Written by Samantha Bossalini, Development and Communications Associate
The city of Dar es Salaam, Tanzania is anything but quiet. An increasingly modern metropolis overlooking the Indian Ocean, Dar is home to 4.4 million people, and is one of the fastest growing cities on the African continent. It’s a cacophony of noises, sounds, colors, and smells; ironic for a city whose name means “Place of Peace.”
On one of Dar’s residential streets, however, there is a peaceful haven. Behind a stone wall sits the Mabinti Centre. The simple house hums with the sound of sewing machines. The women working at the machines range in age from 16 to 30-years-old. They greet visitors with smiles and a warm welcome: “Karibu!” Bright kanga fabric and canvas slips beneath their whirring needles as an instructor crouches down to talk them through a difficult stitch, or to share encouragement. In the garden, ladies gather under a thatched gazebo to practice screen-printing on bolts of fabric. Some are learning to tie-dye, some to stitch tiny dolls made of beads and yarn. All are beginning to heal.
One thing unites these women. Each of them women developed obstetric fistula during childbirth.
Whenever I explain obstetric fistula to someone, I start with the physical symptoms: a hole caused by prolonged, obstructed labor without access to timely medical care. The pressure of the baby’s head on the laboring woman’s pelvic floor kills the soft tissue and creates a hole between the vagina and bladder (or rectum, or both). Women with fistula are left chronically incontinent, leaking urine, feces, or both. They are at severe risk of infection, often in pain, and sometimes suffering nerve damage that limits their mobility.
It feels like a cold, clinical definition for something so devastating.
In 90% of cases, the baby dies during the traumatic delivery. The mother is left to process the physical trauma with the grief of losing a child; she is often left to endure this pain alone. Misconceptions associate obstetric fistula with witchcraft or a punishment for adultery. The constant leaking and smell means many women live in isolation and shame. Often abandoned by their husbands, family and communities and unable to work, women with obstetric fistula are some of the poorest and most marginalized people in the world.
Standing in the Mabinti Centre, surrounded by women who are healing, smiling, and building friendships, it’s hard to imagine they were once outcasts living in unimaginable pain.
The Mabinti Centre was established by Kupona Foundation’s sister organization, CCBRT (Comprehensive Community Based Rehabilitation in Tanzania). Recognizing that surgery is just the first step to recovery, CCBRT’s holistic approach addresses the psychosocial as well as physical impact of fistula. Each patient receives counseling, family planning resources and health education. CCBRT offers numeracy and literacy lessons to women who do not know how to read and write. Members of the Mabinti Centre team offer crochet lessons, providing women with an opportunity to learn a skill. Every year, over 600 women participate in these sessions.
Since 2006, 100 women have completed a training course in sewing, screen-printing, beading, design, English or business skills at Mabinti. These women graduate equipped to start their own business or seek meaningful employment, helping them to build brighter, healthier futures for themselves and their families.
Obstetric fistula is preventable and treatable.
When an expectant mother has access to high quality care, her risk of developing fistula decreases significantly. Since 2010, CCBRT has been improving the quality of maternal and newborn healthcare in 23 medical facilities throughout Dar es Salaam. Thanks to the generous support of our donors and partners, including Fistula Foundation and Johnson & Johnson, CCBRT is one of the largest providers of obstetric fistula treatment in the world, providing over 5,800 fistula surgeries in Tanzania since 2003.
We still have a long way to go. An estimated 3,000 women develop fistula in Tanzania every year. The backlog of women awaiting treatment is in the thousands, so while we work to stop new cases of fistula from developing, we must continue to provide fistula surgery and holistic care to help women recover and thrive after they are treated.
For the women at the Mabinti Centre, they are approaching a new chapter in their story of recovery. Equipped with the skills to move forward, they are building their futures, one stitch at a time.
Interested in learning more? Meet Lidya, who completed her training at Mabinti in 2012 after developing fistula twice. In honor of International Women’s Day on 8 March, consider sharing Lidya’s story and this article on social media or with your contacts.
Cover photo credit: Sala Lewis, Kupona Foundation