But the Hamlins knew it was both fixable and preventable - as they told Ethiopia's then ruler, Haile Selassie.
"He said, why do my women get this terrible thing where they can’t control their body waste?" Dr Hamlin told the BBC.
"We said, it is nothing to do with your women, it is to do with your lack of doctors in the countryside when they need to have a Caesarian section."
Second example:
But the Hamlins would not only help repair the damage; they also gave Mamitu - who has no formal education - a new career: she is now an internationally respected fistula surgeon, having been taught by the Hamlins.
Third example:
Then, in 2007, Dr Hamlin saw one of her initial dreams finally fulfilled: the Hamlin College of Midwives opened.