Reflections from my first trip back after 14 years away
By Lindsey Pollaczek, chief program officer at Fistula Foundation
Walking into the vibrant, blue-and-white building of Bugando Medical Center (BMC) in Mwanza, Tanzania, I am transported back to the start of my journey in the field of fistula care. I first came here 14 years ago. The scenes feel very familiar: Throngs of patients line the open corridors. Doctors and nurses scurry about. An intense energy—one that mixes sickness and despair with healing and hope—pulses through the hospital. The last time I visited BMC, I was here was on my first visit to Africa. That was also my first opportunity to meet with a fistula surgeon and with women who suffer from fistula.
This time, I’m with my colleague and friend Habiba C. Mohamed, and our guide is Dr. Elieza Chibwe, a soft-spoken fistula surgeon who has worked at BMC for nearly 10 years. Dr. Chibwe walks us through the fistula ward, introducing us to about 20 women in various stages of their healing journey—some in recovery, and others awaiting surgery. We walk past the office of Professor Gumodoka, the distinguished fistula surgeon I met more than a decade ago. His name plate still hangs over the office where he worked for most of his life. Now Dr. Chibwe and his colleagues have picked up where Dr. Gumodoka left off.
One of the patients under Dr. Chibwe’s care is Esther, a 19-year-old woman from the Simiyu Region. She was married last year, and went into labor with her first child in early September. Esther labored at home for three days before she sought help at a hospital near her home. The labor was painful. Healthcare providers kept telling her to push and push, until they realized that the baby wasn’t going to come out. She labored at the hospital for another two days before she had a cesarean section. Devastatingly, her delivery ended with a stillborn child, and with a case of fistula.
Providers at the hospital tried to manage Esther’s case by discharging her with a catheter, but she continued to soak her clothes in urine. She returned to the hospital twice more, and twice more they inserted a catheter, thinking that it would heal her injury. The fistula was large, and could not be closed through catheter treatment alone. Surgery was her only option. Once the providers realized that Esther’s case was beyond their skill level, they referred her to BMC for specialized care.
A Bright Future for Esther
Esther’s referral for fistula treatment is part of a larger trend that we’re witnessing in Tanzania. On the one hand, her gaining access to treatment just weeks after developing her condition signals real progress in the field of fistula care. On the other hand, though, her case reflects significant challenges that remain across our global network of partners. Increasingly, our partners are seeing cases that result from surgical errors committed by inadequately skilled providers. This trend is worrisome, and many of our partners are taking note of it. Building capacity to improve the quality of surgical services is high on their agenda.
Esther underwent fistula surgery 10 days before our visit. When we talked with her, she told us that she felt well but was eager to return home as soon as possible. when we asked Esther if she wanted another child, she smiled shyly and pulled her jacket up to hide her eyes. It is difficult to be young and childless in a culture that so highly values childbearing. Fistula patients like Esther are typically anxious to know whether childbearing is still possible after surgery.
Habiba, ever the reassuring counselor to the women we serve, told her it was still possible, as long as she followed the post-operative instructions that she would receive when she was discharged. Dr. Chibwe confirmed that her prognosis was good. The fistula was healing well, and she had been dry since undergoing surgery. He anticipated that she would return home with a bright future ahead of her.
FFTN Will Change the Game
This fall, as I visited our five partner organizations in Tanzania, I saw firsthand the need for high-quality, timely fistula treatment. Our partners are doing heroic work, but they need our help to work more effectively and more efficiently. Pressing needs that are common among our Tanzanian partners include improved coordination and collaboration, strengthened training of surgeons and healthcare providers at all levels, improved post-repair follow-up and reintegration programming, and reliable funding for fistula surgery.
Addressing those needs is what makes the Fistula Foundation Treatment Network (FFTN) model so groundbreaking, and so effective. In 2014, we launched the first-ever FFTN in Kenya as a pilot project. Using a network-of care-model, we worked to connect the myriad stakeholders involved in fistula care to the resources that they need to support women with fistula through all stages of the healing journey. The pilot worked, and indeed exceeded our expectations. We then modified and replicated the model in Zambia, and this year we launched FFTN in the DRC.
Faster Treatment and Better Support
In marked contrast to the women I met the first time I visited BMC—and have met in many hospitals and communities since then—Esther didn’t suffer for years with her fistula. Because she received surgery soon after developing fistula, she will be spared a lifetime of stigma, isolation, and anguish. Fistula won’t leave a deep or lasting scar on Esther. Early identification of her condition and timely referral for care provided her with an opportunity for a healthy future.
As we were wrapping up our conversation with Esther, her grandfather called her on her mobile phone. She picked up to let him know that she was okay, and that she would call him back when her guests had departed. Her mother was waiting for her to return home. Her husband, who supported her throughout the experience, was also waiting for her return. I was glad to hear that Esther had a whole support network waiting for her. This is a luxury that many fistula patients do not possess. They often need help in returning to society after fistula has robbed them of so much. Reintegration is an important tenet of the FFTN model, because healing continues long after a woman leaves the hospital.
I’m excited about what we can accomplish in Tanzania, and how we can better help women like Esther. As we look ahead to expanding the FFTN model to countries like Tanzania in the years to come, we at Fistula Foundation are confident that this approach will accelerate access to treatment for women in need. By building a network of care alongside our partners, we can ensure that no woman with fistula will be left behind.
Published on November 16, 2022