Obstetric fistula, an injury that occurs in unattended childbirth and causes incontinence, is among the most intractable challenges of extreme poverty.
In Tanzania, however, a pilot program that relies on mobile-phone communication has brought fistula sufferers in remote areas to a central hospital for reparative surgery. This strategy, if duplicated elsewhere, could offer hope of a new life for many of the estimated 2 million women afflicted with fistula worldwide.
A fistula is a hole that opens in the birth canal when a mother’s labor is prolonged. The pressure of the baby’s head on the soft tissue creates a gap between the vagina and the bladder and/or the rectum. After delivery (the baby usually dies), the hole remains so that urine, feces or both leak through the woman’s reproductive tract. This chronic incontinence is so severe, sufferers typically are abandoned by their husbands and families. They’re unemployable, too, and live as outcasts.
Most fistulas can be repaired, at a cost of about $300 a surgery. At least 239 facilities in Africa and Asia offer the procedure, often free, according to a project called the Global Fistula Map. Even so, in 2010, only 14,000 of the estimated 50,000 new fistula cases worldwide were treated. Afflicted women either weren’t aware of the procedure or couldn’t afford to travel to the surgical centers. This is why, until recently, the fistula ward at the Comprehensive Community Based Rehabilitation in Tanzania hospital in Dar es Salaam was underused.
In 2009, hospital staff members, with support from the United Nations Population Fund, decided to find the patients. They assembled a countrywide network of volunteers and armed them with mobile phones and basic training to identify potential patients.
Candidates were then diagnosed over the phone; those who appeared to be suffering from obstetric fistula were sent money for bus fare ($30 on average) through a mobile-phone money-transfer service, in care of the volunteer. Volunteers, in turn, received small incentive payments (about $3.50 a referral). This strategy has more than tripled the hospital’s fistula operations, from 150 in 2009 to 500 last year.
There’s no reason it can’t work in countries with the highest rates of fistula -- including Burundi, Chad, the Central African Republic, Somalia and South Sudan. Surgery units exist, although more are needed, and the costs are low enough that, even where donations are unavailable, the countries’ own departments of health should be able to foot the bill.
What’s more, private funding isn’t out of the question. After learning about how its phones and money-transfer system had made the Tanzanian program possible, Vodafone Group Plc helped fund the construction of a new fistula ward at the hospital, which opened in November.
Ultimately, the best answer to obstetric fistula is to prevent it. That requires expanding women’s access to birth control, to trained professionals with midwifery skills and to emergency obstetric care. In the meantime, the backlog of cases grows. Tanzania’s model shows how to take it on.
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