Tanzania's message of hope to mothers
A debilitating condition that causes millions of stillbirths across Africa and can make social outcasts of the mothers who suffer from it could be eradicated in Tanzania in just four years, thanks to the humble SMS.
Every year almost 3 000 women in Tanzania contract obstetric fistula during prolonged or obstructed labour. In almost 95% of cases the baby dies. The women are then often stigmatised by their families, who don’t understand the condition, which causes a hole to appear between the vagina and the rectum.
“They say it’s ‘witchcraft’ and throw the women out of their homes,” Jane Cleophas Rugalabamu, who suffered from the condition, told the Guardian. “When you have it everyone ignores you, you can’t work, you can’t go out in public. Life is not worth living.”
As is typical, Cleophas Rugalabamu didn’t know what was wrong with her and suffered in silence for several months until a friend told her that it was a recognised medical condition that could be put right with a simple $388 operation. Cleophas Rugalabamu was rushed to a Dar es Salaam hospital dedicated to treating the condition. Within 45 minutes she was cured.
Despite the Tanzanian government, the European Union and charities pumping millions of pounds into fighting fistula, the number of cases of the debilitating condition are increasing every year. “We have a nice big hospital, full of good doctors, but no patients,” said Tom Vanneste, deputy director of a local NGO, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT). “The problem is they [the women] either don’t know that they can be cured, or can’t afford the cost of the bus to hospital.”
Vanneste said a bus ride to Dar es Salaam, the capital of Tanzania, from far flung villages can cost more than a month’s wages, and family finances are normally controlled by men.
The problem was noticed by Vodacom, the country’s biggest cellphone network. Last year Vodacom started using its cellphone-based money transfer service, M-Pesa, to SMS the bus fare to affected women.
CCRBT and Vodacom have now appointed a team of 60 “ambassadors” to travel around the country diagnosing women with the condition. Within an hour of an ambassador finding a patient a date is set for surgery and money for transport is texted to the ambassador, who takes the patient to the bus stop.
The ambassador subsequently receives $3 when the woman presents herself for surgery, to ensure that the money is not misused.
Earlier this summer, Vodacom Tanzania presented the details of the project to the directors of Vodafone, its British parent company. The scheme proved an immediate success with Vittorio Colao, Vodafone’s chief executive, who has made the charity one of the key projects for the company’s charity, the Vodafone Foundation.
Last week Colao visited some of the patients in Tanzania, and tonight kicked off a fundraising drive in London. Vodafone has committed to a $12-million programme to scale up the project, in an effort to clear Tanzania’s backlog of 24 000 obstetric fistula cases by 2015. The company has said it will match all donations made by its staff and customers. Mobile users will be encouraged to text a donation to the service during a charity day next May.
Dr Elizabeth Mason, director of the World Health Organisation’s maternal, newborn, child and adolescents health unit, said Vodafone’s plan was a “very welcome initiative that will support women who are often really ostracised when they have this terrible condition”.
Mason’s colleague, Dr Matthai Matthews, said that fistula is one of the biggest challenges to maternal health in Africa, affecting more than 2.5-million young women.
“It is a problem that often affects young girls in their teens who become pregnant before their bodies are ready,” he said. “It can be a very traumatising condition, and also causes a major social problem because untreated women are outcast from society.”
‘Terrible, preventable condition’
While the condition is most often contracted in young women, Vanneste said he has treated some women in their 70s and 80s who have lived with the condition for more than 40 or 50 years. “These women have been living with this terrible, preventable condition for a life time: it’s truly shocking,” he said.
Cleophas Rugalabamu said that many of the affected women are so poor that they cannot afford to buy sanitary towels to use to stem the discharge that the condition causes.
“In the villages, families often have just one bucket of water a day. To clean herself, a women with fistula can need two buckets,” she said. “Women will do anything to be clean - if they can’t afford tampons, they will rip up their dresses and use them.”
Obstetric fistula is a very rare in the Western world, where women have access to hospitals and midwives. Most fistulas occur when the baby is badly positioned; under such circumstances in the west, the baby would be normally be delivered by caesarean section.
Mobile phone banking is more advanced in Africa than the UK, with many Africans using their mobile phone to make purchases, pay utility bills and send money to friends and family across the country. Analysts McKinsey estimate that 80% of adults in sub-Saharan Africa do not have bank accounts, and the Consultative Group to Assist the Poor (CGAP), an international agency that specialises in microfinance, estimates that 1.7-billion people in the developing world will have cellphones—but no bank account—by 2012.
Vanneste said mobile banking is so widespread in Tanzania that church congregations use their phones to make donations rather than placing money in the collection plate. The M-Pesa service works even on basic cellphones that cost less than $10.
The prevalence of mobiles in Africa has already made them a key weapon in the fight against a host of diseases, including HIV/Aids, malaria and polio.
One woman’s story
“I am 28 and proud mother of four children, three boys and a girl. When I felt that the labour pain of my fifth child started, I rushed to the local dispensary in the neighbourhood. The arm of the baby was already out by the time I arrived there but the baby was stuck.”
Miriam (not her real name) was referred to the hospital in Singida. She paid a taxi driver to take her there, but they ran out of petrol in the middle of nowhere. “I was so angry at the taxi driver. I had paid him to bring me safely to the hospital but we never made it. I was in so much pain.”
The doctor that accompanied her decided to pull the baby out. By that time it was midnight and Miriam was nearly unconscious. “I couldn’t move or speak but I did hear the doctor saying that my baby was stillborn.”
Early in the morning somebody came with petrol for the car. Because the doctor had removed the placenta, Miriam decided not to go to the hospital, but to return home. “I washed myself with warm water, ate some porridge and was happy to be alive. A couple of days later I started working again on the ‘shamba’ [Kiswahili for garden]. I noticed that I was leaking, but it didn’t feel like I was peeing. I wondered if this was the ‘fistula’ problem I heard about on the radio.
“It was very embarrassing. My husband had almost left me already once before when I gave birth to our fourth son, a tiny baby with cerebral palsy. At that time we could resolve our problems but when he discovered I was leaking he went to my mother and told her that he couldn’t take it any more, and he would leave me.
“My mother answered that he should take care of the three oldest kids while she was going to make sure I received treatment. I took our youngest child along.”
Miriam’s mother borrowed some money from neighbours and took her to the hospital in Singida.
The doctor confirmed that she had a fistula and referred her to CCBRT. Through the M-Pesa money transfer system, CCBRT sent her the money for transport to the bus station at Dar es Salaam.
“I was afraid to come to Dar es Salaam. I had never been here before and only heard horrible stories about the city. Fortunately a driver of CCBRT picked me up when I got from the bus and brought me immediately to the hospital. A couple of days later I had my surgery and now, three weeks later, I’m dry.”
“As soon as I arrive in my hometown, I will talk and talk and talk about fistula so that no women has to suffer from this problem anymore. CCBRT offers good quality services and really helped me to recover from the trauma of my latest delivery. ” - guardian.co.uk