Joy

~ By guest blogger and photographer, Charlie Ainslie

Charlie traveled with One By One staff on a recent trip to Kenya. While there, she had the chance to join Dr. Mabeya in surgery at Gynocare to watch and photograph a fistula repair.

So, it was my first surgery ever, and I thought I was literally going to pass out. But I got in there, and it was a lot different than I thought it was going to be. I don’t think anyone could have prepared me for what I was going to see. In 6 hours, it was more intense and less intense, scarier and more natural than I had ever expected. It was a total roller coaster of emotions. What I thought would make me queasy completely enthralled me, and what I thought would be simple to watch (sutures, and stitching up the patient), really made my stomach turn.

The one element of the surgery that I loved most was watching Dr. Mabeya do something that only takes a few hours, but completely changes the lives of these women, and he does it with such grace and dignity. He’s so humble, which I don’t understand, because he’s one of the most extraordinary people I’ve ever met.

Dr. Mabeya prepares Joy for surgery.

The surgery I got to watch was on a woman named Joy. Joy is 60 years old and has had fistula since 1982. She’s probably 4’10”, 90 pounds, really little. They rolled her into the operating room, and she didn’t look scared or nervous, just ready. I had no idea she would be awake the whole time, because they were going to be giving her regional anesthesia from the waist down. This made me a little anxious because I was going to be taking photos of her the whole time. As a photographer, my clients are always awake, but there was some relief thinking she would be asleep, so that if I got uncomfortable, or had to take a break, I wouldn’t make her uncomfortable. Little did I know, Joy being awake, not only helped my nerves, but brought her some comfort too, and created an experience with her that I will have for the rest of my life.

As much as I’d like to say I held it together the whole time and didn’t flinch once, there were moments, where I thought I was going to pass out. The few times…ok, the many times this happened, I thought it would be a good idea to go check on Joy, give her a few smiles and take some photos. I so badly wanted to reach out and grab her hand and let her know that I was in this with her. However, I didn’t know her comfort level, and the language barrier made it difficult. Instead I just stood by her, and without saying anything, Joy reached her hand over to my arm, placed it right next to me, gave me a smile, and stroked my arm for about ten minutes. I couldn’t tell who was helping whom more. This became my go-to position any time I felt nervous or light headed. I knew after that moment that Joy was someone extremely special, and I was so happy that she was getting treatment at Gynocare. I couldn’t think of a better place for her to be at that moment. I also knew that she would never get rid of me, because I had to check-up on her and make sure she was ok.

The next day we left to do field work for about week, and when we returned to Eldoret, I was happy to find Joy smiling and recovering at Gynocare. She remembered who I was immediately, and I sat down with her in the grass, held her hands, and one of the nurses, Zehara, interpreted how happy I was to see her in good spirits recovering. We took some photos together, which we printed and gave to her the next day, so she could have something to take home with her from our time together. She became my Kenyan grandmother, and I promised to visit her again when I return to Kenya. The next day, as we were leaving for our next destination, we also ran into her Regional Representative, Evans, who had found Joy during his outreach and had sent her to Gynocare for treatment. He was there to make sure she was doing ok. Between her incredible surgeon, amazing caring staff at Gynocare and support from her Regional Representative, I left the facility knowing she was in great hands, and that I would see her one day again, a repaired woman.

Joy and me at Gynocare while she was recovering.

Visiting West Pokot

After 2 hours on a dirt road and 2 more driving through dry river beds, canyons and red desert, out in rural West Pokot, you feel like you are in the middle of nowhere. The people of West Pokot are nomadic pastoralists, and in a society where women and cattle enjoy approximately the same status, and female genital mutilation (FGM) is practiced freely, it's no wonder that many women develop fistula during childbirth.

But, even out here you can buy a coke! And Habiba, One By One's Field Supervisor, manages to get cell reception. She talks with a Regional Representative about transporting a woman to Gynocare for fistula repair. Coca-Cola has done an incredible job of canvasing the globe with its product. And the cell phone infrastructure in Kenya is amazing. The government and the private sector have poured tons of money into wirelessly connecting the country. It's amazing that when money and priorities are aligned, people can bring product and infrastructure to even the most remote places in the world.

So why can't we do the same with hospitals? Women in West Pokot (and less rural parts of Kenya) still die in childbirth. The closest hospital is at least a day's walk away for most, and even if women make it to a health facility, it is often so under staffed and equipped, it can't do much to help women in need. But, if we shifted our money and our priorities, we could bring the people of West Pokot something they really need - better, well-equipped hospitals, healthy moms and babies, and an end to fistula.

A West Pokot woman with her baby

A West Pokot man with his cell phone

The "road" we drove on in West Pokot

Here's a short video clip of our drive

ONE BY ONE FIELD TRIP TO MIGORI

-- By Nora Otondo, fistula survivor and One By One Regional Representative

Henry Jaoko (above) and Teresa Adamba are the Regional Representatives for the area of Migori. Teresa is married, while Henry just married Scholastica Aluoch due to the nature of his job, which is dealing with women.

Migori is such a wide area but Henry and Teresa have done an incredible job educating the community about fistula and finding patients with fistula. They have had many patients because they encourage each fistula survivor to bring in a new patient to go for treatment.

While One By One visited Migori, we met a young boy Abdul, who was 11 years old, and his mother, Shamimu. He is suffering from uncontrolled stool leakage and wishes he were a woman so we could him get treatment.

The trip extended to the Sibuoche area, which is about 30 kilometers from Migori on a rough, muddy and rocky road. In fact, we got a flat tire in the process.


Motorbike is the only means of transportation to Sibouche, and costs 300 ksh (about $3). Along the way, there are only 3 medical centers, which are Migori District Hospital, a dispensary after over 10 kilometers, and finally Sibuoche dispensary. This means that most people walk over 10 kilometers to get to a medical facility that does not have doctors and/or medical equipment. This puts pregnant women at a high risk of fistula.

The meeting was held at Sibuoche center and after teachings about fistula, we screening for fistula was done and we found 4 patients. Mongare and Habiba also spoke at a separate meeting of fistula survivors. They discovered that some of the women are not yet fully healed and advised them to do exercises and report back in January if no change occurs. Generally most of the survivors are doing well.

The survivors have formed a group, which comprises of 50 members (including 35 survivors, 10 men and 5 additional women). The group needs an office, room to sit, loans to start income generating projects, and a motorbike for transport. Mongare advised them to register as a Community Based Organization (CBO) with the Kenyan government, which will help them access loans.

Western Kenya Model Project

It has been an incredible fall for One By One. Thanks to our generous partners, donors and an incredible team in Kenya, we have launched our most comprehensive and far-reaching program yet.

After five years of working on fistula, through prevention and treatment investments, in different contexts, we felt we had learned a great deal and were ready to make some bold steps to increase our impact. In 2010, One By One made a strategic decision to select two regions in which to make multi-year investments in the development of both comprehensive fistula treatment services and critical prevention activities.

Our first region chosen is Western Kenya – a five county region that includes the Rift Valley and borders Uganda. Our program is called Let’s End Fistula.

Through this partnership effort, we hope to demonstrate a powerful model of how the burden of obstetric fistula can be substantially reduced (and eventually eliminated) with shared vision, commitment and collaboration among local and international organizations, as well as substantial local community involvement.

We launched Let’s End Fistula in several ways this fall. We have supported the start-up of a new fistula treatment center in Eldoret, Kenya called Gynocare. Our partner, Dr. Hillary Mabeya (pictured below) is a well-respected and experienced surgeon who is now performing surgeries at Gynocare with funding from One By One.

Additionally, we hired Ms. Sarah Omega, a fistula survivor and outreach specialist to be our Outreach Manager. On September 23-25, Sarah and a team conducted One By One’s very first Regional Representative Training. This training was made available to 30 people that live throughout the five county region of Western Kenya – 21 of whom are fistula survivors, five are concerned women and four are men who are committed to seeing the end of fistula.

The training lasted three days and was based on a well-planned curriculum that gave each Regional Representative information about fistula treatment, prevention, public speaking skills, data collection training and leadership skills. We also gave each Regional Representative a cell phone, minutes, a One By One t-shirt, a One By One badge and a One By One button. They also were given a binder of information and data collection sheets.

These men and women are incredibly inspiring group that have formed strong bonds together as localized leaders working across boundaries to share best practices as they conduct outreach in their areas. You can see pictures and some of their thoughts about their work with One By One on our facebook page.

This past October I had the privilege of working in Western Kenya alongside our outreach team of Sarah Omega, Habiba Corodhia Mohamed, a social worker working with us who is based in Mumias, and ten of our newly trained Regional Representatives. It was awe-inspiring to watch this group conduct outreach and connect with village chiefs to ensure proper involvement from local communities.

I am amazed and thrilled to report that in the first six weeks of work of our 30 Regional Representatives, this group has conducted 176 rural and local activities, found over 100 women with fistula, and educated over 23,000 people. The Representatives are already far exceeding our expectations!

I will continue to blog about this amazing project so please stay tuned.

In addition, you will be able to read blog postings directly from the field courtesy of Ms. Norah Otondo, here. Norah is a recently repaired fistula survivor who has joined our outreach team as both a Regional Representative and as the “voice” of the Let’s End Fistula project. Norah will be taking photos, posting blog entries about the work of our team in Western Kenya.

I hope you enjoy Norah’s first blog entry and stay tuned for more from Norah and the Let’s End Fistula team!!!

-- Heidi Breeze-Harris

One By One Field Visit in Kenya

-- By Nora Otondo, fistula survivor and One By One Regional Representative (pictured below)

One By One Let’s End Fistula project held a field visit between 15-17 October 2011 to rural areas of Western Kenya including: Bukhalarire, Port Victoria, Khwisero, Kakamega Women’s Prison and finally to Cheptais, Mt. Elgon.

The field visit team consisted of our leaders, Heidi One By One’s co-founder and executive director based in the US, Sarah Omega our Kenyan Outreach Manager, Habiba Mohamed a community social worker, and me, Norah Amisi Otondo alongside ten of our newly trained Regional Representatives. The Regional Representatives took us on field visits and we discovered that fistula is a rampant condition among women in the Western Kenya region. However, the sufferers and the affected are living in ignorance of what fistula is. This has led to family breakup, abandonment etc.

One By One has extended its loving hand, through the Regional Representatives, to reach out to these destitute women to find them, sponsor for their treatment and also to create awareness by teaching the community about fistula, specifically its treatment and prevention. This is what happened in the field trip and continues to this day.

BUKHALALIRE

Meet these women (above) who welcomed One By One with song and dance, most of them fistula survivors. And their song: “Thank you one by one for giving us back our lives, we were in darkness, worthless, abandoned, and hopeless being looked down upon but now we have life, are fine, dignified and smiling again. Thank you.”

Here also meet area Chief Patrick Obuya (pictured above), who is enthusiastic and interested in women’s affairs working to mobilize the community as an administrator. He states that women have suffered so much not knowing there is a remedy for fistula .He thanked Heidi for One By One’s efforts to sponsor women with fistula treatment and encouraged her to keep on. He told us that he would help identify the women for treatment at Gynocare Centre.

Learning about Fistula

Before last year, I knew of fistula only as a Latin word meaning “pipe”. Now, I have learned exactly what obstetric fistula is, and with this knowledge has come a powerful drive to help women in the developing world who are victims of this condition. Last year, through a partnership with One By One and my school, Lakeside, I had some opportunities to do just that.

My first introduction to obstetric fistula was during a class meeting with Heidi Breeze-Harris, One By One’s executive director, where we were shown a video about women suffering from fistula, and told that helping One by One would be our class project for the year. This opportunity to help women in Africa struck a chord with me, because I had traveled to Tanzania over the previous summer. I had the opportunity to help out at a school, meeting many girls around the age of 15. It was amazing for me to see how these girls, who were my age at the time, were a good foot shorter than me, due to a diet without much protein. From the video, I learned that one major cause of fistula is obstructed labor, resulting from child marriage and pregnancy while a girl is still too young. It was nearly impossible for me to imagine that any of the girls who I had laughed and played soccer with could soon become pregnant, especially given their small stature.
I learned more about fistula in history class, when we began to do readings from Nicholas Kristof’s Half the Sky. The excerpts included stories both of girls who were suffering from fistula, and of those who had been cured. These were the first readings for school where I would find myself, thirty minutes after finishing the reading, still staring at it, lost in thought. One of these stories made me want to throw a few pieces of clothing in a bag, hop on a plane to Africa, and go help in a hospital there.
The first opportunity that I had for actual service was selling cookies at a UW tailgate. To sell the cookies, I had to be willing to approach complete strangers, and talk openly with them about obstetric fistula. At first, I felt awkward, which made it tricky to get the point across. As time went on, though, my confidence grew as I thought of the people that I would be helping, and how the money that we raised could change a life.
The second project that I worked on was a benefit concert at Lakeside. My English class organized, promoted, and produced the entire concert, learning more about fistula in the process. I learned how to write a persuasive letter, and how to appeal to a wider audience. At the concert, I decided to emcee, something that was very much outside of my comfort zone. Nevertheless, I came out of the concert much more confident in my speaking abilities, and I was glad that I had stepped up.
By learning about fistula both in the classroom and by venturing out to raise funds myself, I feel like I have gained a greater knowledge about the condition, and the approaches that must be used to cure it. I also had the opportunity to meet Sarah Omega, a fistula survivor and One By One’s Outreach Manager in Western Kenya, and listen to her speak. I found it extremely inspiring that Sarah, who has gone through so much, is still willing to dedicate her life to helping similar victims.

Finding out about this condition has introduced me to a whole future of possibilities that I had never considered before, such as a career in global health. It has also been extremely interesting for me to connect the topic of fistula to the greater subject of women’s rights, and the importance of equal opportunity for education.

Right now, I feel like my education concerning fistula is far from complete; in fact, it’s really just beginning. I hope to make connections with victims and to develop a greater understanding of how to solve the issue. Fistula has been completely eradicated in the United States, and there is no reason that someday, it can’t be eradicated in Africa.

After learning about this condition both in and outside the classroom, I understand that it’s going to take the work and ideas of many to eradicate fistula. The first step is education – people need to understand what fistula is. The task of spreading knowledge now lies in the hands of those who already have it, and we must be willing to speak up, loudly, about the issue. We must also ensure that fistula survivors have a voice. Every one of them has a story that needs to be shared, and these stories will help people around the world to understand the condition, and, more importantly, they will let other victims know that they are not alone.

- By guest blogger, Grace Stonecipher

Send Off to the Field

The third and final day of training began with several songs, which various participants led. As we have every morning, we allowed some time to review the previous day’s topics and ask for comments and questions. Then, we reviewed the forms that the Regional Representatives will use to keep track of activities they lead as well as the women they refer to Gynocare and follow-up with. We had everyone fill out a post-training survey so we can garner feedback from the participants about the training. Then, everyone signed an agreement to take on the responsibilities of a Regional Representative and join our Western Kenya team. We distributed cell phones so that the representatives can communicate with one another, community members, women living with fistulas, and Sarah Omega – phones will be vital to their community outreach and referral work. Everyone exchanged words of thanks, from the facilitators and One by One to the participants and from the participants to Sarah Omega and One by One. Of course, before boarding matatus back to their respective communities we had one last celebratory lunch all together. The Regional Representatives left cheering “One by One Let’s End Fistula. Moja kwa moja Pamoja Tukomeshe Fistula.”

Asante sana to our 31 Regional Representatives!

Day 2 of Training

On the second day of training, the Regional Representatives met in small groups to discuss their personal plans of who they were going to contact in their respective communities to start their outreach work. They jotted down ideas of specific people to speak with, such as religious leaders, chiefs, politicians, women’s group leaders, coaches, and teachers, in order to organize educational outreach activities. Volunteers were given resources to help them with public speaking and to organize their presentations to include personal stories as well as the information they have been taught on the prevention, causes, and treatment of obstetric fistula. Presenting to their communities is one of the many ways that One by One is addressing prevention steps. It also presents the opportunity for women who may not have known there were others with this condition to understand that there is a treatment or for someone in the community to refer a woman living with fistula.

We spent much of the afternoon discussing what the Regional Representatives will do when they find a woman who may have a fistula. The participants offered their ideas on how to provide psychosocial support and involve the woman’s husband and family. To conclude our day, we all took a trip to Gynocare. We toured the facilities and met some of the staff.

We also got the opportunity to speak with some women recovering from fistula repair surgery. Hugs and greets were exchanged, as many of the Regional Representatives knew the patients. It was a joyous conclusion to another day of training.

Introducing One by One's Newest Recruits

Today marked the first day of the first training of One by One’s Regional Representatives for Western Kenya. Thirty-one participants, 27 women and 4 men, have traveled from 20 counties to Eldoret to become trained to do outreach in their communities, refer women with fistulas to Gynocare for free surgical repair, and help provide psychosocial support for these women when they return home.

We began the day with a dynamic introduction by Sarah Omega, fistula survivor and Outreach Manager for One by One, and discussed the goals for the training. Then, each of the participants introduced themselves to their new team of field representatives. We took care of some paperwork, which included a pre-training survey whereby we’ll gain a better understanding of the participants, their knowledge of fistula, and their expectations for the training. After a quick tea and mandazi break, the participants took turns leading a few songs to get everyone energized for the next session. Sarah facilitated a session covering the causes and sequela, treatment, and prevention of obstetric fistula. We also discussed the myths about obstetric fistula that many community members hold, which included the idea that fistulas were caused by unfaithfulness, devils, genetic inheritance, witchcraft, a curse, AIDS, poverty, and not sitting properly (with legs crossed) after giving birth. The Regional Representatives know they will need to work hard to dispel these myths and the stigma around obstetric fistula in their communities.


Then, we went over the importance of community-based outreach and the role each of the Regional Representatives play in creating awareness of obstetric fistula, identifying women in the community with fistulas, spending quality time with these women and building trust, arranging transport for women to travel to Gynocare for treatment, and supporting women when the return home to their community. After a hearty lunch, we gave the 21 participants who were fistula survivors the opportunity to share their story with the group. After each retelling, the other participants offered their words of support and encouragement. Finally, we spent time brainstorming strategies to educate communities about obstetric fistula. Some of the ideas proposed by the participants included: home visits, community meetings (barazas) led by the chief, seminars in churches and schools, youth group meetings, and tournaments.

We concluded an exciting first day of training with a group photo. Check out One by One’s newest volunteers. We’re so excited to have them out in the communities and, soon to be, hard at work to end fistula.

Meet Sarah Omega!

Sarah Omega has been a close friend and partner of One By One for the past year. She is a fistula survivor from Kenya who has dedicated her life to the treatment and prevention of obstetric fistula. Sarah became pregnant after a traumatic sexual encounter when she was 19. The pregnancy resulted in fistula, a condition that she lived with for 12 years. In that time, Sarah was humiliated by coworkers and abandoned by the man who she was supposed to marry. Now recovered, Sarah shares her full story. Since her recovery, Sarah has been an advocate for women living with fistula. Sarah wants women living with fistula to know that life isn't over after getting the condition. She has partnered with One By One and our mission to treat and prevent obstetric fistula. Sarah is a leader in the field of women's advocacy and an amazing person. Recently, Sarah has been working with reporters, telling her story of fistula and her mission of outreach. Her story had been published in a Kenyan newspaper, the Daily Nation! Please read her full story and learn about all that she has done for women living with fistula.
http://www.nation.co.ke/Features/Living/No+woman+needs+to+go+through+what+I+did/-/1218/1208018/-/item/0/-/nf85q5z/-/index.html

Honoring an Outstanding Clinician

Azra Admani scans a fistula patient for One By One's Ultrasound Study

On the 100th Anniversary of International Women’s Day, we want to highlight one woman doing extraordinary work with One By One: Ms. Azra Admani.

Azra is an outstanding ultrasonographer who lives in Mwanza, Tanzania and works at Bugando Medical Center. For the past year, in addition to her full-time duties, Azra has played a critical role on a very exciting research study that we are conducting. Every Monday, Azra spends several hours using her keen ultrasound skills to measure the internal pelvic dimensions of women with fistula and a group of comparison patients. This study will help determine if ultrasound can be used to identify women who are at high risk of experiencing obstructed labor that can lead to fistula formation. If proven to be effective for this purpose, ultrasound may be an important tool for fistula prevention, making it possible to target high-risk women in remote areas and ensure that plans are in place to access emergency care if needed.

Prevention is the key to ending obstetric fistula throughout the world. Azra Admani’s commitment to carrying out this research with great care is making an important contribution to One By One’s efforts to develop innovative and effective prevention strategies. We honor Azra on International Women’s Day for her tremendous work on behalf of girls and women.

A final note: Rep. Carolyn Maloney just introduced the “Fistula Prevention, Treatment, Hope and Dignity Restoration Act”. In her words, this bill would “authorize the President to provide assistance to prevent and treat fistula, including through increasing access to prenatal care, emergency obstetric care, postnatal care, and voluntary family planning; building local capacity and improving national health systems; addressing underlying social and economic inequities such as reducing the incidence of child marriage and increasing access to formal and informal education; and supporting reintegration and training programs to help women who have undergone treatment return to full and productive lives.”

Let’s all thank Rep. Maloney for her commitment to this issue, and support her efforts to persuade the U.S. government to invest in eradicating obstetric fistula worldwide. To echo her call… Spread the word.

Outreach in Rural Kenya

Top Row (from left): Winnie (our translator), Sarah Omega, Emmanuel (the school principal), Heidi, Carolyn; Bottom Row: The school head teacher, Nereah, Catherine

While in Kenya, Sarah took us along on her outreach trip to some rural areas around Eldoret. On our way to a community meeting, we picked up Catherine, a woman that Sarah had met while previously doing outreach in a nearby area. Catherine told us she had heard from a local school principal that one of his students was leaking urine, and had asked us to stop by to see her.

So, we took a detour to Kimilili Deb Primary School, where we met the principal and the head teacher, who introduced us to Nereah, a 17-year old girl with fistula. As a result of her fistula, Nereah has developed a phobia of being around other people. Sarah told Nereah that her fistula could be repaired, something Nereah never knew before. Repair will be life-altering for Nereah as she will be able to sit in class with other students without fear of being ostracized. Thanks to Sarah’s outreach work, we are working with Nereah’s family and school to get her to Eldoret for free treatment.

We then went to the community meeting, where Sarah educated a group of men and women about fistula, and even gave out a phone number where people can reach her, something she does at every outreach event. She told the group that they can call her at anytime if they hear about or find someone living with fistula. As a result, Sarah's message spreads beyond community meetings, allowing her to work through people like Catherine to reach more women who would otherwise never hear about free treatment.

We hope you can join us for our 6th Anniversary Dinner on March 24th to hear more about Sarah's work in rural Kenya. Don't forget to RSVP, if you haven't already.

One By One Community Book Discussion Success!

One By One hosted its first Community Book Discussion focusing on the book Cutting for Stone by Abraham Verghese. Over 40 individuals attended this wildly successful event. We opened the night with Ethiopian-sourced fair trade, organic coffee from Pura Vida (buy Pura Vida through our website and a dollar from every bag of coffee sold goes to One By One!), and wonderful Ethiopian snacks provided by a local Ethiopian caterer, Konjit Fekade.

As the room filled with guests, we started with small group discussions on the book. The room was a-buzz with lively and engaged discussion on Cutting for Stone, Ethiopian culture and society, fistula and maternal health, and One By One’s work in Ethiopia.

These small group discussions were followed by a panel featuring Lydia Assefa-Dawson, a representative from the Ethiopian community who spoke beautifully about her experience growing up as an orphan in Ethiopia; Dr. Laura Hart, a urologist and volunteer fistula repair surgeon who provided her medical expertise from her experience working in the field; and Heidi Breeze-Harris, One By One Co-founder and Executive Director, who spoke about One By One’s programs in Africa. Much like the small group discussions, a lively and varied panel discussion filled the air.

It was inspiring to see the diverse group of community members join in on the discussion and connecting with One By One’s work.

One By One thanks those of you who participated in our first Community Book Discussion and for making it a huge success. For those of you who were unable to join us, we are hoping to plan similar events in the near future, so please stay tuned!

Maternal Deaths Decline

For all of us who care deeply about the rights and well-being of girls and women across the world, it is rare to wake up to good news on the front page of a major newspaper. But on April 13th, this remarkable headline appeared on the cover of the New York Times: “Maternal Deaths Decline Sharply Across the Globe.” So accustomed are we to hearing about the persistent lack of progress in reducing maternal mortality globally, I’m sure that many of us did a double take.And then devoured the article. It describes the new findings, published in the highly regarded scientific journal The Lancet, as “challenging the prevailing view of maternal mortality as an intractable problem that has defied every effort to solve it”, and demonstrating that “money allocated to women’s health is actually accomplishing something.” This is very good news, indeed.

Those of us in the One By One community should be especially heartened by the fact that one of our critical investment areas – increasing the availability of trained birth attendants – is identified as being of one of the key factors responsible for the decline in maternal deaths. We have chosen to support training of birth attendants because we know that they play a vital role in both ensuring that uncomplicated deliveries are clean and safe, and in identifying and supporting women who need to be transferred to a facility that can provide emergency obstetric care that will prevent fistula and save lives.It is great to see the importance of this work being highlighted in this high profile article.

While this long-awaited decline in maternal mortality demonstrates that important progress is being made, there are still hundreds of thousands of girls and women dying each year due to preventable pregnancy-related causes, and vast numbers of others develop devastating childbirth injuries such as fistula. There remains an urgent need to work towards ensuring that all girls and women have access to basic and emergency care during pregnancy and delivery. As Richard Horton, editor of The Lancet so aptly concludes, “ This is a moment to celebrate – and accelerate.” Thank you for supporting our acceleration to end fistula.

Infibulation – a practice of female genital mutilation and how that affects obstructed labor for affected Afar women and girls

Fatuma Abubacker’s story of surviving obstructed labor in the Afar is harrowing but not unique. Afar women give birth often with little skilled assistance and in extremely rural conditions. The women may be very young, malnourished or have had many pregnancies in quick succession making their uterine muscles less capable of moving the fetus into the right position at birth. Additionally many women in Afar culture are infibulated, which is one of the most extreme forms of what we call female genital mutilation or female genital cutting. Women, like Fatuma, in the last story, have their genital areas sewn nearly entirely shut when they are infants or at age six. There is a tiny hole left through which they can urinate and through which they can have intercourse, though often painfully. Infibulation can cause additional health problems and the process of infibulation itself is very painful.

When women who have undergone infibulation go to give birth, the traditional birth attendant arrives, as Fatuma’s story goes, with a knife, the blade of which she would heat up for sterilization. The traditional birth attendant would then cut the laboring mother’s scarred vulva back open so that she might give birth. In Fatuma’s case, her closed vagina was her obstruction. Her labor ended with a deceased child and with a fistula that was too complex to ever permanently repair.

This practice is changing as a result of the grassroots work of many dedicated groups on the ground. One of One By One’s fistula prevention program partners, the Afar Pastoralist Development Association, works within their own community to educate about the issues that the Ethiopian Government calls “Harmful Traditional Practices” which include the practice of infibulation. From the standpoint of obstructed labor, infibulations, for the communities that practice it, is an important area of intervention to save the lives of mothers, babies and an important way to prevent obstetric fistula.

Our grants are going to educate the first midwives that will serve the Afar people. These newly trained Afar women will be placed at the Barbara May Women’s Health Center in Mille, which is a new hospital, that is in process. The midwives will supervise and support the newly trained birth attendants who will have more tools at their disposal to assist women in labor. Enhanced birth education for birth attendants, new midwives, and education on harmful traditional practices are just a few of the incredible grassroots programs operating out of ADPA’s Loggia office. One By One is a proud supporter and with your help, more women and girls can survive and thrive in the Afar region!

All photos courtesy of Heidi Breeze-Harris, (c) 2009

Listen to my interview with Valerie Browning: http://www.youtube.com/watch?v=Dl_UeCsovVU

http://en.wikipedia.org/wiki/Infibulation