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Dead women walking

December 2011
Dar es Salaam, TanzaniaWant to embed this video?
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After surgery they go back home with their dignity restored as new ladies and mothers who can go back out there and have a wonderful life ahead of them."
After years, sometimes decades, of living as pariahs in their communities, a group of Tanzanian women finally have something to be cheerful about.

They all suffered from an obstetric fistula, which can occur during prolonged, traumatic complications while giving birth.

The child usually dies, and the mother is left with a fistula, or tear, between the birth passage and the bladder or rectum.

Without corrective surgery, the woman suffers incontinence for the rest of her life, often, ruining her life.

But at a disability hospital called Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), women can get corrective surgery for free, and with it, a new lease on life.

“One World Bank report called them ‘Dead women walking’”, explains Tom Vanneste, the hospital’s Deputy Director. “That’s how horrible their condition is, how they’re completely socially excluded and embarrassed. So they come here very much depressed, very scared, unsure of what their future is.”

Later, says Vanneste, they feel liberated: “After surgery they go back home with their dignity restored as new ladies and mothers who can go back out there and have a wonderful life ahead of them.”

Rukia Shabiby is one woman who’s long journey led here.

26 years ago, at the age of 13, she was married and became pregnant.

At such a young age, with her body still under-developed, the birth was traumatic, and ended in tragedy.

Her baby was still-born, and Rukia herself would soon discover that something else was very wrong.

During the birth she had suffered a fistula, though she had no idea what it was.

Rukia tells us that in the ensuing weeks, months and years, the odor and perception of uncleanliness led to her being shunned by the community.

And the great tragedy is that like so many other women and girls with this condition, Rukia thought she was the only one.

In reality, the United Nations estimates there are more than two million living with the condition.

In Rukia’s case, after years of suffering, she heard about CCBRT and traveled to Dar es Salaam for a successful operation.

She’s now ready for a fresh start.

“When she goes back,” says Eric Ndambiri, a nurse at CCBRT who helped Rukia through surgery and recovery, “she’s thinking that she’s going to be a good ambassador, to tell others that even you, who feels the condition is incurable, that somewhere there is a solution for your problem.”

As with other developing countries, many women who get fistulas are from poor, rural areas.

Even if they hear that they can be cured, they often don’t have the resources to even pay the bus fare to Dar es Salaam.

To solve that problem, CCBRT employs what it calls “ambassadors” to look out for ostracized women with fistulas.

When they find a possible case, they contact CCBRT for advice, and bus fare.

“When we are sure it’s a fistula patient,” says Tom Vanneste, “we actually use mobile phone money transfer system technology to transfer the money for transport to the ambassador, who basically gets an SMS that says ‘Look, you’ve received $20 from CCBRT hospital.’ He converts the e-money into cash, collects the cash, buys the bus ticket for the patient, helps the patient get on the bus, and basically we pick up the patient here at the bus station and operate on her the next week.”

After surgery, the women stay for at least two weeks to recover.

During that time they learn new skills, like crocheting.

In addition, 18 women are selected each year to stay in Dar es Salaam to be trained in sewing, printing and jewelry-making.

The Mabinti Training Center also teaches them how to speak English and run a small business.

“When I came here I said ‘Wow this is my new beginning. And I have to stick on this so that I can rebuild my life again,’” says Jane Rugalabamu, one of the trainees.

That new life won’t be alone. Jane plans to join with several of the women here to start a business.

Her other job, she says, will be to spread the word and make sure that women and girls don’t spend years in isolation for a condition that can be cured with an operation in less than two hours.
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