A Team Effort for a New Life Free from Fistula

Written by: Leslie Stroud-Romero, UVP Executive Director

The first fistula camp of 2014 started in mid-January. I got the chance to visit Kamuli Mission Hospital and meet some of the women who were there for surgery, as well as one of the surgeons from the UK Childbirth Injuries Fund. It was a long and tiring trip to get to the hospital. Uganda Village Project (UVP) identifies women from all over Uganda’s eastern region to take for surgeries, and without these efforts, the women would never be able to make it to the hospital. 

I asked Loy, UVP’s fistula coordinator, how long most of the women who were there had been suffering with fistula before coming for surgery. “Some just a short time, but more often 20, 30, or more years,” she said, confirming what I’d suspected when visiting the women, many of whom looked middle-aged. I followed up by asking whether they hadn’t come for surgery earlier because they didn’t know it’s curable. “Sometimes,” said Loy, “but most don’t come because they don’t have the funds for transport.” 

There are very few facilities capable of handling fistula surgeries, and so women must travel several hours to be helped. They live each day leaking urine or feces because they lack the small amount that it would take to get them to the hospital, and can’t afford to bring food or necessities with them to the hospital. That’s where UVP and the UK Childbirth Injuries Fund step in. We identify women in very rural villages who suffer with fistula, cover their transport for the long, dusty ride to the hospital, and then provide a food allowance while they are there. Loy looks after them—her caring nature was evident in the way she spoke with the women and they came to her with problems—and then volunteer surgeons from the UK work in partnership with Ugandan staff to heal women through surgery. Each surgery takes just an hour or two: such a short time after years of dealing with the results of a fistula. 

The surgeon I met, Dr. Glyn Constantine, was a friendly guy who had just a short time to talk between patients. Without his support, and that of his colleagues, we wouldn’t be able to provide these surgeries to women. They say it takes a village to raise a child, and during my visit to the hospital I saw that it takes a community to support a woman in need. From the Fistula Foundation that has helped us extend our outreach efforts, to our donors who provide the much-needed funds to transport the patients, our staff who care so deeply about these women, the Ugandan hospital staff at Kamuli who assist in surgery and healing, and the dedicated UK doctors who use their skills to heal—they all came together this month to help 17 women head home in two weeks with the opportunity to start a new life free from fistula. 

Edited by: Tiffany Hsieh

Behind the scenes: Community Sanitation Meeting

Written by: Leslie Stroud-Romero, UVP Executive Director

Edited by: Tiffany Hsieh

When we use the toilet, we flush away all traces of our waste. In many of our Healthy Villages, a lack of latrines means that villagers are confronted daily with evidence of waste. Uganda Village Project’s (UVP) sanitation campaigns highlight the problem of “open defecation” and other unhygienic practices, and then offer solutions to building a healthier community. I was at a recent community meeting to introduce a sanitation campaign for one of our 2013 Healthy Villages. Kasambika 1 is very rural. The road to get there went from paved, to dirt, to a skinny dirt road, to really more of a footpath by the time we reached the meeting site.

UVP staff members traveled there to talk about the sanitation campaign. Before this meeting, UVP had already worked with the Village Health Team members to ensure that their households had proper sanitation facilities in place, which include a latrine with door, a bathing room, a plate stand to hygienically dry dishes in the sun, a trash pit, and a “tippy tap”—or hand washing station. The Village Health Team members will now be responsible for encouraging their neighbors to improve their sanitation practices and facilities, but we wanted to gather everyone for a community meeting first. UVP’s staff member Obbo Titus engaged the participants and, although I understood very little of what was said, it was clear that although they were talking about diarrhea, cleanliness, and piles of waste, the women and men had a great time as they laughed at jokes and nodded in understanding. Titus also shared the results of the baseline sanitation survey that our 2013 summer interns conducted to show them the progress they made from six months ago. 

Titus at the sanitation meeting

During the next three months, Village Health Teams will sell subsidized materials so that their neighbors can build tippy taps. They will consult about proper latrine construction, and lend a hand when cleaning up compounds. The purpose of the UVP sanitation campaigns is to educate or remind villagers about proper hygiene and sanitation, such as why using a latrine is important and how washing hands prevents disease. We do this by helping community members see the problem and then encouraging them to work together for the goal of a healthier community. No one wants to be the only person on the road without a latrine, and people want their compounds to look nice with a functioning tippy tap on site.

Our 2014 summer interns will evaluate the success of the project by identifying the improved sanitation facilities at each household, but if the meeting last week was any indication, it seems that Kasambika 1 is well on its way to making community-wide healthy changes.

Fistula Ambassador Training

Obstetric fistula, a childbirth injury which is a result of prolonged obstructed labor, is common in developing countries where the poor women cannot access proper medical care during pregnancy and labor. Uganda is no exception. Over 200,000 women suffer with fistula throughout the country.

Women with fistula live a life of isolation because the condition causes constant leakage of urine or feces. Sadly, many women suffering with fistula do not know that there is a cure for their condition. Due to a lack of information and education on their condition some even attribute their condition to curses or witchcraft.

The Uganda Village Project works hard to identify patients and giving them access to repair surgeries. However, locating patients proves to be difficult as women with fistula are isolated and marginalized in their communities. Our Fistula Coordinator, Loy, works tirelessly to locate fistula patients across 8 districts in Uganda. She is very successful in communicating about fistula and counseling women suffering with the condition because she herself suffered with the condition and had repair surgery. As one of our former fistula patients said, “I felt more comfortable because the person [fistula coordinator] who came to talk to me about this condition had gone through the same ordeal and was in a position to explain to me what fistula meant and that it could be cured”. Uganda Village Project wants to replicate Loy’s success by identifying other former fistula patients to be ambassadors in their communities.

In November of this year, Uganda Village Project's Fistula Program launched a Fistula Ambassadors project which brought together 18 former fistula patients from the districts of Namayingo, Iganga, Luuka, Budaka, Pallisa, Mayuge and Kaliro. In this two day training, the women were given knowledge on the causes, prevention and treatment of fistula. Additionally, trainees learned how to effectively communicate about fistula in their community and attended a fistula outreach where they could watch our Fistula Coordinator give her presentation and answer the community’s questions.

Now, as fistula ambassadors, these former fistula patients have the skills to actively identify patients in need of treatment, participate and organize outreaches in their communities to educate people about fistula, and create support networks where they can meet and discuss challenges and personal issues prior to or after surgery.

Since 2007, UVP has helped a total of 240 women living with fistula receive fistula surgery by conducting sensitizations, identifying fistula cases and facilitating the process of taking the women for surgery and supporting them while the recover in the hospital.  We hope that with our Fistula Ambassador program, we can help that many more women. UVP’s Fistula Ambassador activities have been funded through a grant from the Fistula Foundation. 

Check out photos from our training below:

Our Fistula Ambassadors

Written by: Kait Maloney
Edited by: Tiffany Hsieh

Dr. Alison Hayward speaks at GlobeMed HillTop Conference 2013

Add caption

This month, Dr. Alison Hayward, Uganda Village Project's co-founder and chair of the board, was invited to speak at the GlobeMed Global Health HillTop conference held at Columbia University in New York City. GlobeMed is a student-founded nonprofit with many similarities to UVP in its mission and values. Both organizations focus on grassroots community-based work to improve health and alleviate poverty via partnerships between students and community members.

Dr. Hayward gave an overview of Uganda Village Project's history and its programs to conference attendees, with emphasis on the Healthy Villages program. This lecture was followed by a lively discussion of the challenges of nonprofit work in resource limited settings and of creating behavior change in communities as part of public health initiatives. Thanks to GlobeMed for the invitation to participate and speak at the conference this year!

UVP Fistula Program in the News

Uganda Village Project (UVP) was mentioned in a recent article about obstetric fistula in Uganda. There are approximately 140,000 to 200,000 women living with fistula in Uganda. This devastating childbirth injury can be fixed--and UVP is working to do just that. We send women to fistula repair camps run by the Uganda Childbirth Injury Fund three times a year. Read more in the article here.

Join us at UVP's 10th Anniversary Celebration!

We're only two weeks away from UVP's 10th Anniversary! It's hard to believe we've already been working with Iganga district for so long, but we have a lot to be proud of. If you are in the New York area (or have friends who are!), please join us for a wonderful night on November 8, 2013. Tickets can be bought here (on the upper right hand side) or at the door.

Hope for Asenath

Since 2005, Uganda Village Project has provided direct assistance to over 220 women with fistula in rural eastern Uganda. To empower former fistula patients, raise awareness about the issue, and save more women’s lives, we’re expanding our fistula work by implementing the Fistula Ambassadors Program in 2014. This work is possible due to a generous grant from the Fistula Foundation, an organization committed to raising awareness of and funding for fistula treatment, prevention and educational programs worldwide.  

The Fistula Foundation has funded Uganda
Village Project to expand our fistula work and
implement the Fistula Ambassador's program.

The Fistula Ambassadors program will train former fistula patients to become Ambassadors by utilizing their trusted community networks to increase the impact of our fistula programs and services in local communities in Iganga. Ambassadors will conduct awareness and educational outreaches in communities, reach out to women and girls in their area who suffer from fistula, and support them through the surgery and reintegration process. The first training of Fistula Ambassadors will start next month.

Fistula survivors lend a powerful voice to speak out about fistula, and can play a valuable role in championing the issue by reaching out to their communities to help prevent and treat fistula, thereby saving countless

Asenath helps other fistula patients in her region

numbers of women and girls suffering from fistula. Asenath, a fistula patient Uganda Village Project has worked with, has always been an example of strength and hope. At our most recent camp, Asenath echoed the ideas behind the Fistula Ambassador’s Program:

“Whether I am healed or not, I will continue to tell more women about fistula and identify more patients because someone once told me about fistula surgery.  And I can only repay them back by telling more women about free fistula surgery, for no woman should live like that when there is a chance of getting repaired.”

Asenath has had several unsuccessful surgeries, but she spends two days a week traveling to neighboring villages educating people about fistula. It is with this spirit that Uganda Village Project undertakes the expansion of our fistula work by implementing the Fistula Ambassador’s Program in 2014. Community by community, woman by woman—we hope to make fistula a thing of the past. And thanks to this generous grant from the Fistula Foundation, we’re step closer to that goal.      

A new start for Safina

Uganda Village Project (UVP) is wrapping up one of the thrice-yearly fistula repair camps that happen at Kamuli Mission Hospital. We partner with the UK Childbirth Injuries Fund to run the camps that offer a new start to women with fistula. UVP conducts community outreaches to teach rural areas about fistula and identify women who are in need of repair. The UK Childbirth Injuries Fund sends surgeons to support the local facilities and provide surgeries to heal women with fistula.

Safina recovers in the hospital after her repair surgery

Safina, a 25 year old woman from eastern Uganda, is one of those women. She had heard about how important it was to deliver in a health center during her visits to antenatal clinics during her pregnancy. The nurses at the health centers stressed the risk of delivering at home, so when Safina’s labor pains started she prepared to go to the health center. Her husband, however, refused, and took her instead to a traditional birth attendant. Safina delivered her healthy baby after two days of labor, but immediately after childbirth she began leaking urine. Due to prolonged labor, she had sustained an obstetric fistula and leaked for six months. Although devastating, Safina is one of the lucky ones. She attended one of the repair camps last year and is now fully healed from her injury.

Our fistula activities will increase this next year because of a recent grant from the Fistula Foundation. We’re excited for the opportunity to provide life changing surgeries for women, and conduct outreaches that prevent women from encountering fistula in the first place. Safina is proof of the difference that we are making with your help. Thank you for helping Safina be repaired and start a new life.

[Kasambiika 1] A Musical Farewell

It has now been over a week since we left Kasambiika 1. Most of us have already reverted back to our home environments, but we all still hold warm memories of the village. We left with heavy hearts and full stomachs.  After hosting a dinner for the whole community, our VHTs threw us a surprise party, which happened to coincide with the request of another villager who wanted us to attend his house for a dinner party. The Kasaambiika 1 intern team was not afraid of challenges, especially challenges involving food—it's true, one time Raphael ate 5 bowls of porridge then ate a whole egg in one bite! Just kidding that was me—and we ate at all of them. 

Before we get into the lessons and our closing thoughts, we need to make a quick shout out to Mama, the woman who cooked and housed us. Miss ya mama!

Lessons learned

All of us learned a lot about working with different personalities, both within the group and our village stakeholders. We all put aside differences to work together towards our common goal: improving the health of Kasambiika 1 and empowering its residents to make healthy decisions.

One thing we all had to work together on was leaving Kasambiika Primary School with a new paint job. Most of us had left the village by the time this got finished, but Tina was still around and got this picture.

In Lusoga this says wash your hands every day. Before you eat, after you use the latrine, after you play.

Sometimes there are problems that you have to leave behind. Throughout our entire internship we could tell that there were underlying tensions between the health center and the village population. We could not do anything to fix these problems while we were in the village. We did not want to cause more harm than good, and we did not have the permanent presence to make sure everything was resolved. We hope that the UVP staff is better able to mediate between the two parties and work towards a more harmonious health system in K1.

Closing thoughts for the summer

This was our final project for the UVP staff. For everyone outside of UVP and Uganda village life, annotations follow.

0:00-0:59 to the song “Pretty Boy Swag” by Soulja Boi. This song is about our head VHT, Swaga. Swaga made a huge difference in our outreaches for the village. He was instrumental in mobilizing, planning, presenting, and pretty much everything else we did in the village. This is our tribute to him and the other VHTs.

1:00-1:45 to the song “Ignition (remix)” by R Kelly. This song is about promoting birth control in the village. A laysoo is the traditional Busoga waist covering worn by Josie in our video. Pills, depo, and IUDs are all birth control devices that we promote in our UVP work. We only provided the Depo shot once during the internship (Maureen brought it, as the song suggests), but more options are available at the health center. Also, other NGOs like Marie Stopes work to promote birth control in the villages.

2:00-2:39 to the song “Hot n Cold” by Katy Perry. This song (sung by my sister, thanks Naomi!) is a story of a child getting malaria. A baby child was the subject because children under five (and pregnant women) are more prone to getting malaria. Small children's immune systems are not developed, and for pregnant women's immune systems are weakened by the strain of pregnancy. Towards the end of the song we emphasize the importance of prevention and recommend two methods: sleeping under bed nets and clearing stagnant water. We mention misdiagnosis in the song. During baseline surveys we asked what the symptoms of malaria were and we often got answers that corresponded more with a common cold or virus than malaria. While you can still get these symptoms if you have malaria, sometimes when a child or adult is sick in the village it is just a bacterial or viral infection instead. People, especially children, should not take anti-malarials for illnesses that are not malaria.

2:40-3:25 to the song “Call Me Maybe” by Carly Rae Jepsen. This song is about our shallow well request forms. Kasambiika had two boreholes and one shallow well. Water access was a problem in our village, as in many of the other launch villages. We hope that if adequate shallow well sites are found that UVP can start digging soon.

3:25-6:18 to the song “Thrift Shop” by Macklemore. This song covers the lighter side of village life. The first verse is about getting vaccines to go to Uganda, and complaining about having to take Doxycycline as an anti-malarial every day. We were lucky to have prophylaxis, as the people in our village do not have access to the kind of malarial prevention that we could afford. There are a number of other jokes in this song, so comment on this post or send us a question if you want anything else explained.

Miss you Kasambiika! Warm regards from Kampala and America. 

The K1 team

[Kasambiika 2] "Your work will not end with you. We will continue it"

Jambo again from Kasambiika 2!

The last two months has been a whirlwind! And we can’t believe the time has already come for us to leave our beautiful village!

It has been an amazing journey, filled with a lot of love, laughs and a few tears. We feel blessed to have worked with so many amazing people and to have made memories that will last a lifetime!

As part of our good-bye to the community, we threw a large farewell dinner to show our appreciation for their hard work. We were able to thank all our supporters and recognize those whom without we would not have succeeded. We stressed the need to continue implementing health measures and maintaining the dedication the community has shown during our time together. After the formalities were finished, our guests eagerly hit the dance floor! It was great to see so many of our new friends enjoying the rare treat of stereo music!

In all seriousness, our farewell dinner was symbolic of our last two months: fun, happy, a little stressful but surrounded by love and support! It was the perfect way to end our time here!

Our friends in Kasambiika 2 warmly shared some kind words that have resonated strongly with all of us. While words fail to define the experiences and memories we are taking home with us, these come pretty darn close!

“Your work will not end with you. We will continue it.”

“There is a saying that states ‘out of sight, out of mind’. That is not true for us!”

“You come from such great distances to be with us… that is a sign of true love!”

Muzungu, BYE-EEEEE!!!! (for now!)