By Lottie Howard-Merrill, FORWARD Africa Programme Assistant, Policy and Research
We have changed the names of the women to protect their identity.
This May staff from our London team were privileged to visit FORWARD’s partner UTU Mwanmke on a field visit in the Dodoma Region of central Tanzania. The aim of the visit was to check on the progress of obstetric fistula survivors taking part in maternal health project supported by FORWARD.
We set off at 7am with our flasks of masala tea and LOTS of biscuits. Stopping frequently to talk to UTU Mwanamke’s contacts in each village, we found the three women who were able to take a break from their work to talk with us about the project and their role in it. The women and UTU Mwanamke staff greeted each other with laughter, hugs and high fives. They have been working closely together since 2013, doing research, forming a network, kick starting small businesses and providing each other with practical and emotional support. Adimu was one of the women we met who has been involved in the project since it began.
Adimu went into labour with her second child when she was 22 years old. After waiting over night at her local health dispensary to be seen by a nurse, it became clear a natural delivery would not be possible. After an hour, a car came to take her to Mpwapwa Hospital where better health care was available. On the way to the hospital the car broke down, leaving her stranded with no transport, water or health care. After 7 hours she reached the hospital and had a vacuum assisted vaginal delivery. The baby died shortly after being delivered, and the body was disposed of without Adimu ever being able to hold it.
While she was recovering from childbirth in the hospital, a nurse removed Adimu’s catheter, and the bed became wet. This made Adimu worried as she hadn’t actively relieved herself. During her prolonged labour, she had developed obstetric fistula, a hole between the vagina and rectum or bladder. The nurse was unable to identify the condition, and told Adimu that it could be solved by replacing the catheter. Adimu was could not afford to pay for further health care and so was forced to return home whilst leaking urine.
Adimu lived at home with obstetric fistula for over a year. Even when a family member suggested it was likely she had obstetric fistula, and explained that the condition could be treated, her husband refused to pay for her transport and eventually left her. Her neighbours ‘denied’ her, not wanting to associate with someone constantly leaking urine. When a specialist team drove through her village offering women affected by obstetric fistula free transport to treatment centres, Adimu was out working in the fields.
Eventually Adimu saved up enough money to take public transport to a treatment centre in Dar es Salaam. They provided her with clothes, bedding, soap and food for three weeks while she waited to be treated. Following a successful operation, Adimu was discharged and returned home with the instructions to drink a lot of water, and avoid having sex for 4 months, and pregnancy for 2 years.
In 2013 Adimu was invited to be a community researcher in Participatory Ethnographic Evaluation Research (PEER) being carried out by FORWARD. Adimu explained how she had grown in confidence, learning research skills and hearing about experiences of women similar to her own. More recently she took part in entrepreneurship training with UTU Mwanamke and received a small accompanying loan.
Adimu has used her loan to start a business making local beer. She has also used the money to strengthen her family’s agricultural work, raising pigs and growing sunflowers to make cooking oil. She is now able to cover the cost of basic healthcare for her family and special medication for her father who has mental health problems.
Adimu developed fistula because she experienced multiple delays in accessing good quality maternal health care. The nurses she dealt with were unable to recognise the warning signs, identify the problem, or sensitively deal with the loss of her child. Once she had developed obstetric fistula, lack of understanding from health professionals as well as her family and community meant she lived with the condition for much too long. Obstetric fistula is both preventable and treatable, and cases like Adimu’s are unacceptable. You can find more information here about the range of approaches required to end obstetric fistula.