Field Notes: A 10-Hour Bus Ride and a Long Journey to Healing

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By Lindsey Pollaczek, Senior Program Director

Lupaula Province, Zambia — Amidst the throngs of women and children at Kabole Health Center in northern Zambia, twenty women slowly boarded a dusty green bus with Mansa General Hospital emblazoned in white lettering on the side. As the women took their seats and waited for the bus to depart, they were nervous, excited, and hopeful—chatting among themselves about the upcoming ride to the hospital, and how they may be able to receive treatment that would finally restore their health.

Their long journey to healing had just become a little closer to reality.

In January of this year, Fistula Foundation launched a new program in Zambia designed to significantly increase the number of women able to access fistula treatment, while also building long-term capacity for fistula surgery in the country. The initiative was made possible by the invaluable support of Johnson & Johnson—the program’s primary funder—and community partners on the ground.

After discussions with our partners at the Ministry of Health, the Luapula Province—a region in the far north of Zambia that borders the Democratic Republic of Congo—emerged as an area of predominant need.

The province has the highest rates of maternal death and morbidity in the country, a troubling distinction. A high level of poverty, early childbearing age, poor roads and infrastructure, and long distances between health care facilities all contribute to these rates.

Building Community Support

Lack of understanding and misconceptions about fistula are pervasive in the region. To address this information gap, Fistula Foundation—with the support of the provincial and district health teams—has trained 25 Community Health Volunteers. These volunteers are raising awareness and working to identify and refer women in need of treatment. Fistula Foundation has also sensitized over 200 civic and religious leaders to help strengthen community support.

On May 23, 2017, International Day to End Obstetric Fistula was commemorated for the first time in Zambia. Local leaders, government officials, and health service providers came to take part in the festivities near Kabole Health Center in the Chiengi District. Community leaders and government officials delivered passionate speeches, and a processional and rally through the town helped generate attention.

A Fistula Foundation event commemorating International Day to End Obstetric Fistula, May 23, 2017, in Kabole, Zambia.

Senior Chief Mununga, a highly respected local leader, joined the festivities and took up the drum as song and dance overtook the crowd. Advocates and women who had been treated for fistula danced side-by-side with the same women who were on their way to surgery in the dusty green bus.

As the event concluded, we witnessed these women board the bus once more. They continued their long drive down the road to Mansa—and towards treatment that would finally free them from the suffering caused by obstetric fistula.

Training Fistula Surgeons

Dr. Aubrey Shanzi

Dr. Aubrey Shanzi is a young and dedicated obstetrician gynecologist who recently trained in obstetric fistula surgery. He was the first OB/GYN to be posted in the Luapula province in over 20 years. The Chiengi District—ground zero for Fistula Foundation’s program and the most remote district in the entire province—saw its very first hospital open only three years ago. There are no paved roads in the district, no running water, and no electricity.

The lack of trained fistula surgeons is another major barrier for Zambian women to receive fistula repair surgery. In the whole country, there are less than five doctors who are able to perform fistula surgery.

This significantly limits the availability of services, particularly in hard-to-reach provinces, where women have to rely on annual “fistula camps” to access care. Fistula Foundation is working to train more Zambian surgeons so that fistula surgery can be institutionalized within the health system, and hospitals can provide the service more than once a year.

Through on-site training and surgeon mentorship at Mansa General Hospital—and a meaningful partnership with FIGO, the Federation of International Gynecology and Obstetrics—Fistula Foundation is taking steps towards improving the surgical capacity in Zambia, so that women from all parts of the country can have access to timely and reliable treatment.

Fistula surgery theatre at Mansa General Hospital in Mansa, Zambia

One Woman’s Story: Yvonne

After a 10-hour ride, Yvonne N’gandwe was one of the women who disembarked at Mansa General.  She was hopeful that the next time she got to ride in a bus, she would be riding in a dry dress for the first time in 17 years.

Yvonne, 36, is a mother of four from a village in Zambia’s northern Luapula Province. She developed a fistula during her first pregnancy in the year 2000, after a prolonged labor that lasted for several days.

Yvonne’s labor began around midnight, and she was first taken to a clinic where she stayed for more than 24 hours without delivering.  She then was taken to several other health centers and hospitals before finally arriving at a facility that had a doctor on duty.

After receiving an episiotomy procedure and being discharged from the hospital, Yvonne noticed that she was leaking urine. She returned to the hospital and was given medication. Yet, the medication did nothing to address her condition.

Living with fistula, Yvonne was ashamed of her smell and leakage. She stopped attending social gatherings and church rallies. Her first husband abandoned her. In 2006, she remarried a man who accepted her condition.

Yvonne continued to seek medical care, and a year later, she was advised to travel to the capital city of Lusaka for treatment—over 700 miles away from her home.  Bus fare was far too expensive for her to afford the trip.

In March 2017, her father heard information about fistula repair surgeries on the local community radio station. Yvonne followed up immediately and was screened over the phone. Just a few weeks later, she was given an appointment for surgery at one of Fistula Foundation’s partner hospitals, Mansa General Hospital.

Yvonne traveled with twenty other women on a 10-hour bus ride to Mansa, where she finally received treatment in May 2017. Now that she has found relief, she is feeling happy and grateful.

Yvonne’s strong desire is for Fistula Foundation to continue helping women affected by obstetric fistula and needing treatment. She knows there are still more women suffering the way she did for nearly two decades.

Between February and May of this year, Fistula Foundation has supported fistula repair surgeries for over forty women in northern Zambia at Mansa General and other partner hospitals.

Our work in Zambia is just beginning. Together, with the generous support of Johnson & Johnson and our entire donor community, we will be able to change the lives of so many more women who are still waiting for that opportunity.

Photography by John Healey. View more photos in this digital slideshow:

Yvonne, 36, is a mother of four from a village in Zambia’s northern Luapula Province. She developed a fistula during her first pregnancy in the year 2000, after a prolonged labor that lasted for several days.

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