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.