Day 2 in Dar

Met with Maggie Bangser, former ED of the Women’s Dignity Project. This was the first org to do fistula advocacy from a pro women/feminist standpoint. Prior to WDP, nearly all fistula work was being done by missionaries and other faith-based groups.

Maggie and Dr. Gumodoka were the two individuals to start the Fistula Ward at Bugando Medical Center in Mwanza (our main focus of this trip and of the project).

I asked her about prevention vs treatment, and her response was disheartening: while 1,000 fistula repairs are being done each year in TZ, there are 3,000 new cases. However, she recommended focusing on treatment programs rather than prevention, since prevention efforts in this country have been diffuse and ineffective

In the afternoon we met with representatives from the UNFPA (United Nations Population Fund). They have focused their efforts on changing policies at the national level. They have a voice at the policy making table and feel they have been effective advocates for maternal health and reproductive health. As an example, there is now a line in the TZ budget for contraception. They also feel they have been successful at bringing the “gender lens” to the issue of maternal/reproductive health. They are doing a study now to get a sense of men’s perceptions of their role in both areas, and will develop educational radio messages based on their findings.

1st day in Dar

12/10/08

Arrived safely in Dar and Laura H was at the airport to pick us up. We stayed last night with a friend of Laura’s family, a retired TZ army general. His name is Nova Matiku and his wife is Zania. He lives about 20km north of Dar. He and his family were so lovely to open their home to us.

Had a lovely breakfast in the morning. Pineapple is in season here and I couldn’t eat enough of it. We all talked about some of the issues facing Tanzania, such as a the need to build better infrastructure in order to better feed the country and create more access to health care.

I was amazed driving in to town this morning that in this capital city, only a few major roads are even paved. There are only a few roads into town from where Nova lives, so the 20mile trip can take up to 2.5 hours during rush hour. In addition, very few roads are labeled. We had to stop several times and ask at barber shops and corner groceries for directions to our appointment.

Laura H and I had an appointment scheduled with the ED of an that does advocacy for fistula and I believe they also fund projects. Unfortunately today was Eid, the end of Ramadan, and a national holiday, so the offices were closed. A program assistant came by the office just as we arrived to do some catch-up work. She called the woman we were to meet with, who she said she could be in in an hour. Neither of us felt comfortable asking her to come in on a holiday. So we did a few errands, and then took the long drive home so that I could go back to bed.

Nova’s son is a doctor and has an MPH. Laura H talked with him while I napped, and they had a great talk. He is starting a small clinic out in the village area where his father was born. He told Laura that the solutions need to come one village at a time….(i.e. if your goal is education in a village, you may need to deal with more urgent issues first, such as giving them access to clean water before you can even think about building a school). We are planning on meeting up with him again before leaving Dar on Friday. I’m looking forward to hearing more of his thoughts.

First project donation!!!!

12-9-08 En route from Amsterdam to Dar Es Salaam

I just received my first donation!! I met Bill Mast of Richland, WA, at the Seattle airport. We were waiting in line to check in. He’s on his first trip to Africa. The flight from Amsterdam to Kilimanjaro (where he got off) was pretty empty, so we were able to sit together, and we had a great talk. He asked me at one point how much I was hoping to raise for fistula. I told him, and said I hadn’t raised a penny at this point and was kind of nervous about getting started. He reached into his wallet and handed me $100. It almost made me cry. Thank you, Bill!!!

Talking Fistula during Layover in Amsterdam

During our layover in Amsterdam, I met Dean and Elaine Peterson from Idaho. Dean was a Lutheran missionary in TZ for 30-some years. I told him about my project and he gave me the contact info of a doctor who lives and works near Arusha and who has talked all over the world about fistula.

Dean also told me about a minister he worked with in Tanzania in the 60’s. The minister’s wife suffered a fistula during labor, and after a couple of years, the minister just couldn’t take it any longer. He divorced her, and left the church. Dean said at the time he didn’t have any idea what a fistula was, and his wife Elaine agreed. She said she was embarrassed that she lived there all those years, and never knew that it existed. Now that they’re friend is involved in treatment and awareness, they know about it. But at the time, they didn’t.

I wonder when doctors began repairing fistulas in TZ?

Background Info 2

Two years later (almost exactly one year ago), my friend Leslie Garland invited me to a “giving circle” at her home. It would be an evening dedicated to women and girls in Tanzania who lived with a horrific injury obtained during an obstructed labor.

I couldn’t believe it.

At the party I met Heidi Breeze-Harris, the Executive Director of One By One (fightfistula.org), which funds fistula treatment and prevention in developing countries (primarily Tanzania at this point). If my conscience had not succeeded at getting me up off my laurels, meeting Heidi certainly did.

As I got to know Heidi and learned more about her organization, all that energy and desire that had dissipated after my Ethiopia trip came back. I learned something important about myself (something that now seems so obvious): Passion wasn’t sustainable for me in a vacuum. I had to involve myself with people who shared the same vision that I had if I wanted to keep it alive in me.

That spring and summer I thought up projects that I could potentially run through One By One. Heidi and I talked several times over the summer. Some of my ideas were feasible, others less so. But one thing became clear: Heidi’s own plate was too full to take on anything else. If were going to start something, I would need to do it on my own.

In September, Eden started back at school. I enrolled in a personal development course where participants create and implement projects for the community of their choice. With their – and Heidi’s - guidance, this project has grown into a fundraising and educational project [that still lacks a good name…]

Its goals are to raise $100k for fistula treatment and development, and to take a group of donors to TZ and possibly Kenya next year. The trip will focus on the underlying causes of fistula, as well as prevention and treatment programs. I have three target audiences: 1) Individuals from the medical community, 2) People interested in women’s issues, and 3) Policy makers.
This site visit I’m now making to Tanzania is to help me learn about the state of fistula and maternal health in the country, to help me identify one or more partners, and to help me set and price out an itinerary for next year’s trip. All in two short weeks.

Dr. Laura Hart of Seattle will be traveling with me to assist with the project. I met Laura at a One By One fundraiser. She arrived a few days ago in Dar Es Salaam; She flew in from Mozambique, where she has spent the last 3 weeks doing fistula-repair surgery. I can’t wait to hear about her experiences.

Background Info

I first learned about fistula before my 2005 trip to Ethiopia. I was traveling to the country for the opening of an eye clinic my father had helped found.

Eric and Mary Oemig, friends of mine who had been to Ethiopia, said that while I was there, I had to be sure to visit the hospital for obstetric fistula.

I said: "Fistu-huh?"

So they told me about the condition.

Obstetric fistula is a devastating childbirth injury caused by an unrelieved obstructed labor. In the US, if your pelvis is too small, or for some other reason the baby gets stuck during labor, a doctor performs a C-section.

In poorer areas of developing countries, laboring girls and women often don't have access to medical care. In these cases, the woman will continue to labor for up to 2 weeks. The baby nearly always dies, and if the woman survives, she is often left with a tear in her vaginal wall that causes her to leak urine and sometimes feces.

Because of her smell, a woman with fistula is relegated to the edges of society, unable to board a bus, share a meal, or work with others. In some areas, members of her community believe that her condition is punishment for having been unfaithful to her husband.

For women without access to treatment (a $300 surgery), their suffering and isolation is life-long.

Seeing the clinic in Addis was an a transformative experience. Before surgery, women are pariahs with little hope for the future. After surgery, they see a new possibility for re-integrating into society, and many of the women and girls smile for the first time in years.

It was moving the way the hospital staff treated their patients with such dignity. Classes were held prior to surgery to teach the women and girls about the procedure, and how to care for themselves post-op. I remember seeing a staff member entering a classroom after the students filed out, and humming to herself as she cleaned the urine off of the floor so the room would be ready for the next class. I was amazed at how clean the clinic was and how beautiful the hospital grounds were. What moved me most at the clinic, though, was learning that the average age of their patients was 14.

I left Ethiopia completely mortified that this problem existed. I promised myself that I would do something about it. What exactly I didn't know. But something.

When I got back to Seattle, I experienced the kind of things that people often do when they return from overseas. I saw my home and surrounding with a new appreciation for their familiarity. I knew exactly where to find everything I needed at the grocery store. No more fumbling with my dictionary every time I had a conversation. My local barista asked me where I'd been and did I want the usual? It was good to be home.

The next week I got busy working on an article (I was writing at the time). And 6 months later, I remembered the trip as an amazing experience, with the condition of fistula still upsetting to me, but more like the feeling I'm left with after a real downer of documentary film, rather than something that I had once felt enough passionate for to commit to doing something it.

Besides, it wasn't as though I was sitting around eating bon-bons all day. I had my writing, and my volunteer hours developing the school newsletter. I had a daughter who wouldn't eat her vegetables, and a husband who's car was in the shop. I had my own stuff to deal with. So quit nagging me. Stupid Conscience. Sheesh.