We expect this will be the first contribution of many to support fistula repair services in centers throughout the country.

It was great to be able see the supplies on both sides of the world – first at headquarters in Santa Barbara, Calif. and then more than 7,000 miles away in Niger, the country that ranks second to last in the world on the Human Development Index, a composite measure of health, education, and income.

Dr. Sanda Ganda, the lead surgeon at CNRFO, told me he was happy to receive these supplies and that they are of superior quality. Dr. Sanda estimates that 360 women will receive treatment for obstetric fistula at this center in 2014.

Present at the hand-over were representatives from Her Excellency the First Lady of Niger and the Guri Foundation; the Director General of Reproductive Health from the Ministry of Health; representatives from Direct Relief’s local partner Women and Health Alliance International (WAHA); and 61 women who have received treatment at the Center.

The fistula ladies joined the group for a photo and were happy in the ward when we did a round, showing off their handicraft skills they learned through the Center.

The post From the Field: Fistula Repair Supplies Arrive in Niger appeared first on Direct Relief.

Nearly six months ago, Bridget*, 28,  received fistula repair surgery at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi during the UNFPA Malawi outreach fistula repair camp that Direct Relief supported with surgical supplies. While traveling, I was able to meet Bridget and her extended family who live in the rural Mangochi District.

*indicates name has been changed for privacy purposes

Bridget became pregnant with her first child when she was very young – around 13 or 14 years of age. When she went into labor, her family encouraged her to stay at home with a traditional birth attendant. She labored for four days before it was finally decided she should go to the hospital.

Upon arriving, she received a cesarean section. They removed her stillborn baby. Soon after leaving the hospital, she started leaking urine continuously, but didn’t know she had developed an obstetric fistula – a hole in the birth canal caused by prolonged and obstructed labor.

Bridget lived with the condition for 13 years. During this difficult time, she had sores on her legs because of the constant wetness. She said she felt like a baby because she was continuously leaking. Moreover, her husband abandoned her.

Bridget felt ashamed and preferred to isolate herself from her family and friends.  When she went to the field to garden she said it was as if someone was pouring water down her legs, which made it nearly impossible for her to do her work. It was a burden she was unsure she would ever overcome.

Fortunately for Bridget, she met a very supportive man during this time who wanted to marry her despite the challenges she faced. She was raised by her aunt and grandmother, and her family stuck by her side, even though she felt ashamed and embarrassed by her condition. Her family was sad she could not come to the mosque because she was unclean and therefore could not participate in religious life so important to their community.

One day, she met an outreach worker who was conducting community meetings to raise awareness about obstetric fistula. She learned about her condition and that help was available. At first, her family was afraid to let her go for treatment, as she would have to travel more than 200 kilometers to Queen Elizabeth Central Hospital (QECH) in the big city of Blantyre. But eventually, they encouraged her to try her luck and see if she could get help.

Bridget received surgery repairing the physical wounds to stop the leaking in May 2013 at QECH. While there, she was joined by over 60 women who also received treatment. She had no idea that so many other women also suffered from this condition. Together, they made handicrafts while on the ward, and supported each other during their two week post-operative stay.

Nearly six months later, back at home, Bridget is happy and dry. She says she no longer has pain from the sores on her legs and she is able to freely socialize with her friends and family. She is now able to go to the mosque and this year – for the first time in over a decade – was able participate in the observance of Ramadan, a very important holiday for her family and community.

Her husband sits beside her and says she is doing much better and he feels that she is much improved. When she first came back after her operation, her family couldn’t believe she was cured after so many years living with the condition. They kept checking where she sat to see if it was dry until they really did believe she was better. They all gather around Bridget to express their support, and to offer their gratitude that this service was available her, as well as to others that may suffer.

In order for Bridget and other women like her to receive fistula repair, hospitals must have the necessary medicines and surgical supplies. Direct Relief is dedicated to providing the necessary supplies to QECH and other hospitals providing fistula treatment in Malawi.

While the supplies are not sophisticated or high tech, they are critical for the operation and post-operative care. Ms. Grace Hiwa, coordinator of UNFPA Malawi’s fistula program, says that the donation of supplies from Direct Relief that arrived prior to the camp last May made it possible for Bridget and the other women to get treatment. This was because there was a major shortage of the appropriate size Foley catheter—an essential item for fistula repair surgery—which could not be found anywhere in hospitals and private pharmacies through the entire country. Ms. Hiwa emphasized that the Direct Relief donation came at a critical time and allowed the camp and treatment for these women to go forward.

Judging from the large number of women that turn out at every UNFPA-supported fistula camp and the long waiting list that remains, there is a serious need to continue and accelerate availability of fistula repair services in Malawi. As long as there is a need, Direct Relief is committed to providing the medical and surgical supplies critical to support this life-transforming care.

The post Life After Fistula: A Malawi Survivor’s Story appeared first on Direct Relief.

Walking into the post-operative ward at Queen Elizabeth Central Hospital, in Blantyre, Malawi, the room full of more than 80 women erupt into song, expressing their happiness to be dry and the chance to live free of their condition.

They are celebrating the end of suffering from obstetric fistula, a debilitating childbirth injury that occurs primarily during  prolonged, obstructed labor and leaves the woman with a hole in the birth canal, causing chronic incontinence.

With just a couple days left of the three week fistula repair outreach camp, organized by the United Nations Population Fund – Malawi (UNFPA – Malawi), an estimated 82 women from districts throughout Malawi and neighboring Mozambique will receive free treatment. The women range from 15 to 50 years old and had lived with the condition for as little as a few months to more than 20 years.

Direct Relief provided the essential medicines and medical supplies to support the fistula treatment services at Queen Elizabeth Central Hospital in partnership with UNFPA Malawi. Direct Relief also supports the fistula repair services provided at the Bwaila Fistula Center in Lilongwe, Malawi, as well as over 25 facilities throughout sub-Saharan Africa and South East Asia.

One young woman on the ward, Esmie (pictured above), was 17 when she became pregnant. She did not receive any pre-natal care during her pregnancy, so by the time she went into labor she felt it was too late to seek help at a health facility. She went into labor on Friday, and stayed at home with only her grandmother until she finally delivered on Sunday. The baby was stillborn. She began leaking immediately but for several years was unable to find help.

Finally, after hearing from her aunt that treatment might be available at Queen Elizabeth Central Hospital she came seeking help—and was registered for an operation during the twice-annual outreach camp. She is feeling better now and she is ready to go home and tell other people that help is available. She hopes she will be able to start a business selling fish, and hopes at some point to get pregnant again, at which point she will attend antenatal care visits and will come to the hospital when she goes into labor.

The post Fistula Surgeries Provide Renewed Hope for Women in Malawi appeared first on Direct Relief.

When Phoebe was just 15 years old, she became pregnant and suffered from a condition no woman should have to endure – obstetric fistula, a hole in the birth canal caused by prolonged and obstructed labor.

She is now a fistula survivor who lives in the Siaya District of western Kenya, but her journey to recovery wasn’t easy.

Upon becoming pregnant at such a young age, she was unable to continue going to school. Phoebe lives in a rural area far from the nearest hospital, so when her labor began she decided to stay at home.

After 20 hours in labor and no progress, she finally made the long trip to the nearest hospital, however, once she arrived they had no ability to provide an emergency cesarean section. She was referred to another hospital, but by the time she got there, it was too late. She delivered a stillborn baby.

Not only was the young girl devastated by the heartbreaking experience, but when she returned home she discovered she was leaking urine uncontrollably – a common symptom of obstetric fistula. Neither she nor her family understood what she was suffering from and they waited for it to go away.

Finally, after a year of suffering with the condition – which made it very difficult for Phoebe to carry on a normal life – she traveled to Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, Kenya, where she was screened and booked for treatment with the support from Direct Relief’s Kenyan partner organization, the OGRA Foundation.

Phoebe had a successful fistula repair operation and she feels relieved and happy to no longer be leaking urine. She is excited to go back to living a normal life and hopes to resume her studies now that she is healed.

Courageous women like Phoebe are the reason why Direct Relief is committed to ensuring others like her have a chance at hope and healing by providing its partners like the OGRA Foundation with the medical supplies needed for repair surgery.

Direct Relief continues to grow its program to support health and hope for women affected by fistula with a goal of enabling 10,000 surgeries over the next three years.

Find out more about obstetric fistula at this link. To support the effort and help make a difference in the lives of women like Phoebe, click here.

The post Young Kenyan Fistula Survivor Returns to School appeared first on Direct Relief.

The Aberdeen Women’s Centre (AWC) is the only facility in the country that is dedicated to providing comprehensive care for women living with obstetric fistula, one of the most devastating injuries that women can suffer during childbirth.

Their first-ever Direct Relief donation included many of the items that Aberdeen Women’s Centre requires on a daily basis to provide high-quality surgical care, including sutures and catheters, syringes and needles, pain medication, antibiotics, infection control supplies, and incontinence products.

“The supplies and drugs from Direct Relief are of superior quality and came in at a time they were really needed,” said Samuel Munywoki, the Fistula Program Manager at AWC.

“Some of the drugs have been very difficult for us to get in the past but are important for fistula cases. These drugs and medical supplies have and will continue to contribute to the success of the project particularly the fistula ward and operating theatre. It is a big gift. Thank you for your kind donation to Sierra Leone and Aberdeen Women’s Centre.”

Since the facility was founded in 2005 by Mercy Ships, it has provided life-restoring fistula repair to over 2,000 women. The facility is now managed by the Gloag Foundation.  In 2012 alone, more than 220 women received life-restoring fistula repair surgery.

Beyond ensuring high quality surgical treatment, Aberdeen also runs a maternity clinic to care for women during pregnancy and childbirth in order to prevent fistula and reduce maternal mortality. Last year, 1,093 babies were safely delivered at the facility.

But Aberdeen Women’s Centre provides more than just medical care. It’s a place of hope and happiness for many women who suffer from fistula.

Samuel Munywoki explained, “The women come here and are very down and depressed, but when they come here they are appreciated, they are given clean clothes, and they meet a whole group of women with the same problem and they come to know that they were not the only one. They see those that are happy. They feel at home after suffering for some time.  After repair we give them a new dress and then we sing and dance, we have a “Glady Glady” so they feel honored. When they are dry they want to go home and tell their villages ‘now I’m dry, I’m different, and I have a new life.”

The post Women With Fistula Feel at Home at Aberdeen Women’s Centre appeared first on Direct Relief.

Obstetric fistula is a devastating childbirth injury that happens when women lack access to skilled birth attendants and emergency obstetric care. The condition is largely treatable with a surgical procedure.

Direct Relief supported the camp by air-freighting a shipment of essential medicines and medical and surgical supplies in response to an urgent request from UNFPA. The shipment arrived just in time to be put to use during the camp.

According to the report submitted by the UNFPA Malawi office, the Direct Relief supplies were particularly crucial because of a nationwide shortage of Foley catheters, one of the tools most essential for obstetric fistula repair.

Additionally, the donated supplies from Direct Relief allowed the hospital to spend its limited resources on procuring food for the patients, instead of spending the money to purchase medicines and supplies.

As indicated in the report by Dr. Ennet Chipungu, Medical Director of UNFPA Malawi, this was very helpful since it is critical that the patients have food, but it is often difficult to have a sufficient stock when the fistula patients stay a long time in the hospital and come from very far, rural areas.

The report also noted that the incontinence pads provided were a big relief and comfort to the patients, who remarked being very happy they had this extra support during their recovery.

Women who live with obstetric fistula often live lives of isolation and suffering. Fistula repair gives them an opportunity to regain their sense of dignity and self-respect, and allows them to return to their communities as healthy and hopeful individuals.

UNFPA Malawi is looking forward to the next camp scheduled for this fall and has requested Direct Relief’s assistance in providing medicines and supplies. Dr. Chipungu commented, “We just want to appreciate the speed in which you were able to send the supplies to us after we signed our partnership agreement.  We are very grateful.”

Direct Relief looks forward to partnering again with UNFPA Malawi and Queen Elizabeth Central Hospital to ensure women in need have access to timely fistula treatment.

The post Women in Malawi Receive Life-Restoring Fistula Treatment appeared first on Direct Relief.

Five fistula surgeons from across the country assisted with 106 repairs over the course of the camp, which was coordinated by EngenderHealth. This far surpassed the initial target of 80 women.

Obstetric fistula is a hole in the birth canal caused by prolonged and obstructed labor. Without treatment, a woman with obstetric fistula will experience constant and uncontrollable leakage of urine and/or feces.  In addition to physical injuries, many women with fistula suffer humiliation, isolation, and stigma as a result of the smell and constant leakage. After undergoing repair, these 106 women are now able to return to a healthier, more hopeful life.

Direct Relief provided essential medicines for the camp,  including a range of antibiotics, pain medications, and anesthesia to support the effort. These basic medications are critical to fistula repair surgery and post-operative care. Without them these important services would not have been possible.

In a follow up email, Dr. Rose Mukisa Bisoborwa, the country project manager for EngenderHealth in Uganda, expressed her excitement for the women as well as her gratitude for all who were a part of the camp’s mission.

“I wish to take this opportunity to thank all that have supported this camp and consequently contributed to making a difference in the lives of these 106 women. We are so indebted to Direct Relief,” she wrote.

Dr. Bisoborwa said a closing ceremony was attended by national and local government officials, religious leaders, hospital administration and staff, and the women and their families who had benefited from the repair.

During the closing ceremony, two women that received treatment provided heartfelt testimony about what it meant to live with the devastating condition for so many years, and how they felt hopeful and happy after now having finally received treatment.

The event was well covered by a number of media outlets including the Uganda Broadcasting Corporation (UBC) and Wavah Broadcasting Services (WBS). The footage of the closing ceremony was aired as part of an effort to promote awareness and advocacy for fistula services.

The post 106 Women Receive Life-Restoring Fistula Treatment in Western Uganda appeared first on Direct Relief.

Direct Relief was recognized and thanked by the Minister of Health, Head of School, and all dignitaries at the event—as well as by the graduates themselves—for imparting this very valuable contribution that will help provide the right tools for the new midwives to save lives in their communities.

Carrying a large banner declaring “The World Needs Midwives Now More Than Ever” the processional of graduates and students proudly filed into the graduation ceremony, singing with great enthusiasm the song that had come to symbolize the heart of their commitment: “No, no, no, pregnant woman should die when she is giving birth…we are going to stop that in Sierra Leone.”

Meeting the Challenge in Sierra Leone

Sierra Leone has some of the highest maternal and infant mortality rates in the world, the most recent data (2008) indicating 847 maternal deaths per 100,000 live births. The majority of these deaths are preventable, and having a trained and equipped midwife present during delivery is one of the most critical interventions to save lives.

This fact was not lost on the graduates and dignitaries at the ceremony—the midwives committed themselves to doing whatever was in their power to always provide quality and compassionate care, and to bringing Sierra Leone up from its undesirable position at the bottom of the index for maternal and infant mortality.

The School of Midwifery in Makeni is only the second school of Midwifery in Sierra Leone, and the first outside the capital of Freetown, which makes it more accessible to students from the rural areas. The school has now trained 135 midwives—with the first set of graduates joining the health workforce last year—and has a primary emphasis on placing midwives at the Community Health Centers that are serving women and children in the more rural areas, far from the town and hospitals.

The Minister of Health and Sanitation, Hon. Miatta Kargbo, provided the keynote address during the ceremony and she commended the school for raising the bar in the professionalism of nursing and midwifery and encouraged the graduates to meet the challenges of reducing maternal and infant mortality.

The Right Tools to Save Lives

Direct Relief is working to improve maternal and child health in Sierra Leone by ensuring that midwives are equipped with the right tools to enable them to provide life-saving antenatal, delivery, and post-partum care. All graduates from the School of Midwifery in Makeni are equipped with a Direct Relief Midwife Kit that contains essential equipment and supplies that can be used at the community health center where they are posted following their training.

The midwives train for two years to prepare themselves with knowledge and skills they need to provide quality health services; but for a midwife to be successful it is also critical that they are equipped with the right tools. Marie Sheriff ,who was recognized during the ceremony as “Best Overall Graduating Student,” said of the importance
of having the Direct Relief Midwife Kit: “You don’t send a farmer to the field without a hoe. And you can’t send a midwife to the community without the tools she needs.”

Sierra Leone is one of the few West African nations to allow men to train as midwives as they recognize the importance in involving men—often the key decision makers in the family—in the overall strategy to improve maternal and child health. So far, there have been only a few male graduates from the School of Midwifery Makeni, but in a symbolic gesture the Head of School nominated a male midwife to accept the Direct Relief Midwife Kit on behalf of the Class of 2013 during the ceremony.

In 2011, Direct Relief and MRC committed to working together to ensure that all graduates from the School of Midwifery Makeni could begin their placements with the essential supplies and equipment that they needed and also to re-supply the materials as they are consumed. To date, Direct Relief has supplied 135 Midwife Kits that are placed throughout the country and plans to support the 130 midwife students in training that will graduate in 2014 and 2015.

The Minister encouraged the graduates as she wrapped up her speech:  “The world needs midwives now more than ever. So go out there and serve your communities with dignity, respect, and professionalism…the school has adequately prepared you for the challenges ahead. I hope you will make a positive difference as you go out in the world to render services to humanity; go out and serve the citizens of this great nation.”

The post Sierra Leone Midwife Graduates Equipped to Save the Lives of Mothers and Children appeared first on Direct Relief.

As a remarkable man who embarked on his course of transformative work as an obstetrician gynecologist more than fifteen years ago, the story of Dr. Mabeya showcases one amazing individual that Direct Relief has the privilege of working with to restore health and hope to women living with this condition.

Beginning in West Pokot as a newly trained medical doctor, Dr. Hillary Mabeya noted a significant number of women coming to the hospital with obstetric fistula, including symptoms of constant leaking of urine and sometimes feces, and in desperate need of assistance.

At the time, there was nothing to be done except send the women home and tell them to wait—usually one year—until a visiting surgeon from Nairobi was available to come to the hospital for a few days to provide treatment. For Dr. Mabeya, meeting these women only to send them away in such an unfortunate state was the turning point when he decided to take a stand to help these women lead more dignified lives.

Dr. Mabeya set to work obtaining his Master’s in Obstetrics and Gynecology at Nairobi University, while also training in fistula repair under pioneering surgeons and later at the Addis Ababa Fistula Hospital, the preeminent center for fistula repair and training.

Throughout the years, Dr. Mabeya has remained committed to treating women in Western Kenya and at hospitals around the country, but because of the ever-constant number of women seeking fistula repair; the inability of existing health facilities to meet the demand; and his passion and ability to do something about it, Dr. Mabeya was motivated to think even bigger.

In 2009, Dr. Mabeya committed to opening the Gynocare health facility while simultaneously undertaking a PhD at Ghent University in Belgium, and constructing his family’s home in Eldoret. Jokingly, Dr. Mabeya refers to this remarkably busy, yet exciting, period as part of his mid-life crisis.

Dr. Mabeya remains humble and gracious in acknowledging the many donors and supporters that have made Gynocare a reality. “I am most grateful for the kind donation and this will most be useful as we start fistula surgeries and care of fistula patients,” said Dr. Mabeya when the first shipment of medicines and supplies  was received from Direct Relief. “The donation has come at the right time when we are embarking on starting surgeries.”

With a fistula ward full of women, the needs are numerous and the experiences are deeply moving; from a sweet 15-year-old young girl who obtained the condition as a devastating result of an arranged marriage and no access to care during pregnancy and delivery, to an 83-year-old woman who has lived her life with the condition after being told for decades there was no hope for treatment.

Gynocare is one of ten fistula repair facilities in seven countries Direct Relief supports works with to bolster local efforts to treat women living with obstetric fistula. Direct Relief is pleased to count Gynocare Fistula Center as one of our partners, and Dr. Mabeya is always appreciative: “I am serious when I say because of Direct Relief we were able to open Gynocare and start performing surgeries. When we had the supplies we needed, we knew that we could start.”

The post Physician Spotlight: Dr. Hillary Mabeya appeared first on Direct Relief.

Obstetric fistula is a hole in the birth canal caused by prolonged and obstructed labor without prompt medical intervention. Fistula affects impoverished women in remote areas, far from medical care, and causes chronic incontinence that can lead to severe medical problems and social ostracization.

According to the Pakistan National Forum on Women’s Health, roughly 4,000-5,000 new cases of fistula occur annually in Pakistan. The current capacity to treat women with fistula in Pakistan remains at about 400-500 women per year.

The End Fistula Challenge Program is a partnership between Direct Relief, Janum Network, Abu Zafar Institute of Medical Sciences (AZIMS), and the Fistula Foundation. The program will focus on expanding treatment to five hospitals in high-risk districts in the remote areas of Pakistan with the goal of providing life-restoring fistula repair surgery for 400 women over the next 12 months.

Considering that approximately 400 women received fistula repair in Pakistan in 2011, this program will double the number of women in the country receiving treatment this year. This program will also address the financial constraints, lack of skilled human resources, and low awareness of treatment availability that impede access to fistula treatment.

The program will improve awareness of obstetric fistula in remote areas and enroll more women in treatment by training 200 health workers. The newly trained health workers will work with members of their community to increase knowledge of treatment availability and prevention activities.

The program will provide training in fistula management and ensure that the selected centers have personnel trained in fistula care. Capacity building efforts will also focus on fistula prevention through training of midwives, doctors, and gynecologists. Such efforts will help improve emergency obstetric and newborn care and early detection of obstructed labor, ultimately reducing the incidence of this condition.

To help women become productive members of their communities once again, rehabilitation of women following fistula repair surgery will be another important component of the program. Women will receive health education sessions and vocational skill development training after they have healed from their fistula surgery.

Direct Relief is thrilled to start 2013 with the initiation of such an important partnership that will do so much to transform the lives of women living with obstetric fistula and help prevent needless suffering through critical prevention efforts.

The post Partnership Launched to Fight Fistula in Pakistan appeared first on Direct Relief.

Direct Relief’s partnership with Bumi Sehat was initiated immediately following the 2004 Indian Ocean Tsunami, and has evolved over the years to become a longstanding commitment to support Bumi Sehat’s tireless efforts to improve the health of mothers and children of Indonesia. In 2011, Bumi Sehat served more than 33,000 patients and community members through their holistic health services, attended more than 500 deliveries, and provided more than 6,400 pre-and post-natal care check-ups and home visits.

Ibu Robin Lim, the founder and director of Bumi Sehat, who was named 2011 CNN Hero of the Year for her life-long commitment to saving the lives of women and children, shared a heartwarming note in response to learning about the grant support in memory of Glenda Martin. Excerpts from the message follow below:

Dear Direct Relief Family:

I am in tears. There are just no words in English or in Bahasa Indonesia to tell you how much gratitude I am feeling for your support. Direct Relief has strengthened our vision and supported our work for so long, through many disasters and heartbreaking times. You have given me hope, when I was hopeless… and you just keep giving. Thank YOU…

…We live in times of religious strife and unrest between cultures, yet in this small clinic in Bali, harmony prevails and life-long bonds are formed between families who would otherwise shun one another. Healing comes on so many levels and brings so many surprises to us. We set out to provide much needed medical care, especially reproductive health services, and the side-effect has been a community bright spot, for building and inspiring peace between people…

…As a team we know we are the hands of Bumi Sehat. You; Team Direct Relief, and all our supporters, are the HEART. For the heart pumps life, nourishment and oxygen to the body… without you, the heart, there is no Bumi Sehat, no Healthy Mother Earth Foundation. For our very existence and for the opportunity you give us to continue the work we love, Thank YOU.

~ Ibu Robin and Team Bumi Sehat.

The post Improving the Lives of Mothers and Children in Indonesia appeared first on Direct Relief.

Here at Direct Relief, we are collaborating with ministries of health, nongovernmental organizations and leading healthcare companies to equip front-line health providers in 45 developing countries throughout sub-Saharan Africa, Asia, and Latin America with the supplies they need to provide HIV testing, treatment, and support for people living with or at risk of HIV infection.

On World AIDS Day, Direct Relief celebrates two key programs that made substantial gains in preventing HIV infection in children and improving quality of life for people living with HIV/AIDS in 2012.

In June, Direct Relief, along with its supporters Abbott and the Abbott Fund, reached a major milestone by distributing 20 million rapid HIV tests free of charge to HIV testing and counseling programs serving pregnant women and their families in 43 developing countries.

By making sure health providers have rapid HIV tests to serve their clients—the first step in preventing mother-to-child transmission of HIV—Direct Relief is excited to be part of the remarkable progress made in recent years in reducing new infections among newborn children.

To date, more than 150 partner organizations have participated in the program, serving more than 8,000 health facilities. HIV-positive mothers identified through the program can be referred to anti-retroviral therapy to help prevent their child from being infected with HIV.

The UNAIDS 2012 World AIDS Day report indicates that half of the global reductions in new HIV infections in the last two years have been among newborn children, perhaps one of the biggest achievements in the global fight against HIV/AIDS.

In celebration of World AIDS Day, Direct Relief is releasing the Diflucan Partnership Program Map, an interactive map that highlights the significant achievements made by Diflucan Partnership Program since 2000, including the provision of over 89 million defined daily doses of Diflucan to people living with HIV in 60 countries in sub-Saharan Africa, Asia, and Latin America.

The Diflucan Partnership Program seeks to improve access to Diflucan (fluconazole), an essential anti-fungal medicine, for patients living with HIV. In Fiscal Year 2012 alone Direct Relief distributed more than $122.6 million in Diflucan to governments and nongovernmental organizations free of charge.

The Diflucan Partnership Program is critical to ensuring HIV patients with two serious fungal infections—cryptococal meningitis and esophageal candidiasis—have the treatment they need and can lead healthy and productive lives.

The post Celebrating Victories in the Global Fight Against HIV appeared first on Direct Relief.

This is a personal From the Field story by Direct Relief Staff, Lindsey Pollaczek.

More than 300 delegates gathered in Dhaka, Bangladesh last week at the International Society of Obstetric Fistula Surgeons (ISOFS) Congress 2012. The meeting theme this year: Fistula: An Injustice to Women- Let’s Work to Bring Justice, calls upon all of us to work together to address this devastating childbirth injury, suffered by an estimated 2 million women in developing countries.

The meeting is well attended by fistula surgeons, public health professionals, and advocates from more than 35 countries, all eager to share the latest research and achievements, and discuss remaining challenges in our work to treat, prevent, and rehabilitate women with obstetric fistula.

On behalf of Direct Relief, I presented the Global Fistula Map—the largest and most comprehensive source of information for fistula treatment services worldwide—at Thursday’s Plenary Session.

The map, which was launched in February 2012 and recently highlighted in the UN Secretary General Report on efforts to end obstetric fistula, has been an important tool to help improve our understanding of the current capacity for fistula treatment, enhance collaboration, and improve allocation of scarce resources to help more women living with this debilitating condition.

The Global Fistula Map currently displays over 175 facilities in 40 countries that provided roughly 15,000 fistula surgeries in 2010—a far cry from what is needed to address the estimated 50,000-100,000 new cases each year, not to mention the estimated 2 million women currently living with the condition.

The conference has been an excellent opportunity to interact with many renowned surgeons that Direct Relief supports with essential surgical and medical supplies for fistula repair, and a great forum to meet additional surgeons and advocates that are likely to be excellent future partners.

Direct Relief has been supplying medical and surgical supplies to hospitals providing fistula repair services since 2003, and currently works with 10 facilities in sub-Saharan Africa and Asia. We are excited to continue this work, and expand our network to do even more.

Among the many great colleagues I interacted with, it was particularly great to catch up with Dr. Steve Arrowsmith, one of the most well-known and respected fistula surgeons in the world, who is also once of the nicest and most genuine people I know (and loves to tell corny jokes).

Just a few weeks ago, we were able to respond immediately to an urgent request from Dr. Arrowsmith for a year’s supply of sutures, one of the most critical supplies for fistula surgery, which were provided by Ethicon, one of Direct Relief’s many healthcare company partners actively supporting fistula repair efforts.

Dr. Arrowsmith had just come from Cox’s Bazar Hospital for Women and Children in southern Bangladesh, a hospital that Direct Relief has been working with for over three years, where his objective was to provide additional fistula repair training to the local surgeon and treat as many women as possible (they managed to do 24 cases).

It was fantastic to hear about the work being done at Cox’s Bazar Hospital from our main contact, Dr. Iftikher Mahmood, the founder of the hospital, and Kate Grant of the Fistula Foundation (also a terrific Direct Relief partner), who is providing funding to support the fistula surgery at the hospital.

I left the conference inspired and invigorated by the many fantastic individuals I have met and reconnected with at this conference. With so many talented and committed people in this community I feel fired up that we can really make a big difference in the lives of women living with obstetric fistula, particularly if we work together to really move this important work forward.

Editor’s note: The Global Fistula Map was migrated to the Global Fistula Hub in 2020 to better understand the landscape, known need, and availability of fistula repair services around the world.

The post Global Fistula Map Presented at International Conference appeared first on Direct Relief.

Beatrice developed fistula – a hole in the birth canal caused by prolonged and obstructed labor – after laboring at home for two days in the presence of a traditional birth attendant. The distance to the hospital was too far for Beatrice to travel, and she stayed at home until her situation became life-threatening.

By the time Beatrice arrived at the hospital, the baby was stillborn and she had started leaking urine uncontrollably. She also developed foot-drop, which made it difficult and painful for her to walk, as a result of nerve damage caused during the prolonged labor.

The staff at Homa Bay Hospital – several of whom received training in obstetric fistula management six months before during a camp sponsored by The Fistula Foundation – recognized the condition and advised Beatrice and her family to go to the Nyanza Provincial General Hospital where she could receive surgical repair. Beatrice’s family arranged transportation to Kisuma, about two hours from her home, where she was admitted for surgery in May 2012.

Beatrice’s treatment was successful and she is no longer leaking urine. The pain in her leg is feeling better and most of all she is happy to be back in school. She thinks she would like to have children, but only after she has finished her studies and she is ready to have a family. Beatrice’s mother is  relieved her daughter is back to good health and feels she has a bright future.

Thanks to the availability of fistula repair at Nyanza Provincial General Hospital and the quick referral from health workers trained to recognize her condition, Beatrice did not suffer the severe stigma and isolation that many women with fistula endure.

When girls and young women like Beatrice develop fistula, it is imperative they have treatment as early as possible and a strong support system to minimize the heavy toll that fistula can take on their physical, social, and psychological well-being.

Neither Beatrice nor any woman should suffer from such a devastating, preventable injury. In Kenya, an estimated 3,000 new obstetric fistula cases occur each year – approximately one to two per 1,000 deliveries. The UNFPA estimates that only 7.5 percent of women with fistula are able to access treatment.

As we strengthen prevention efforts, it is essential that women living with fistula also have access to the treatment they need.   The collaboration between Direct Relief, The Fistula Foundation and the OGRA Foundation has made this possible for Beatrice and more than 300 women who have received life-transforming fistula treatment at the Nyanza Provincial General Hospital since 2009.

Update (03/04/2013): Nyanza Provincial General Hospital recently changed their name and is now known as the Jaramogi Oginga Odinga Teaching and Referral Hospital.

The post Fistula Repair Surgery Restores Hope for Young Kenyan Woman appeared first on Direct Relief.

Down a bumpy dirt track nearly three hours south of Hargeisa, the capital of Somaliland, Edna Adan and I crawl our way to the town of Baligubadle, just steps from the Ethiopian border.

At the Maternal and Child Health Center in this small town, which serves approximately 25,000 in Somaliland plus those from neighboring Ethiopia, we meet Sado, a 25-year old Community Midwife who has been hard at work providing health care to the mothers and children in this community for four years.

Sado was part of the first class of graduates from the Edna Adan University Hospital training program for Community Midwives, one of the remarkable programs instituted by hospital founder Edna Adan. When asked why Sado decided to become a Community Midwife, Sado said it was the lack of trained health providers in her community that made her interested in this work. Having a trained Community Midwife present in every village in Somaliland is part of Edna’s vision to reduce maternal and newborn mortality across the country.

The purpose of the Community Midwife is not to replace the doctor, who has a critical role in providing emergency cesarean sections for women experiencing complications, but to serve as a front-line health worker providing care in often rural and remote parts of the country. Until now there have been few or no health providers that can provide high quality care during pregnancy, delivery, and in the days and weeks after birth in these remote Maternal and Child Health Centers.

When Sado was undergoing her 18-month training, the hospital frequently received women in labor from the Baligubadle area who arrived with very serious complications. Many times, they arrived too late for anything to be done. When Sado graduated she knew it was important for her to return to this rural area to use her midwifery skills to help women deliver safely at a health center near their home, and to use her knowledge to refer women with serious complications early to emergency care to save their lives and the lives of their babies.

Sado says she is happy that she has chosen this profession, yet she also recognizes the many challenges that midwives face working in a remote area like this, with limited resources: “Sometimes when we can’t help a woman we feel like running away. When we don’t have the equipment or means we feel very bad. But if we run away, there will be no one, and so we stay, and we do what we can.”

Today, Direct Relief is providing a Midwife Kit to the Baligubadle Maternal and Child Health Center to help Sado in her daily work of delivering women safely. The Direct Relief Midwife Kit, one of 40 donated to Edna Adan Hospital to be distributed to the Community Midwives that are practicing in similar areas throughout Somaliland, contains essential delivery instruments, basic diagnostic equipment and medical supplies to help a midwife like Sado put her training to use. Sado quickly recognizes all of the items in the Midwife Kit, and confirms readily she will be able to put them to good use. She is very thankful for the supplies and is particularly excited to see the headlamp, which she has not had before and will be a great help when women deliver at night since the health center has no electricity.

Sado is overcome with emotion when she is asked what Edna means to her—“She is like my mother,” she says. The remarkable Edna Adan, a woman with over five decades of midwifery experience and a fierce passion for instilling knowledge in young people, wraps her arm around Sado’s shoulder. “At my age you have to pass the torch, and I choose to pass it to them,” Edna says. “You have no idea how many lives she has saved, and this is why I continue to do what I do.”

The post Supporting Midwives in Somaliland appeared first on Direct Relief.

While rates of maternal mortality are still some of the highest in the world, according to the Director General of the Ministry of Health, they have declined from 1,600 deaths per 100,000 live births in 1997 to 1,044 per 100,000 births in 2006. Edna Adan Ismail and her hospital in Hargeisa, the capital of the autonomous region, have contributed significantly to improving maternal health in this region.

The Edna Adan University Hospital in Hargeisa was established in 2002 as the Maternity and Teaching Hospital to provide quality medical services for women and children. The first qualified nurse-midwife in her country, Edna spent more than three decades working with the World Health Organization as an adviser on maternal and child health and served as both Minister of Social Welfare and Minister of Foreign Affairs for Somaliland.

In her retirement from the United Nations, Edna dedicated her pension and other personal assets to build the hospital to address the grave health problems that endangered the lives of women and children. The hospital has expanded to provide care for all members of the community, and as the only referral and teaching hospital in Hargeisa, serves a vital role in the training of midwives, nurses, laboratory technicians, and pharmacists. Watch a New York Times video featuring Edna Adan Ismail.

Direct Relief has supported the Edna Adan University Hospital since 2005. Donations have focused on improving the hospital’s maternal health capacity, and in November 2005 Direct Relief supplied items to upgrade the operating theater and delivery room, including an examination table, operating room light, sterilizer, instruments, general and surgical hospital supplies, pharmaceuticals, and nutritional products. Direct Relief has provided the hospital with medical material support valued at more than $1.1 million (wholesale).

In 2009, Direct Relief expanded its support to increase the hospital’s ability to provide treatment and care for women with obstetric fistula, a tragic injury sustained during obstructed childbirth that leaves a woman incontinent and ultimately shunned by her family. In collaboration with the Fistula Foundation, Direct Relief has funded the construction and equipping of three operating theaters and the development of a training curriculum for midwives and nurses in obstetric fistula management. The grant vastly increases the hospital’s capacity to treat patients and its role as a leading teaching facility in the region.

Direct Relief is committed to increasing access to obstetric fistula repair surgery. When asked about the importance of providing fistula repair Edna remarked, “I am grateful as a woman and human being to be able to help women like them. People think I have given something but they don’t know how much I am getting. There is no bank in the world big enough to hold what I get from the satisfaction of seeing a woman who was leaking urine for 30 years leave the hospital and go home dry.”

The post Partner Spotlight: Edna Adan University Hospital, Somaliland appeared first on Direct Relief.

Until February 2011, Kabale District had only the Regional Referral Hospital offering emergency maternal care services. Bearing in mind the challenges common to all government facilities, it goes without saying that the Kabale maternal and child health situation could only be worse than the stated national situation.

Rugarama Hospital realized the need to establish emergency maternal care services as far back as 2004, however due to limited resources this dream went many years unrealized. Several attempts to start were made, but with key components lacking, they were always fruitless.  However, there was a ray of hope in April 2010 when officials from Direct Relief visited the Hospital with an intention to improve maternal and child health services in Kabale. It was on May 24, 2011 that there was a communication from Direct Relief as such “Direct Relief was committed to health system strengthening in Kabale in the years ahead, and to that effect was prioritizing establishment of Emergency Obstetric theater, based at Rugarama hospital.”

The district has since constructed a second operating theater and there has been tremendous improvement in maternal and child health service utilization at Rugarama Hospital. For the years 2008, 2009 and 2010 the total number of deliveries at the hospital was 55, 82 and 212 respectively. However with the introduction of emergency maternal care services by Direct Relief support the total number of deliveries of 2011 were 453 and already in the first quarter of 2012 deliveries are already 90 in total. Nearly 1/3 of the deliveries are by caesarean section. On August 5 2011, this was realized and there was an official handover of theater equipment required to establish emergency maternal care services.

In addition to theater equipment, Direct Relief supported Rugarama Hospital in establishing the second blood bank in the district and also a number of oxygen concentrators for use in the hospital neonatal unit that takes care of both neonates and premature babies- the only one in the region.

All these interventions have greatly improved both maternal and neonatal outcomes at the hospital and in the district at large.  The hospital is committed to putting the donated equipment to the intended purpose as it seems the only appropriate appreciation to Direct Relief for the offer.

The post Clinic Partner: Rugarma Hospital, Uganda appeared first on Direct Relief.

Gynocare Fistula Center, a nongovernmental organization in western Kenya, is dedicated to preventing and treating obstetric fistula – a hole in the birth canal that is caused by prolonged and obstructed labor. The center opened as an outpatient clinic in 2009 and expanded its services to provide fistula repair surgery in June 2011, with support from Direct Relief.

In just the few short months since Gynocare started admitting women with fistula, the small center has provided life-restoring treatment to over 70 women. By any standard in fistula surgery, this is a remarkable number to do within a few months’ time. To achieve this with one surgeon, in one operating theater, and with a small support staff,  is extraordinary.

Under the leadership of the dynamic and dedicated Dr. Hillary Mabeya, a fistula surgeon since 2003, Gynocare Center emphasizes a holistic approach to addressing fistula prevention, treatment, and recovery, including the woman’s reintegration into her community.

“I was operating the other day and a 55-year-old lady told me that now she can visit her daughter’s home to see her grandchildren because she is not ashamed anymore,” Dr. Mabeya reported. “Another young caretaker of a school told me that she can now reclaim her husband and her job after receiving the operation. These words of the two ladies make me work harder toward a fistula-free society.”

The center places a strong focus on outreach and advocacy to sensitize the community about obstetric fistula and to ensure that more women who need surgery can receive it free of charge at Gynocare Center.

Leading the outreach efforts is Sarah Omega, a fistula survivor who received successful reconstructive surgery from Dr. Mabeya in June 2007, ending her 12 years of suffering with the condition. Sarah is a strong advocate for obstetric fistula prevention and repair, rallying support for better reproductive health services and access to treatment for women living with this condition.

Direct Relief was introduced to Gynocare and its exceptional work through partnership with One by One, a Seattle, Washington–based foundation dedicated to eliminating obstetric fistula. After the introduction, Direct Relief immediately provided $25,000 worth of specifically requested medicines and surgical supplies to help Gynocare jumpstart its surgical services.

“I am most grateful for the kind donation and this will most be useful as we start fistula surgeries and care of fistula patients,” said Dr. Mabeya when the material was received. “The donation has come at the right time when we are embarking on starting surgeries.”

The 15-ward center remains full to the brim. As soon as patients are discharged, those already identified and waiting in their communities, are swiftly transported in to fill the vacant beds.  No hour, or day of the week is off-limits for Gynocare staff to be hard at work—it is not uncommon to find the team at 11pm or early on Saturday and Sunday mornings in the operating theater.

The goal is to ensure that the women don’t wait more than a day longer than necessary once they arrive at Gynocare—so within one or two days after arrival, the women are reviewed and counseled, receive surgical repair, and are on their way to becoming healthy and dry within an average 2-week post-operative period.

Gynocare’s mandate is to be an exceptional center for quality and accessible reproductive health services. Direct Relief is privileged to partner with Dr. Mabeya and the exceptional staff of Gynocare Center in its efforts to restore health and hope to women living with obstetric fistula.

The post Partner Spotlight: Gynocare Fistula Center appeared first on Direct Relief.

In Freetown, I meet Dr. Alyona Lewis and her dedicated staff at Aberdeen Women’s Center. The Center provides treatment and support for women who have developed a debilitating obstetric fistula as a result of prolonged and obstructed labor. Obstetric fistula is almost entirely preventable with improved obstetric services. In places like Sierra Leone and other countries in sub-Saharan Africa where access to and quality of care is inadequate, obstetric fistula still occurs at alarming rates.

In 2010, Aberdeen Women’s Center provided fistula repair for 189 women who came from all parts of the country and even neighboring Guinea and Liberia. The center includes a maternity ward (which was completely full during my visit) and an outpatient clinic for children. All services are provided free of charge.

The joyful rhythm of African drumming and singing rose up over the compound during my visit, happily interrupting my conversation with the procurement manager as we were discussing how Direct Relief could provide surgical supplies and medical materials to the center. I witnessed the Glady-Glady ceremony, a weekly celebration when the whole center breaks into song and dance to bid farewell and good luck to the women who are leaving to return to their villages. After staying about two weeks to heal following their fistula surgical repair, the women don a new dress and get ready to return home to their families and their community as a whole new person. The hope and positive energy of these brief weekly celebrations underscore the significant value of a center like Aberdeen.

The Center focuses on holistically healing women with obstetric fistula—repairing the debilitating physical condition and treating the emotional and psychological distress attached to the stigma of fistula. A three-month follow-up visit is required for every woman, to ensure the integrity of the surgical repair as well as providing an opportunity to share information on family planning and reproductive health. Dr. Alyona told me that when a woman returns, she often wants to learn about how to plan her family and is curious about her ability to have another child. (Women with a repaired obstetric fistula can have children but are counseled on the importance of having a cesarean section.)

The good news: The long waiting lists for fistula surgery in Sierra Leone have all but disappeared. While there are likely to be women that are harder to reach, or are tentative to come for treatment–many women from remote areas have never been to the Capital and are afraid to leave their village for an unfamiliar place–it is also possible that the incidence of fistula has decreased due to recent interventions to improve access to and quality of obstetric services. Aberdeen is planning an expanded outreach program in the coming months to areas not yet reached to offer help to women who still need treatment. Meanwhile, continued attention remains on improving obstetric care to prevent fistula and maternal death.

Someday, the fistula ward at Aberdeen Women’s Center will become obsolete, like the Fistula Hospital in New York City that was torn down 150 years ago and later became the famous Waldorf Astoria Hotel. Until then, Aberdeen Women’s Center will continue to play a critical role in restoring the health of women living with obstetric fistula and Direct Relief will remain committed to bolstering such important efforts.

The post Restoring Health to Women with Obstetric Fistula appeared first on Direct Relief.

About 15 percent of all deliveries will be complicated and will require emergency obstetric care. Many complicated cases can be managed at a lower level facility if the skilled birth attendant is trained in the management of basic emergency cases and has the tools they need to do their job. This skilled birth attendant is also trained to recognize the danger signs when a woman does require referral to a higher level of care where cesarean section and blood transfusion are available, and can make that decision promptly in order to save a woman’s life.

Successful emergency obstetric care requires three critical components: trained providers at each level of the health system who know how to manage and when to refer emergency cases; availability of the proper equipment and supplies to manage such cases; and a functioning referral system that can move a woman quickly to the appropriate level of care.

Medical Research Center (MRC), a Sierra Leonean nongovernmental organization and Direct Relief’s key partner in the country, is focused on providing inputs to each of these levels in order to improve emergency obstetric care. MRC has been working in Sierra Leone for more than 30 years and works closely with the Ministry of Health to improve healthcare delivery at the level of Peripheral Health Units (PHU), the health centers closest to the community that provide essential primary care and maternal health services. With support from organizations like Direct Relief, MRC distributes medicines, supplies, and equipment to the health centers that care for women in pregnancy and childbirth. MRC has also trained all healthcare workers that provide delivery services in basic emergency obstetric care and has established an ambulance referral system to transport women in emergencies to the nearest hospital.

But the nearest hospital is often very far away. To witness just how far, I traveled with MRC staff to one of their most remote operational areas, the chiefdom of Sambaia. For more than three hours we bumped over incredibly rough terrain which included a long, steep climb and descent through the hill country, then another hour of travel to reach the village of Bendugu. When we told people at the hospital in Makeni town that we were heading out to Sambaia, they all shook their heads and commented on the long distance and disadvantaged community. Our trip was in the middle of day in the dry season, but emergencies happen at the most inopportune times, like late at night in pouring rain. It’s difficult to imagine a woman in obstructed labor making this treacherous journey in any scenario.

This demonstrates the critical importance for MRC to continue improving quality of services in remote areas so that more woman can deliver safely at the health centers, and when a case requires emergency transport, the health workers are able to identify danger signs early enough to make the call and save a woman’s life.

Yele Community Health Center, also supported by MRC, is down the road in Bo District. Yele CHC has been selected as the basic emergency obstetric care referral center for its chiefdom of over 50,000 people. The community health officer in charge, Peter Konneh, is a dynamic man who is passionate about improving maternal health and proudly recognizes that the health center has had zero maternal deaths in the last few years, thanks to its work to educate the community and ensure that its staff is qualified to manage nearly all obstetric cases.

Peter was a young boy when the civil war broke out and rebels invaded his home village in Kailahun District in eastern Sierra Leone. It was a terrible time for thousands of Sierra Leoneans and Peter was one of many who were forced to flee their homes. After spending 10 years in a refugee camp in Guinea, Peter returned to Sierra Leone and trained as a community health officer, which is just below the level of medical doctor. Upon graduation, MRC employed him in 2006 and he was posted to Yele CHC, where he has committed to overseeing this important work for the long term.

Direct Relief has been working with MRC since 2008 and has provided three donations of medicines, supplies and equipment for the 32 health centers, hospitals, and the School of Midwifery in Makeni. MRC purchases medicines and supplies that are not donated, which is a significant expense. MRC is an excellent partner for Direct Relief; the medical supplies we provide do a great deal to support the primary care system and strengthen emergency obstetric care in Sierra Leone.

The post Improving Services for Obstetric Emergencies appeared first on Direct Relief.

Sierra Leone has one of the highest reported maternal death rates in the world. In 2005, the maternal mortality ratio was 2,100 deaths per 100,000 live births and a woman’s lifetime risk of dying due to complications in pregnancy and childbirth was 1 in 8. Long distances to health facilities, the cost of health services, shortages of health workers and essential drugs, supplies, and equipment, and the low status of women are familiar challenges in sub-Saharan Africa – and chronic issues in Sierra Leone.

But it’s not all bleak. In fact, the documented maternal mortality figures have slightly improved, and after spending the last few days traveling through Sierra Leone I have seen some encouraging interventions which improve quality of and access to maternal health services. These, along with the government’s introduction of Free Health Care Initiative for pregnant and lactating mothers and children under five in April 2010, are working to break down the barriers which limit a woman’s access to care in pregnancy, delivery, and the post-partum period. At Direct Relief, we focus on three key interventions which improve maternal health services and quality of life. In Sierra Leone, I uncovered each of these important interventions during my journey.

One of the most important interventions to reduce maternal death and disability is for women to deliver with a skilled birth attendant. The skilled attendant is able to manage normal deliveries and can recognize signs of life-threatening complications that require referral to a higher-level of care.

The School of Midwifery in Makeni, Bombali District, is the largest midwifery school in the country and is currently training 138 midwives. The new school is unique as it trains a lower level of nurse that previously was not allowed to enter midwife training. Only the higher level of nurse was able to train as a midwife, but they often elected to work in more attractive settings following their graduation: hospitals in larger cities or in management positions with the Ministry of Health. Therefore, most deliveries in primary health centers at present time are attended by maternal-child health aides and traditional birth attendants, neither of which qualifies for the title of “Skilled Birth Attendant,” according to the World Health Organization’s definition. The new generation of the midwives at Makeni will help change the current situation.

Bright and early Monday morning, the school was full of eager students working hard to gain the honor of becoming the first graduating class of the Makeni School of Midwifery in January 2012. Most of the midwives trained at Makeni will work in remote clinics in rural areas, where the needs are often greatest. I spoke with a few students who had been nominated by their peers to represent the class. They shared with me their appreciation for the training and their motivation for taking up the course. “There are certain things I used to do, maybe not the right way,” said student Ramatu Kano, “but now that I am in the program I have seen my mistakes and already corrected them. I am very happy to be part of this course.”

This is the first time that midwifery training has been open to qualified males, and several have enrolled in the program. Midwife-in-training Steven Ngaujah lost his sister when she died giving birth to twins without a skilled birth attendant present. “So many other women in Sierra Leone are in this position, so I was moved to be part of this work to see that maternal mortality is reduced in this country,” he explained. He recognized that his position as a male midwife in Sierra Leone was rare but he was willing to break down that barrier to see that women receive better care in pregnancy.

Once the midwives graduate from Makeni and are posted in rural areas, they must have the right equipment and supplies to use their new skills fully. Imagine spending two years in training only to be placed at a health facility that lacks the tools you need to do your job. This is a common scenario in Sierra Leone that is demoralizing for the health provider and potentially life-threatening for the women who need care. Direct Relief is working with the School of Midwifery in Makeni to ensure that when the midwives graduate they have the supplies they need.

“Now in the community and in the health facilities there are midwives working barely without equipment,” said Francess Fornah, the head of the school. “If we can equip the midwives with the midwifery kits and delivery sets then I think we have gone a long way.”

The midwife students agreed. “These [midwife kits] are very difficult to get here,” Ramatu Kano said. “This would help me to work in the community, and I would appreciate this very much.” When Francess introduced me to the first class of 72 students during the tour of the school and she announced that Direct Relief was equipping all of the graduating midwives, the students erupted in great applause.

The post Improving Maternal Healthcare in Sierra Leone appeared first on Direct Relief.

Today is the final day of the International Society of Obstetric Fistula Surgeons (ISOFS) meeting in Dakar, Senegal. It has been an incredibly busy few days as fistula surgeons and health professionals have come together to share diverse experiences, research findings, and recommendations for improving quality of treatment, management, and prevention of obstetric fistula. Representatives from more than 40 countries are participating in the conference, all sharing the common goal of working to improve fistula care and a vision for eradication of this preventable condition due to failures in maternal health care.

Representing Direct Relief, I have had the unique opportunity to engage with many of the preeminent fistula surgeons in the world. Many of the pioneers in the field are here, surgeons who have dedicated their careers to treating women with fistula, training other surgeons, and spearheading research to improve the outcomes for fistula care. Many more youthful faces from the next generation are here—motivated, committed, primarily African surgeons from all parts of the continent have come to learn from each other and improve their expertise in a region where the burden of obstetric fistula is highest.

The surgeons provide an essential service for helping restore the dignity of women living with obstetric fistula. Also present are advocates, community organizers, and public health professionals who are addressing the important areas of prevention of fistula through improved obstetric care and also social reintegration of women back into their communities after their physical wound has been healed. This community recognizes that it is simply not enough to surgically repair the fistula and send a woman on her way after she has lived often for many years with a highly stigmatizing and socially humiliating condition. The conference theme acknowledges the increased effort which must be made not only to treat the physical condition but to ensure that women can return to normal, healthy lives in their community.

A great deal of good work is being done by many organizations across Africa and Asia to address obstetric fistula. A shared understanding of exactly where these services are located and the current capacity for treatment remains elusive. Direct Relief is working together with ISOFS and the Fistula Foundation to help illuminate this information in a way that is accessible to all stakeholders.  Using our experience in GIS (geographic information systems) technology, Direct Relief hopes to help create powerful tool for everyone in the fistula care community—to understand the current landscape for treatment, help identify unmet need, and provide a tool to guide decisions on future resource and service allocation.

Direct Relief is currently providing surgical supplies to support fistula-repair programs in seven hospitals across Africa, many of which are represented here.  It is clear through the level of engagement at this conference – and by the preliminary results of the fistula treatment mapping – that there are many more facilities where surgical supplies are needed. Working together with healthcare companies like Johnson & Johnson, Ethicon, Covidien, and CR Bard, Direct Relief hopes to support more surgeons so they have the supplies they need to do this valuable work.

This gathering has reassured my confidence in Direct Relief’s decision in making fistula care and prevention a central part of its maternal health strategy over the next five years. There is a lot of good momentum and energy here at this conference. We all agree that a lot remains to be done.

Now off to the closing ceremony and to the work ahead!

The post United in Prevention appeared first on Direct Relief.

“For the last two and a half years Direct Relief has been supporting Maridi County Hospital through its partnership with AMREF in Southern Sudan.  Maridi County has an estimated population of at least 500,000, but in reality no one knows the true population size as people are still returning from the refugee camps in Uganda and the Democratic Republic of Congo after 21 years of civil war in Southern Sudan.

Maridi County Hospital is the only hospital in the area and the only facility able to perform any kind of surgical procedure. The next nearest hospital is in Yambio, a two-hour drive in the dry season and significantly longer in the rainy season.  In 2006 the Government of Sothern Sudan, in partnership with UNICEF, WHO, UNFPA, USAID, and others, released a household health survey.  It found that of all the states in Southern Sudan, Western Equatoria, where Maridi is located, had the worse maternal mortality rate, with 2,327 women dying out of every 100,000 who give birth.

After experiencing the roads and remoteness, visiting the hospital, and seeing for myself the lack of medical staff, sadly, I understood why this number is so high. Women aren’t coming to the medical facilities because the facilities aren’t properly staffed or equipped. Clearly, the training programs for clinical officers and midwives are essential, and I’m proud that Direct Relief supports them. The need is everywhere.

At Maridi County Hospital the staff was doing what they could with what they had. The equipment in the operating theater is more than 20 years old and desperately needs replacement. The operating table no longer adjusts in height and the lights are broken except for one fluorescent light in the ceiling. Anesthesia is administered through the spine. There is no sterilizer; all surgical tools are boiled over charcoal. Blood transfusion takes place on-demand, as there is no blood-bank refrigerator to store it. The good news, however, is that the hospital has its own borehole (or well), so it has access to clean water and has a functioning generator for power.  There are currently two doctors and four clinical officers working in Maridi County Hospital, and 10 nurses and midwives run the 24-hour labor and delivery ward.

With the support of some generous foundations and others, Direct Relief has committed $63,500 to equip Maridi County Hospital to provide emergency obstetric care services. The theater has been renovated and, once equipped, will allow for increased training for the clinical officers.  A container for Maridi with donated medicines and supplies will ship with the procured emergency obstetric equipment this fall and should arrive at the beginning of next year.

In 2006 there were approximately 58 midwives in all of Southern Sudan, serving an estimated population of 10 million.  Since that time, three midwife schools (two of which are now located at the National Health Training Institute, where the clinical officers are being trained) have trained an additional 151. The majority of births take place in the home attended by mothers, mothers-in-law, traditional birth attendants (TBA) or maternal-child health workers (MCHW).

The community midwife program at NHTI is an 18-month-long, Ministry of Health–recognized program.  While visiting Maridi I observed the midwife students on rotation at the hospital and sat in on a class teaching the signs of labor and recognizing when a mother has reached the second stage of labor.  The instructor also explained what a fistula is, why it develops, and how a midwife can help prevent it. Earlier that day I had asked Christine, the head midwife at NHTI, if fistulas were a concern here. She replied, “Oh, yes, fistula is quite common and no one here can do the repairs. The girls are delivering quite young.  Many get pregnant when they are 12, 13, and 14. They are too young to be having babies.”

After some investigation I learned that there is one surgeon in Juba—five or six hours away in the dry season—who is trained, but neither he nor any other trained surgeon has been to Maridi to do repairs. Christine and other AMREF staff were eager to have a fistula repair camp and to offer additional training to the graduated clinical officers.

Today, the hope of access to safe delivery in Southern Sudan lies mostly with NHTI. It is the only school for clinical officers in all of Southern Sudan and trains two-thirds of the country’s midwives.”

The post A Hope for Safe Delivery appeared first on Direct Relief.

“Dr. Mike Marks and I just returned from visiting AMREF and the National Health Training institute (NHTI) in Southern Sudan. NHTI was established in 1998 as a school to train clinical officers.  In 2006 it began training community midwives and is now running a third training program, for public health officers. NHTI has graduated 269 clinical officers and 26 community midwives; the first class of public health officers has yet to graduate.

There are 38 third-year clinical officer students, of which Direct Relief is supporting 30. They are currently in the field in Yei and Torit, 75 miles and 186 miles away from Maridi. These locations were chosen because of the staffing and medical supplies available at these facilities. The students will spend one month working within a health unit and two months at the hospital before returning to Maridi in October for final classes and exams. In November, each student will select his or her preferred location for internship.

Because the one-year internship does not pay, locations are selected based on where the students have family or friends that they can stay with. Preferences must be submitted to the school for approval.  The students will have the month of December off and will begin their internships in January 2011. Although graduated in November 2010, the students will commemorate their graduation in November 2011, as graduation ceremonies are held every other year.

Clinical officers are in high demand in Southern Sudan.  Already now, four months before graduation, the announcement board at the school has notices of posts available. The accreditation received upon completion isn’t recognized outside the country, but within Southern Sudan, clinical officers are seen as the primary access to medical care, as doctors are in such short supply. Of those graduating, 99 percent find jobs and stay within the country.

During my visit I was able to meet, attend class with, and participate in rounds at the hospital with the year one and year two classes of clinical officers. I also spent many hours with the head midwife for the midwife training program, Christine Nakayenga. She is a petite woman, but she has an air of confidence about her and is determined to bring knowledge and access to safe birthing across Southern Sudan. We talked about what organizations are doing in the area and what still needs to be done.  She is a wealth of information. I will send more about the Maridi County Hospital soon.”

The post Better Health for Southern Sudan appeared first on Direct Relief.

For two hours we bump down a dusty red dirt road heading out of Soroti town toward the village of Kagwara, situated at the shore of Lake Kyoga, the second largest lake in Uganda. We are joined by members of AMREF Uganda and Terrewode, two organizations working in the Teso Region to improve outcomes for women during pregnancy and childbirth. AMREF Uganda, a longtime Direct Relief partner, is implementing a safe motherhood project in this region, and works with groups like Terrewode, which was founded in 1999 during the period of civil war to provide support to women and girls who were acutely affected by the conflict. Direct Relief works with indigenous groups like these to improve maternal health care, and today, we find ourselves heading deep into the bush of eastern Uganda, to the end of the road where maternal health complications often arise.

Ugandan women have an incredibly high fertility rate—nearly 7 children in their lifetime. Given long distances to health facilities, lack of means to cover the costs of transportation, and chronic shortage of supplies at all levels of the health system, the majority of births in the country happen in the village at home. Births which occur outside a health facility without the presence of a trained birth attendant are prone to risk and complication. Community sensitization and education is essential to promote the importance of attending antenatal clinics, having a birth plan, and delivering in a health facility, which takes the involvement of community-based organizations to be most effective.

A woman who experiences complications in delivery is in a really difficult spot if she comes from Kagwara village. The nearest health facility providing comprehensive emergency obstetrics care—a cesarean section—is back where we started our journey in Soroti town, two hours away in a sturdy 4×4 vehicle. The thought of making this journey quickly in unreliable public transport, or on a bicycle, is hard to imagine in the best of scenarios. It’s just too far. Add to that a woman who has been in labor for two or three days and you begin to understand why maternal death and disability remains high in this country. While there is a health center closer to the village which should be able to provide this service, there is no doctor that is on staff to oversee the operation.

If the delays in receiving a cesarean section are too long—delay in deciding to seek care when complications arrive, delay in reaching a facility where the procedure can be performed (for the laboring woman in Kagwara, only in Soroti General Hospital), and delay in receiving care at the facility (at Soroti General there is one theater that performs over 2,000 major operations every year)—major injuries, such as obstetric fistula, can develop. A woman left incontinent of urine and or feces due to obstetric fistula is a severe and heartbreaking consequence of lacking obstetrics care.

“We are mopping the floor but the tap continues to leak.”

The women in Teso Region are fortunate only in that competent fistula repair services are available at the regional referral center. Under the guidance of the consultant specialist Dr. Fred Kirya, about 50 women receive treatment annually. But here, like at all levels of the health system, there are challenges: lack of special supplies for the repair, the burden on the healthcare workers to take on additional work with no commensurate pay, and the demand on the one incredibly busy operating theater. Considering the barriers a woman with fistula will be confronted with all along the way, if she receives the repair it is truly a thing to be celebrated, as this is a procedure that is completely life-restoring. However, for every woman who is repaired, another will develop a fistula unless comprehensive improvements in obstetric care are made. Dr. Kirya acknowledged the great value and importance of fistula repair and his belief that there are many women with the condition which have not yet been reached. However, the preventive component is essential, because as he put: “We are mopping the floor but the tap continues to leak.”

Back in the village of Kagwara we talk with Terrorode volunteers and their local affiliate TEETE, a group of 26 community members concerned with uplifting the economic and health status of their people. Terrewode volunteers demonstrate the education which is provided on use of the mama kit—very basic delivery supplies including sterile gloves and blade, which can reduce the chance of infection and be a lifesaver for mother and child. In just two months since being trained by Terrewode, the volunteers have identified six women with fistula in their village and surrounding area. One of the ladies identified and educated about her condition sits quietly during the meeting—she has agreed to get treatment but is still unable to afford the transportation to the hospital. I fight the urge to put this woman who has already been through so much in our vehicle and drive her straight to the hospital; we discuss potential solutions to remedying this so that once a woman is identified and agrees to be treated, she can get the care she deserves.

We return by the same dusty road at dusk, whizzing past villages filled with children and pregnant mothers. I imagine the clock ticking down to the arrival of labor pains—I hope for the best outcome, but fear the worst. The challenges for a woman to receive proper care during her pregnancy and delivery are stark and myriad: distance, poverty, education, and a health system in need of serious repair. We at Direct Relief are working to equip midwives, doctors, and surgeons and the health facilities where they operate. This includes midwife kits (see above photo) which include basic materials for outreach to remote, lower-level health facilities; equipping the operating theater at the Health Center IV (one level below hospital) so that comprehensive emergency obstetrics care can be provided, bringing cesarean section capacity closer to the mothers while easing the demand on the hospital for this service; and equipping surgeons with tools for fistula repair.

During this brief visit, we have also identified areas where we hope to provide additional resources, working through local groups like Terrewode and AMREF at the village level and through government health centers and regional referral hospital. Our input alone will not solve all of the issues–deep-seated cultural, economic, and political challenges—but with these committed organizations and people, we’re moving toward improving health for mothers in pregnancy and childbirth.

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I woke up this morning to thunder rattling the window panes. Unlike yesterday’s brief and powerful storm, the rain has not stopped falling for the past two hours. I keep thinking about Gloria’s family in their small tin shell of a home. I hope it’s not raining in Snake Park.

Conditions in many townships of Soweto have improved markedly in the last few years—in the vast, sprawling area of 3 million some are living rather comfortably. Homes have TVs, running water, a gas stove. But you don’t travel far before you meet abject urban poverty. Our visit yesterday in the Soweto township known locally as Snake Park illustrated how dire the situation is for many, particularly those who are sick and poor.

The dark sky has been threatening rain for an hour, but the deluge starts just as we enter the final home of the day. I watch Sr. Freda and Wilhelmina, Soweto Hospice’s nurse and community health worker, offer words of support to their patient Gloria when  the downpour on the tin roof becomes deafening. The conversation fades as the sound of the rain overtakes the small space. Gloria’s daughters hurry to place small containers around the one-room home to catch the rain falling through the holes in the roof. The small puddles outside quickly turn to muddy rivers that begin to rush through the settlement. Twenty minutes pass and the rain stops as quickly as it has begun.  Sr. Freda and Wilhelmina say their parting words to Gloria and we pick our way through the mud back to our 4×4 vehicle and wave goodbye.  Freda and Wilhelmina are already thinking about when they’ll be able to come back—to bring a lifeline to Gloria and her family, to ensure she has adequate support to live comfortably with HIV in this terribly impoverished neighborhood of Soweto.

We are in Snake Park. The name conjures up a wild, inhospitable place. Nearly a decade ago, informal settlements started appearing in the grassy fields, apparently the original home to a number of resident snakes.  It didn’t take long before the fields were overtaken with tin shacks, the homes of tens of thousands of people who couldn’t afford to live anywhere else. I’m told that the government’s Reconstruction and Development Program is  undertaking infrastructure improvements here to provide better housing, water, and sanitation. Unfortunately, this is not at all apparent from Gloria’s neighborhood.

Gloria was diagnosed with HIV in 2006. Freda, a specialized nurse with six years of training, received a call from Gloria’s brother in 2007 and was asked to come by for a visit. When they first met, Gloria was very sick and barely able to care for herself. Since then, Freda has provided support all along the way through the many ups and downs in managing Gloria’s illness. This week Gloria is feeling relatively well, but she still has some chest pain and is coughing a fair amount. Last week Freda referred her to get a sputum test for tuberculosis and she is still awaiting her result. There is a good chance Gloria has TB, as co-infection among HIV patients is very high.

Gloria adheres closely to the antiretroviral regimen therapy she receives for free from the government. However, without a consistent supply of food, she struggles to remain healthy. The family has no source of income aside from the small government grant that her eldest daughter receives for her child. This is less than $28 a month to feed a family of five–not remotely enough.  Her HIV drugs will not have the maximum benefit if she is not able to keep herself well nourished. Food scarcity also affects her family. Her eldest daughter has epilepsy and had a seizure last time Freda visited. When asked if she took her medicine, she admitted she had not because it made her ill to take it on an empty stomach, and there was no food with which she could take it.

During their near-weekly visits, Freda and Wilhelmina often bring food if the hospice has it available. It is not always possible, because the hospice itself is very strapped for resources as it attempts to care for over 1,250 patients at home and many more in their pediatric and adult in-patient units for those requiring around-the-clock care. Gloria is just one of Freda’s 250 patients to which she provides home- based palliative care. But in Soweto, a township of 3 million, there are undoubtedly many people that cannot be reached.

Soweto Hospice is a member of the Hospice Palliative Care Association of South Africa (HPCA), an umbrella organization that provides financial and technical support to develop the capacity of its more than 150 member hospices. The hospice and palliative care approach is to improve the quality of life of patients and their families facing a life-threatening illness through prevention and relief of suffering. In sub-Saharan Africa, over 90 percent of patients have HIV/AIDS. Fortunately, with the support of nurses and community health workers like Freda and Wilhelmina, many HIV patients in hospice care are becoming healthier and learning to manage their illness as a chronic condition that can be kept under control. Direct Relief has supported the efforts of HPCA and its member hospices by providing donations of medical supplies which are needed in home-based settings and in-patient units. Wound care dressings, through support of Johnson and Johnson, are currently being distributed throughout the HPCA network.

The amount of compassion and commitment shown by the hospice and palliative care staff is admirable. With very limited resources they are managing to uplift many to good health and provide relief from suffering and pain for those that are nearing the end of their lives. They are just touching the surface of caring for people living with HIV, but they are wholly dedicated to providing the best care they possibly can.

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It’s Saturday night on one of the main streets of Kisumu town. Against the backdrop of a busy night scene—music blaring from a nearby shop, people of all ages milling about in the street—are six Coleman camping tents which have been set up on the side of the road. Three bare lightbulbs strung across the row cast a pale light over the tents, which tonight are serving as private consultation rooms for voluntary testing and counseling of HIV. People congregate outside the tents, waiting their turn for the free service, asking questions and raising concerns about HIV and its mode of transmission, treatment options, and what it will means to know their status. Inside the tents, which are all occupied, HIV counselors provide information on these very issues for people who would otherwise not make it to a health center.

Several days later, many miles north of Kisumu in Wenyila village of Bungoma East District, Florence and Matutu, two skilled counselors, go door-to-door in an HIV counseling and testing program designed to leave no one behind. This is their second week canvassing the village to reach all 140 households, which were alerted prior to their visit by a respected member of the community. Florence and Matutu carry their green Home Counseling and Testing bags over their shoulders, stocked full with HIV testing accessories, and the electronic handheld device on which they gather detailed information about the household and the individual’s HIV status. If someone in the household is HIV positive, the counselors will set up an appointment for them at the nearest health center, will even offer to accompany them to the facility, and will return to do a follow-up if the person does not make their appointment. High priority is given to pregnant women that are HIV-positive to ensure they will be able to access treatment to prevent the transmission of the virus to their child.

Innovative approaches such as the Twilight Voluntary Counseling and Testing and the Health at Home Initiative are important for making HIV testing and counseling accessible to more people. HIV testing and counseling is often referred to as the gateway to prevention, treatment, and care, because it is essential for people to know their status in order to stop the spread of the virus and to be referred to treatment without delay. While the number of health facilities providing HIV counseling and testing in sub-Saharan Africa has grown rapidly in recent years as governments work toward universal access to HIV prevention, treatment and care, a very large part of the population remains unaware of their HIV status.

Community-based approaches have great potential to reach the segment of the population that is not able to invest the time, effort, and resources to get to a health facility for testing. During the night I visited the Twilight VCT, supported by Ringroad Clinic in the Nyalenda slum and Marie Stopes Kenya, I talked to men and female sex workers who thought it very convenient that these services were being offered at a time (6 to 10 pm) and in a place where they could be easily reached. Men in general and commercial sex workers are two groups that often do not come for testing in a facility setting.  Florence and Matatu, the counselors with AMPATH (Academic Model for the Prevention and Treatment of HIV) were essentially reaching all community members, many of which did not have access to testing prior to the visit.  More than half of the people I met that day in their homes had never had an HIV test and knew very little about the virus.

The 2009 United Nations report on universal access to HIV prevention, treatment, and care discusses where the global health community stands on this internationally endorsed goal. Although many indicators are moving in the right direction, many countries are still far from reaching the goal of universal access. While the number of people in 2008 who received HIV testing and counseling increased over the previous year, recent surveys indicate that more than half of all people living with HIV are unaware of their status.

Direct Relief is helping to address this issue by providing donations of Determine rapid HIV tests in partnership with Abbott, so that more people are able to know their status, primarily pregnant women to work to prevent the transmission to their child. The rapid test is an important tool in diagnosing HIV, but universal access to testing and counseling—and to the essential treatment and care which must accompany it—is only going to be accomplished if a variety of strategies are used. Innovative approaches like the Home Counseling and Testing and Twilight VCT are bringing us one small step closer.

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These women have endured what women in the developed world will never have to endure. Many of us outside the public health circle do not know this condition. Why should these women have things any differently? Here are their stories—certainly sad but also hopeful, as they are some of the lucky few that have made it to a surgical center and have great potential to leave Bugando with their dignity restored.

Meet Celestina
Celestina is from Kigoma region along Lake Tanganika, many hundreds of kilometers (about 300 miles) from Bugando. She was in labor for three days at home with her eighth child. She did not have the bus fare to make it to the district hospital in time. When she finally arrived, her baby was stillborn and she had developed a fistula. During a routine outreach visit that the Bugando Medical Centre surgeons do in hospitals around the country, Celestina learned of the fistula repair services available at Bugando. (There were too many people on the waiting list in Kigoma for Celestina to be treated there.)

She had her fistula surgery two weeks ago and is healing nicely. When she is discharged from the hospital, she will be given  bus fare for her trip home. Only when she arrived at Bugando did she realize that she was not alone in suffering from this condition. She will spread the good news that treatment is available at Bugando to others in her village who may have fistulas.

Meet Nkwimba
In March, Nkwimba went into labor with her eighth child in her village in Shinyanga District. She was also at home and had no bus fare to the hospital, which was too far on bad roads. Nkwimba suffered significant injury in childbirth, including paralysis of her right leg due to prolonged obstructed labor, severe back pain, and two fistulas, vesico-vaginal (VVF) and rectal-vaginal (RVF). She has been at the hospital since May when her husband was able to afford to bring her to the VVF ward. Her leg feels much better now, and the RVF has been repaired. She is still waiting for her VVF surgery, which could be several more weeks, given the ever-expanding waiting list. It is amazing that she can still smile given what she has been through.

Meet Speciosa
Speciosa is from a small island in Lake Victoria. She is one of the older ladies in the VVF ward at 39 years old. Speciosa developed a fistula 10 years ago when giving birth to her first child, which was stillborn. Since developing a fistula, she has been divorced from her husband and has no children. She is waiting for her third surgery; the first two – performed  over the last five years – have not been successful. For many women, one surgery repairs the fistula. Speciosa remains hopeful. She has taken on a maternal role among the pre- and post-surgery patients in the VVF ward.

More than two million women worldwide suffer from fistula and have similar stories to Celestina, Nkwimba, and Speciosa. Eighty percent of these women are in Africa. Direct Relief can do a significant amount for them and for the incredible surgeons who have dedicated their life to helping these women who are the poorest of the poor. There are not many doctors who want to do VVF repair as it is a time-consuming procedure and more urgent cases take precedence (i.e. cesarean sections, which, of course, are critical to preventing the fistulas in the first place). Fistula repair is clearly part of maternal and child health that is at the core of what we do. Fistula does not directly cause maternal mortality—very often prolonged and obstructed labor results in the death of the child—but it is the worst kind of injury and morbidity in childbirth I can think of.

I realize what I’ve written sounds rather sad, but really it was a hopeful day as these women have access to treatment that will truly change their lives. The women were happy to tell me their stories and were laughing and smiling, and particularly enjoyed looking at their digital portraits.

Women must have access to cesarean section and good emergency obstetric care if the incidence of maternal and infant mortality and morbidity, including fistula, is to be reduced. Small steps are being taken by our partner facilities in Tanzania and throughout Africa to make this a reality. In select regions, Direct Relief is helping to facilitate the installation of operating theater suites that have enabled more women to get the care they need.

Until fistulas are eradicated in Tanzania—as they have been in the developing world—with the advancement of good emergency obstetric care, BugandoMedicalCenter’s VVF program and its outreach treatment services give women a reason to smile.

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