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International Day to End Obstetric Fistula '15

Diana lived with the shame and discomfort of fistula for 23 years. Four weeks after successful surgery at cbm partner hospital, CCBRT, Diana is thrilled to return home and spend time with her friends and family.

On International Day to End Obstetric Fistula (23 May 2015) we speak with Dr. Vindhya Pathirana, obstretic surgeon and head of the vesicovaginal fistula (VVF) department at our partner organisation, CCBRT in Tanzania.

cbm: Please tell us a little bit about your organisation and how it addresses fistula
Dr. Vindhya Pathirana: Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) is a disability hospital which was established in 1998. Fistula treatment started in the hospital in 2000. By 2009 the hospital was repairing 150 to 160 patients per year. When I joined CCBRT in December 2009, there was no fistula department. Fistula surgeries were carried out by the orthopaedic department.

In the month of December 2009 the ward was empty. We had just 16 beds, one surgeon and one assistant medical officer. I told the management that I had worked in rural areas before and I knew that fistula was a much bigger problem. I was convinced that if we can bring people to us and provide health care, we would achieve something.  After a lot of discussions, we had the crazy idea of transporting the patient. But how do we send money for them to come to us? With the help of M-Pesa, a mobile phone based money transfer system. So we started asking people who knew any woman who was leaking urine or faeces to call a toll free number. When we were convinced that this is indeed a fistula condition, we send money for the patient to come to CCBRT at Dar es Salaam. The patient is given free accommodation, surgery and meals throughout her stay.

Our first donor who came forward to do the pilot project of 6 months was UNFPA. The first six months the number of patients doubled and then tripled. Then Vodaphone contacted us - they were interested in using Mpesa in a hospital, so they came on board for the funding for the rest of the programme.

cbm: How does fistula impact women?
Dr. Vindhya Pathirana: Fistula I think is a social and human rights issue!  A woman loses her dignity when she gets fistula. She becomes a social outcast, her own husband and parents cannot tolerate the smell, and she becomes a burden to the society.

cbm: Can you describe the fistula situation in the African countries you operate in?
Dr. Vindhya Pathirana: First of all obstetric fistula is not yet recognised as a cause of near miss maternal mortality. One of the causes of maternal mortality is obstructed labour. Now a woman who experiences obstructed labour either loses her life or she lives with urine and faecal incontinence with some tears which do not allow her to walk at all. So a woman who gives birth to a child should have maximum protection during child birth. It's a global responsibility.

cbm: How does your organisation identify women suffering from fistula? How do you seek out these women in remote communities?
Dr. Vindhya Pathirana: CCBRT has community programmers around the country, hence to spread the word of fistula is easy, also to recruit ambassadors (people who find fistula for CCBRT) was easy. We provide awareness raising and outreach services in selected hospitals. Today CCBRT plays a major role in treatment of fistula in Tanzania. The fistula patients get complete holistic care, with counselling services, hygiene and education, nutrition and skills development training. There is follow up of patients for 6 months after discharge. We also have a centre which teaches girls to learn crafts. We provide instruction and counselling for family planning and birth preparedness. Normally a patient stays a minimum of two weeks in the hospital after surgery.

CCBRT receives fistula patients from all over Tanzania. Currently it is a referral centre for fistula and reconstructive surgery. We go from region to region looking for hidden patients and bring them to hospital for treatment. Since we have community based programs it's easy to get information about such patients.

cbm: Have you conducted fistula surgeries on women with disabilities?
Dr. Vindhya Pathirana: Yes I have operated on women who had disabilities. The most traumatic experience is when girls with disabilities who have been raped by their own family members then got pregnant and ended up with fistula. Then you find the triple discrimination- gender, disability and fistula. But there were also patients who were supported by their husbands, who finally got on with their lives.

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