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The Power of Mobile Technology to Help End Fistula

Each year, 3,000 new cases of fistula are recorded in Tanzania, leaving thousands of women to suffer the stigma of chronic incontinence. But mobile technology makes it possible for NGOs to get women the help they need, writes Abbey Kocan of the Kupona Foundation.

Written by Abbey Kocan Published on Read time Approx. 4 minutes
A Maasai tribeswomen carries her baby on her back at a village on the outskirts of Serengeti, northern Tanzania. More than 20,000 women in Tanzania are living with obstetric fistula and, as a result, many are ostracized from their communities. AP/Nariman El-Mofty

Like millions of women worldwide, Ruth, from the Iringa region of central Tanzania, has a story of loss and endurance to tell.

“I was 20 years old when I learned that I was pregnant,” she said. “I was so excited to welcome my child into the world. When the time came, I had labor pains for a day before my family sent me to the hospital. It took me four hours to get there. When I eventually arrived at the hospital it was too late. My baby didn’t survive. A few days later, I realized that I was leaking urine.”

Ruth had developed obstetric fistula during her prolonged obstructed labor and delivery. A hole had formed between her vagina and bladder, leaving her with chronic incontinence. “None of my doctors explained what was happening, and I left the facility with no idea what was wrong,” she said.

That was in 1985.

“My community turned their backs on me and I had to leave my home,” Ruth said. “A Good Samaritan let me stay with her, and I started to look for treatment. I went to several hospitals, but nobody could help me.”

Ruth became one of more than 20,000 women in Tanzania – along with millions of women worldwide – living with obstetric fistula. Estimates suggest that each year, 3,000 new cases occur in Tanzania alone.

Obstetric fistula carries severe stigma within many communities, and may be viewed as a curse or punishment for a woman’s wrongdoings. Women living with fistula are often abandoned by their families, excluded from their communities and unable to work. As a consequence, they are among the poorest and most marginalized people in the world.

Fistula can be repaired with surgery, but a lack of awareness around the condition and available treatment, combined with the costs of transportation to the hospital, prevents women from seeking medical care. Many women, like Ruth, live with no hope of a cure.

Earlier this year, almost three decades after she first developed fistula, a single text message changed everything for Ruth.

“My brother heard a group of people talking about fistula, and a hospital that treats it. He went to our nearest hospital and asked a nurse how he could contact this place so that they could help me,” she said.

The hospital in question was CCBRT Disability Hospital, the largest provider of obstetric fistula treatment in Tanzania. With the hospital located in Dar es Salaam, more than 300 miles (480km) away from her home, Ruth would have to travel for hours to get treatment – a daunting journey in her condition and one that she simply could not afford.

So Ruth was introduced to a CCBRT fistula ambassador, one of 1,600 volunteers around the country tasked with identifying and referring women with fistula for treatment. As Ruth was unable to afford the journey to the hospital, her ambassador triggered CCBRT’s innovative referral process, TransportMyPatient. CCBRT sent the money for Ruth’s bus ticket to the ambassador’s mobile phone via M-PESA, the mobile money transfer technology developed by Vodafone. After getting a text message from CCBRT, the ambassador simply redeemed the text for cash and bought Ruth a bus ticket to Dar es Salaam.

After her surgery, Ruth participated in group and individual counseling sessions and received health education, family planning advice and physiotherapy. At no point did Ruth have to pay for her surgery, rehabilitation, food or stay in the hospital.

Ruth was 48 years old when she finally received treatment. By then, she had lived with fistula for longer than she had lived without it. But a single text message changed the course of her life. “After 28 years, I am finally dry and on the path to recovery,” she said.

With help from a mobile money transfer, Ruth was able to get the medical attention she needed to treat her fistula. (Sala Lewis)
With help from a mobile money transfer, Ruth was able to get the medical attention she needed to treat her fistula. (Sala Lewis)

A text message to transform a life

TransportMyPatient was launched in 2009, and in the program’s first year, CCBRT saw the number of women seeking treatment increase by 65 percent. Since then, the number of women accessing treatment has grown steadily, reaching 920 women in 2015 alone.

With funding from the Vodafone Foundation in partnership with organizations including USAID/PEPFAR, Fistula Foundation and Johnson & Johnson, CCBRT’s fistula program has grown to become one of the biggest worldwide. From 2012 to 2015, CCBRT and its satellite facilities carried out more than 65 percent of all fistula surgeries reported in Tanzania.

Shining a light on a hidden tragedy

Stories like Ruth’s need to be told. Women living with obstetric fistula are hidden from view, and as a result those with the power to change things are oblivious to their struggle. As CCBRT’s U.S.-based sister organization, Kupona Foundation has mobilized more than $1.3 million for the treatment and prevention of obstetric fistula in Tanzania.

On May 23, the fourth International Day to End Obstetric Fistula, United Nations Secretary-General Ban Ki-Moon released a statement saying, “Fistula has virtually been eliminated in most high- and middle-income countries around the world, so we know that it can be eliminated in every country. Today … I call for an end to fistula within a generation.”

Organizations like Kupona Foundation, CCBRT and others are answering that call. TransportMyPatient has revolutionized patient referral at CCBRT and unlocked access to life-changing surgeries for thousands of women in Tanzania. By working to reach the thousands of women still in need of treatment, and to improve the quality of maternal healthcare to prevent injuries like fistula from occurring, we can end fistula within a generation.

Learn more about obstetric fistula and the experiences of women like Ruth at Kupona Foundation’s Drawing Out Obstetric Fistula Art Exhibition at the New York University (NYU) Kimmel Center. Visit Fistula Foundation: Resilience for more details.

The views expressed in this article belong to the author and do not necessarily reflect those of Women & Girls Hub.

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