Australian obstetrician and gynaecologist Catherine Hamlin is thankful to still be carrying out surgery at the age of 85.
But she dreams the procedures she performs to save poor African women from becoming social outcasts due to incontinence after childbirth will one day be relegated to the medical history books.
Dr Hamlin has spent half a century in Ethiopia performing surgery to fix obstetric fistulas, a condition eradicated in most developed nations almost a century ago.
She moved to Ethiopia with her late husband Reginald Hamlin in 1959 on a three-year contract and has never left.
The Addis Ababa Fistula Hospital they founded in the nation's capital and in four regional outreach centres together treat about 3000 women every year.
The facilities provide operations for women who have a fistula, or hole, in their bladder or rectum as a result of a prolonged or obstructed labour.
Women with fistulas often have stillborn babies and, if left untreated, the condition can lead to ulcerations, kidney disease and nerve damage in the legs.
Dr Hamlin says she still enjoys performing surgery and plans to continue ''as long as the body is willing''.
''I operate usually on a Thursday morning,'' she said after arriving in Sydney on a five-week trip to visit family and promote her work. ''I enjoy the surgery. It's not like ordinary surgery because you can sit down because you've got [the patient's] legs up on stirrups.''
The hospital has two other doctors permanently on staff and two more in training to go to outlying clinics.
She receives great support from medical communities around the world, but the vast majority of doctors in developed nations aren't trained in the surgery.
''We have a lot of visiting obstetricians and gynaecologists, but they're no help to us unless they've had some training because we never see an obstetric fistula in Australia,'' Dr Hamlin said.
The first fistula hospital was set up in the 1850s by J.Marion Sims and his pioneering work eventually led to an end to fistula problems in developed countries.
''In fact we're using some of his instruments even today,'' Dr Hamlin said.
''[The surgery] can be quite difficult sometimes or it can very, very simple.
''Most people think that it's just a tear, but it's not a tear. It's a loss of tissue because the tissue dies from the pressure of the baby's head against the bony pelvis.''
Although easily treatable, with 93per cent of patients making a full recovery, untreated women can be ostracised in Ethiopian culture, shunned by husbands, family and friends due to their condition.
Dr Hamlin said this drove her to continue her work and help women regain their lives and dignity. ''Her plight is one of the most tragic as a young woman, a beautiful young woman looking to perhaps her first baby.''
The hospital, which employs about 400 mainly local people, has been praised for its holistic approach to tackling the fistula problem. It has a psychiatric nurse and physiotherapists on staff to help patients overcome mental and physical problems associated with fistulas.
''They have psychiatric problems from the trauma of the experience and very often they are very withdrawn when they come,'' she said.
The hospital also has a self-help rural village to accommodate patients who cannot be completely cured and require ongoing medical care.
It recently established a cafe, training patients in work skills they can use to rebuild their lives. Former patients are also employed as nursing aides.
''They're wonderful because they've been through the experience,'' Dr Hamlin said.
''They have great sympathy and love for the patients that are arriving. They encourage them, they look after then and they nurse them.''
However, Dr Hamlin hopes the hospital's new midwifery college, created this year, will help move her work to prevention as well as cure.
The midwives will be sent to outlying villages after the three-year diploma course.
''The most important way of preventing this injury is to put midwives in the villages well-trained midwives, not just birth [helpers],'' Dr Hamlin said.
''They'll be able to diagnose when a woman's likely to get into obstructive labour. It's no use waiting until the labour starts, because then you've got to get them to the hospital.''
Poor communications and transport in Ethiopia means many pregnant women are isolated.
''We've got a very poor country, with terrific difficulty for women to get help when they're in obstructive labour because of the nature of the country,'' she said.
''It's very mountainous and rugged. There's some good internal roads, arterial roads, but very few little roads connecting a village to a main road.''
Dr Hamlin won a Right Livelihood Award, known as an ''alternative Nobel'', on Tuesday for dedicating her life to ''restoring the health, hope and dignity of thousands of Africa's poorest women''.
The awards, to be presented in December, were founded by Swedish-German philanthropist Jakob von Uexkull in 1980 to recognise deeds he felt were ignored by the Nobel committee.
Dr Hamlin said she saw the award as a chance to further promote her work, rather than a personal milestone.
''I'm always excited to get something, not for my own sake but for the cause we're upholding ... because the more people that know the better. It's an honour to have this award for me too, but I only really like them because they bring the world's attention to the needs of these women.''
She said the awful plight of women suffering fistulas made it relatively easy to gather support.
''I feel that once you tell people, they're really touched by the plight of these patients and it's really an easy cause to raise money for, especially when you're speaking to an audience of women,'' she said.
The hospital is funded by charitable trusts set up in a number of countries including Australia, New Zealand, England, the United States, Japan and Sweden, as well as grants from government aid agencies such as AusAID.
During her Australian visit she will celebrate her ''golden jubilee'' with supporters, marking 50 years in Ethiopia, and will help promote a new documentary on her work, Lighting a Candle, produced with the help of AusAID.
Though proudly Australian, Dr Hamlin plans to be buried in Ethiopia next to her husband, but has no thoughts yet of putting down her surgical instruments.
''I've still got a job to do. I can't see the point in retiring. I just hope that this hospital will keep going and the midwives will do an enormous amount of preventive work in the countryside once we start deploying them.''
Dr Hamlin will receive her Right Livelihood Award and 50,000 euros ($A80,000) in prize money at a ceremony in the Swedish parliament on December 4.
More information about her work can be found at Hamlin Fistula Relief and Aid Fund's website: www.fistulatrust.org AAP