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Last Updated: Monday, 12 January, 2004, 09:59 GMT
Tanzania women's pains of poverty
By Daniel Dickinson
BBC correspondent in Dar es Salaam

Tanzanian clinic
Tanzania has few resources to spend on health
A fan blows a gentle breeze across a women's ward in a hospital in Dar es Salaam in Tanzania.

It comes as a relief to 25-year-old Rukia Pendeza who lies in a bed recovering from an operation to repair an obstetric fistula.

Obstetric fistula occurs following a protracted and difficult childbirth and leaves women unable to control their urine and faeces.

It is a gynaecological problem which affects the poorest of women in developing countries and it also appears to be on the increase in Tanzania.

Rukia's anguish

The fistula she suffered was basically a hole formed between the bladder, vagina and rectum. It happened during a protracted childbirth when she was just 15 years old.

Rukia Pendeza
People used to laugh at me... They didn't want me near. I couldn't help in the fields. I just stayed at home for those 10 years
Rukia Pendeza
She has been leaking urine and faeces ever since - with devastating consequences for her life.

"People used to laugh at me," said Rukia.

"I just had to sit in a room by myself, never going out. People laughed because of the smell of the urine.

"They didn't want me near. I couldn't help in the fields. I just stayed at home for those 10 years."

Like most women with fistula, her child was stillborn - further adding to her anguish.

The operation she has just undergone cost $60 - a huge amount of money to Rukia, who comes from an impoverished rural community a day's journey from Dar es Salaam. Her father sold charcoal, saving a few cents every day to pay for the operation.

Rukia says it has all been worthwhile.

"I will be able to go to church again. I will be able to help a bit in the fields. I will be able to go shopping and to go on the back of someone's bicycle - all the things that other people normally do."

'Limited money'

Rukia's story is by no means unique. It is thought the number of women suffering new cases of fistulas in Tanzania is around 1,200 each year, with anecdotal evidence suggesting that the number is on the increase.

The latest figures suggest that only around 700 operations are carried out over the same time span.

Dr Zachary Berege
Dr Berege admits the problem is on the increase
Dr Zachary Berege, a gynaecologist and the director of hospital services at the Ministry of Health, admits services are stretched.

"The health sector is a big sector and we have a lot of priorities so the money available for this condition is limited.

"Nevertheless, we want the public, health workers and politicians to know that this problem is growing but that action can be taken to lessen the impact on ordinary women."

Obstetric fistula affects both young and older women. What they have in common is that they are typically from poor rural areas, where obstetric care is limited or non-existent.

'Health iniquities'

The Dar es Salaam-based organisation, Women's Dignity Project, was set up with the explicit purpose of helping those women, as well as raising awareness of obstetric fistula.

Its director, Maggie Bangser, says it is a condition inextricably linked to poverty.

"Fistula is just one symptom of broader health inequities. There are two issues here. One is governance - who is involved and not involved in making decisions about health care for the poor.

"The second is accountability in resource allocation, whether money which is supposed to benefit the poor is actually getting to them."

The Tanzanian Government has recognised that obstetric fistula is a serious issue with both health and social implications.

It has recently earmarked a significant amount of money to treating fistula cases.

Surgeons are now attempting to clear the huge backlog of patients.

The ultimate goal, however, is to make sure all women have access to the right maternal care - which would help to ensure that fistulas did not occur in the first place.


SEE ALSO:
Teaching about safer births
22 Jun 03  |  Health


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