A new film by Emmy winning film maker Lisa Russell documenting how mobile technology is facilitating fistula treatment in Tanzania had its premiere at the historic Zanzibar International Film Festival—ZIFF, East Africa’s largest film and music gathering, in July. The film, produced with support by UNFPA and the Campaign to End Fistula, was chosen to be part of ZIFF’s Women’s Panorama program which brings select films to screen in the villages.
A new film by Emmy winning film maker Lisa Russell documenting how mobile technology is facilitating fistula treatment in Tanzania had its premiere at the historic Zanzibar International Film Festival—ZIFF, East Africa’s largest film and music gathering, in July. The film, produced with support by UNFPA and the Campaign to End Fistula, was chosen to be part of ZIFF’s Women’s Panorama program which brings select films to screen in the villages.
The documentary highlights an innovative project at CCBRT—a rehabilitation hospital located in Dar es Salaam that provides fistula repair services among other things in Tanzania. At the end of 2009, CCBRT began a pilot scheme using Vodacom’s M-PESA banking system to send money via mobile phones to women in need of fistula surgery.
Community based doctors, nurses, healthcare workers and traditional midwives from 15 regions in Tanzania make up the “ambassadors,” who identify fistula patients and use M-PESA to receive money and pay for their transportation to the hospital. Once at the hospital, the patients receive free admission, food and care.
Thanks to the project, there was a 65 per cent increase in the number of women and girls receiving fistula treatment in the center since 2009.
According to specialists, mobile phone technology has the power to greatly improve maternal health. “Its potential is only just starting to reach women with obstetric fistula, who often live in remote areas, in conditions of extreme poverty,” said the UNFPA Representative in the country, Ms. Julitta Onabanjo.
More often than not, in rural areas, it is difficult to access a skilled health care provider to get emergency care when childbirth complications arise or treatment in case of disabilities. Roads and transportation are often rudimentary, and hospitals and health centres are spread over wide distances.
“Women might have to travel for many hours—even days—by bus, donkey cart or on foot to reach a hospital or medical center. It is often too late for a safe delivery by the time they get there. Most often, they simply don’t have the resources to seek treatment when they develop a condition like fistula,” Ms. Onabanjo explained.
“One of the more tragic situations I’ve encountered in my filming is meeting women living in very rural areas who desperately need a fistula repair surgery but cannot afford the transport costs,” said Russell who has also filmed fistula programs in Niger, the Democratic Republic of Congo, Liberia and Sierra Leone.
“Mobile phone technology has the ability to revolutionize women’s access to fistula treatment programs. It was incredibly inspiring to be able to document such a hopeful and positive story in Tanzania, and we are all excited that the film is premiering in the region.” the film maker added.
For Gillian Slinger, UNFPA Coordinator of the global Campaign to End Fistula, women and girls living in rural areas are not only the most difficult to reach, but also the hardest hit by poverty.
“They often have little access to education, and less decisional power. Even in countries where national legislation exists to ensure women’s rights, for many reasons, this may be less respected the farther you go from the capital.
“Cultural traditions can further perpetuate inequities and gender issues, with crucial birthing decisions often made by the husband or mother-in-law, who may favor traditional practices, like early marriages and home deliveries.
“We hope the film will be used to share the message with practitioners around the world so that they can be inspired to replicate this good practice and develop new ideas about mobile phone use to reach women and girls with fistula in the future, and to improve maternal health,” Ms. Slinger added.
With the slogan “Don't close your eyes. We can end fistula,” a new public service announcement stresses the importance of ensuring access to emergency obstetric care and skilled health professionals—especially midwives—to all women to prevent and help ensure treatment for obstetric fistula.
With the slogan “Don't close your eyes. We can end fistula,” a new public service announcement stresses the importance of ensuring access to emergency obstetric care and skilled health professionals—especially midwives—to all women to prevent and help ensure treatment for obstetric fistula.
The PSA, to be launched in African countries in 2012, was developed by the Brazilian illustrator Rodrigo Mafra, based on the soundtrack created by Grupo UAKTI. “As artists, we need to alert society about fistula, hoping that the necessary investments are made so that this issue becomes history,” said Marco Antônio Guimarães, UAKTI’s leader. Fistula is a childbirth injury caused by the lack of skilled attendance during prolonged, obstructed labour. If every woman had access to adequate and timely care, we could end fistula.
Madina, 30, lives in Mogadishu, Somalia. She developed fistula after a difficult and prolonged labor when she was only 17. Her baby died of asphyxia before delivery. Soon after, she noticed that she could no longer control her bladder.
Madina, 30, lives in Mogadishu, Somalia. She developed fistula after a difficult and prolonged labor when she was only 17. Her baby died of asphyxia before delivery. Soon after, she noticed that she could no longer control her bladder.
Leaking urine uncontrollably and not knowing what had happened to her, Madina decided to live in silence, hoping that she would get better eventually. Unfortunately her condition worsened as the days went by.
Madina’s husband decided that he could no longer live with her because of the smell and divorced her. Depressed, she went back to her mother’s house, feeling that the world had turned against her: first she had lost her baby, then she got “sick” with that dreadful condition and now she was divorced.
Her mother tried to encourage Madina, but she felt lonely and cried all the time, especially at night. To try to avoid desperation, she did what she could to keep herself busy with household chores. Every day, by the time she was finished, Madina was so tired that she usually fell asleep immediately.
Most of Madina’s friends deserted her, visitors became rare and she never left the house, embarrassed by her condition. She needed to wear many layers of clothes to absorb the urine and this became another burden.
After one year, Madina decided to go to Somaliland to seek treatment and, there, she underwent two surgeries, both unsuccessful. She was supposed to undergo a third surgery but she decided to give up and go back home, in Mogadishu.
Madina lived with fistula for several years until a relative who lived in the central region told her about the Galkayo Medical Centre (GMC), a UNFPA-supported initiative targeting fistula patients in the South Central Zone of Somalia.
When Madina finally got to GMC after a long journey, she didn’t know what to expect. But, after a new surgery at the center, her fistula was finally repaired. Madina might need to undergo one last surgery to eliminate all remaining traces of incontinence. “But you see, I don’t smell of urine anymore,” she says with renewed hope.
Madina’s story is not uncommon in Somalia. Mariam, from a village in the same area, developed fistula when she was 15-years-old. Coming from a nomadic tribe, her labor started when she was alone in the bush. Unfortunately for her, the baby was in the difficult breech position.
Mariam delivered by herself. The baby’s head got stuck in the birth canal, forcing Mariam to walk for miles with her baby partially inside her before she could find someone to assist her. The villagers she found tried to pull the baby out without success. By that time, Mariam had fallen into a coma.
They brought Mariam back to her family unconscious. When she finally woke up, she realized that she couldn’t stand up or move her legs as a result of the trauma she had experienced earlier.
Mariam had developed an infection, which affected the nerves around her pelvis and prevented her from walking. Also, the tissue of the birth canal had slough off due to necrosis, leading to a double fistula – Mariam couldn’t control her urine or stool anymore.
Mariam, recuperating from surgery in the fistula ward.
The family learned about the fistula project on the radio and then organized a trip to Galkayo to try a surgical repair. At GMC, the doctors treated the infections and removed the necrotic tissue. Mariam was then scheduled for fistula surgery. After treatment, she became continent and was able to walk again.
“I so happy,” she said with tears. “I did not know there was a cure for my condition. Thank you very much,” she added as she left the center.
GMC, managed by Dr. Abdulcadir Dhagacade, provides a safe and easy to access reference facility for emergency obstetric care and fistula repair in central Somalia. So far, 51 fistula cases and 74 complicated deliveries have been attended by health professionals at the center. Transportation and surgery costs are covered by UNFPA.
UNFPA’s country office for Somalia is also working with partners in providing much needed reproductive health care services. Among many projects, UNFPA is working on the opening of a midwifery school in Mogadishu later this year.
It is critically important to work with local partners in Somalia. For one, it is a matter of access to the areas of the country where only few organizations are allowed to operate. In addition, UNFPA’s partners in Somalia possess a deep understanding of the country’s culture, family affairs and decision-making processes in a context that calls for collaboration with faith-based organizations.
Roar Bakke Sorensen reported from Somalia with contributions by Alexandra Sicotte-Levesque.
Engel Entertainment is producing a documentary about five Ethiopian women whose lives have been devastated by obstetric fistula and the difficult journey they undertake to reach the Addis Ababa Fistula Hospital. Watch the 10-minute trailer.
Engel Entertainment is producing a documentary about five Ethiopian women whose lives have been devastated by obstetric fistula and the difficult journey they undertake to reach the Addis Ababa Fistula Hospital. Watch the 10-minute trailer.
