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Blog: Duke University student on fistula outreach in Tanzania

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This summer, Duke University student Korrine Terroso had the opportunity to take part in a community outreach initiative in rural Tanzania funded by Fistula Foundation. In the following blog post, Korrine recounts her experience.

This summer, I had the privilege of accompanying a community outreach team on a 10-day trip to identify women with obstetric fistula and link them to surgical care. The trip was funded by a grant from the Fistula Foundation to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. KCMC is a regional referral hospital and one of five specialized centers for obstetric fistula surgery in Tanzania. The program is led by Dr. Gileard Masenga, a highly skilled and passionate fistula surgeon who works tirelessly for the health of Tanzanian women. Dr. Masenga conducts about five fistula surgeries per month, but feels that the program can handle many more cases and that the needs in the community for fistula repair are still not being met. It was on this basis that he applied for and received a grant from the Fistula Foundation for outreach activities.

The outreach trip traveled to Kilindi, a rural area about 10 hours drive from Moshi. Our goals were to identify women with fistula and refer them for care at KCMC, provide information to the community about obstetric fistula in order to raise awareness about the condition for both prevention and care, and to connect with local leaders who could continue with objectives one and two after we left.

The outreach team was led by Lucas Toroya, a fierce advocate for women’s health who is based out of Selian Lutheran Hospital in Arusha. KCMC and Selian work closely together to provide fistula repair services in the Northern Tanzanian region. In order to accomplish the outreach objectives, we interacted closely with community members, local leaders, and health care providers. Our goal was to spread the word about the free surgical repair for fistula at KCMC, and to identify women who needed this service.

To begin, everywhere that we went, each of us carried a stack of flyers and brochures to give to each person that we talked to. The flyers contained information about what fistula is, what causes the problem, and the treatment that is available. In addition, it contained contact information for the hospitals that are providing treatment. This contact information allowed potential patients and their families to confirm where the patient is suffering from fistula and plan the necessary transport to get treatment at KCMC.

Secondly, we gave presentations at public gatherings. These gatherings included the public market, a church, and clinics. At each place, Lucas would give a 30-60 minute presentation about everything related to obstetric fistula. He would use that time to determine what the community knew (or believed) about fistula, dispel myths, and provide accurate information related to the social stigma attached to fistula, the cause, and the treatment available. At the end, we would once again pass out flyers and brochures, and allow those who knew someone who might have a fistula come forward to speak with us.

Finally, we had numerous meetings with local leaders. During that time, we would begin by asking questions focused on understanding what people from that area knew and believed about fistula. Then, we would ask whether that person would be willing to help us to raise awareness about fistula, and identify women living with the condition. If they seemed capable of assisting us and were willing, we would share with them all of the necessary information then provide them with flyers to share, and contact information if they learned about women with fistula.

At the end of the trip, we returned to KCMC with four fistula patients. One of these women was a young (18 year old) Maasai while the other three women were older and had lived with fistula for many years, and in one case, decades. Only one of these women knew about treatment, and she had previously attempted to get treatment but the surgery had failed. In addition to these four women, we also identified four additional women who likely had obstetric fistula and were not yet ready to travel to Kilindi because of Ramadan (the Muslim holy days) or harvesting responsibilities. KCMC continues to be in touch with these women, and is now helping to facilitate their transport to KCMC.

In addition, the connections we made during the outreach trip are bearing fruit in the identification and referral of fistula patients. A clinical officer who we got to know has now taken it upon herself to go out into the community and identify women with fistula and help to get them to KCMC for care. We reimburse her transportation funds and provide a small incentive (~$6) for each fistula patient she sends to KCMC, but it is clear that the motivation comes from her desire to see these women get repaired.

In total, we expect that because of the Fistula Foundation’s investment in this outreach trip, at least ten women will have reached KCMC for surgical care for an obstetric fistula. Their lives will be changed beyond measure.

My experience on this outreach trip convinced me that there is no substitute for face-to-face contact to identify women with fistula who need referrals to care. While popular media – radio, TV, newspapers, billboards – are important for raising awareness about fistula, outreach trips like this one take it one step further, allowing us to have conversations about fistula that dispel myths and reduce stigma, and giving us the opportunity to meet women with fistula and their families and tell them about the opportunities for a cure.

As an undergraduate student, being part of this trip has given me a much greater understanding of the challenges of maternal health care in East Africa. It was a humbling experience, and deepened my commitment to dedicate my career to women’s health. I am grateful to Duke University, and particularly my mentor Dr. Melissa Watt, for empowering me to have this experience. Most importantly, I am grateful for the Fistula Foundation for their untiring support of women with obstetric fistula globally.

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