. I had never read anything about it. According to the latest figures from the World Health Organisation, 300,000 women die in childbirth each year, almost all in poor countries, almost all preventable with medical care. The same number will survive, but with uncontrolled leakages of urine and sometimes stool. 300,000: that’s three planeloads a day.” Her face clouds with outrage.

You or I can, I think, be forgiven from not knowing about these 300,000 women. Collie herself was 30 and had nearly finished her surgical training before she found out that they existed in anything like those numbers. When she did, she was working in an MSF hospital for refugees near Ethiopia’s northern border with Eritrea. She wanted to learn more, so she went to a fistula clinic in Addis Ababa to find out how to, in layman’s terms, mend gynaecologically broken women.

Three weeks at the fistula clinic in the Ethiopian capital in 2000 changed her life. “I was completely set on being a surgeon and had done enough training not to be intimidated by whatever came through the doors. But this was a project I could get my teeth into, and could commit myself to for years.

“I’m quite hands-on. I like to do things myself. It’s probably why I’m a surgeon in the first place Maybe I’m a bit impatient. I like to be able to say to a patient ‘What you need is this’ and then just be able to go ahead and do it. Sorting out women’s internal plumbing, closing the holes [fistulas] between the vagina and bladder and/or rectum, ending their incontinence, was something I could do.”

She had a whole other life back in her native Scotland, not least her Edinburgh GP husband Bill and (later) their two children. She wasn’t going to stay in Ethiopia: her career was always going to pull her back, first to finish her surgical training in London and then to push on up the medical ladder to being a colorectal consultant at Edinburgh’s Western General Hospital (she was appointed in 2005). In any case, most surgeons’ MSF placements seldom last longer than a year, and she also wanted to repay the NHS for training her in the first place.

But she didn’t forget those incontinent African women, and knew exactly what she’d do to help them. She’d co-found up a charity where it seemed to be needed most – Uganda, she thought – in 2003. They’d build up a team of UK-based and African doctors and nurses, the Africans gradually taking over with time. If, with better healthcare, Ugandan women’s childbirth injuries became less severe, they’d refocus their efforts on prevention instead of treatment and move on to other countries – Malawi, Sierra Leone, Madagascar – where they were needed even more.

Since then, there have only been a couple of years – when her children were very young – when she hasn't spent around half of her annual leave working - unpaid - for her charity, Ugandan Childbirth Injury Fund. This year alone she has already worked in fistula clinics in Uganda, Madagascar, with Sierra Leone and more Uganda still to come. Incidentally, she hates flying.

But what she’s seen, what keeps her going back to Africa, is something you or I might never see if we lived there for years. Women rendered incontinent by childbirth would be hidden from us by relatives or deliberately hide themselves. As they leave a trail or odour wherever they go, their presence anywhere is a taboo.

Only 150 years ago, that was the same story here too. In novels written before gynaecological operations became widespread, there are many mentions of mothers dying in childbirth (Oliver Twist’s, Snow White’s, Prince Andrei’s wife in War and Peace) and all manner of illnesses but can you think of a single one about ones with lives ruined by incontinence – despite the actual numerical equivalence between the two? Now, as then, shame continues to silence. The three daily planeloads of women continue to metaphorically take off. Or, rather, crash.

“It only costs £250 per patient for the operation,” says Collie, “and we’ll pay that and for the local surgeon. We’ll also meet all the costs of a fistula camp out in the bush, where we might treat about 30 or 40 women a week. Our success rate is high and you can see results straight away if their bed isn’t wet again in the morning. But seeing a fistula patient dry again, laughing and full of hope is quite an incredible experience – the best!”

Mhairi Collie explores these flashes of hope amid despair in her debut novel, The Bright Fabric of Life, which is published this month [Sep] – “A fine novel,” in the words of Sir Alexander McCall Smith on its back cover, “that will linger long in the mind – and in the heart of the reader”.

“Essentially,” says Collie, “it’s a medical romance set in a remote part of Africa that is just emerging from war. The romance bit is made up, but the medical aspects – the landmine injuries, and of course the women’s childbirth injuries, are all based on things I’ve seen.”

It’s exactly this assuredness in opening up two worlds most of us know nothing about – that gives her novel its power. It shows us both what it’s like to need basic medical care in a country where this barely exists, and what life is like for those attempting to provide it. “If you have nine operations that work out fine and the tenth doesn’t,” says Collie, “that’s the one you’re always – always – going to focus on. This is the weight that surgeons carry around with them, and I wanted to explore that too.”

As a reader, indeed as a former books editor of this paper, I’d like to think I recognise a talented writer – and an important subject – when I see one. As a patient, I can say the same thing about surgeons. In Mhairi Collie’s case, I happen to know how good she is in both roles. Some years ago she operated on me at Edinburgh’s Western General. Before she did, I had bowel cancer, and afterwards I didn’t. It’s not just planeloads of African women who owe her.

The Bright Fabric of Life by Mhairi Collie is published by Maclean Dubois, priced £12.99. All the money it raises will go to fistula work via the Uganda Childbirth Injury Fund (www.ucif.co.uk) and the Fistula Foundation.