Fighting fistula with mobile money

Evelina Kessy (not her real name) knew that she was probably maimed for life when she suffered complications at childbirth a year ago.

"I don't want to remember that day, I could hardly walk. I knew I was dying," she recalled.

The 19 year-old woman lives in Kibondo district near Tanzania's western border to Burundi. She told DW that her ordeal was aggravated by transport problems. Her relatives could not meet transport costs to rush her to hospital on time.

"When we arrived there was a queue in the labor room and when it was my turn to deliver, the doctors realized that the baby had already died," she recounted. Kessy said that the doctors at the district hospital inserted instruments to pull the dead infant from her womb and few days later she developed a condition known as fistula.

Shunned by the community

Obstetric fistula is a childbirth related injury caused by prolonged and complicated labor, without timely medical intervention. It often affects young girls, whose bodies are not yet fully developed. The fistula itself is a hole between the woman's vagina and her internal organs. Affected women are unable to control their flow of urine, feces and blood. If the fistula is not treated, they are often unable to give birth to another healthy child.

Women with obstetric fistula are often abandoned by their husbands, rejected by their communities and forced to live in shame and isolation. In some traditional setting in Tanzania, suffering from fistula is even seen as a curse.

"I was constantly leaking urine. Very often my bed sheets were soiled with feces," said Kessy. She is now recuperating from a successful repair surgery, she believes that her baby's life would have been saved if she had received urgent treatment.

A preventable condition

Kessy's story highlights the plight of thousands of women in Tanzania who get fistula due to lack of specialized treatment. According to the United Nations Population Fund (UNFPA) there are as many as 3000 new cases of obstetric fistula every year. "Obstetric fistula is also an issue of poverty and of rights. Birthing decisions are often taken by husband or mother- in-law who may favor traditional practices," said Sawiche Wamunza, UNFPA's communications analyst.

While health services for pregnant women are free in Tanzania, the women and their families need to pay for the journey to the hospital. Women in rural areas therefore still have difficulties in accessing the health care that they need.

Mobile money to remote areas

One successful attempt to help women suffering from fistula was started in 2011. It is run by one of the country's largest providers of fistula surgery, the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), in collaboration with the UN Population Fund (UNFPA) and the telecommunications company Vodacom. They provide fistula patients with transport costs for their repair surgery through M-Pesa, a mobile banking system.

CCBRT's communications manager Abdul Kajumulo told DW, that the money is sent via SMS to so-called fistula volunteer ambassadors. These may be former patients, health workers or staff of non-governmental organizations.

The ambassadors identify women suffering from fistula and then buy the bus tickets for them. When the patient arrives at the hospital, the ambassador receives Tsh.10,000 ($6 or 4.37 euro) as an incentive.

"This system had a huge impact. In the first year of the program we saw a 65 percent increase in the number of patients being treated," Kajumulo said. He added that CCBRT now has a network of over 500 ambassadors across the country, who have referred over 2,000 women for treatment since the program started. In the last year, 100 new ambassadors were trained. According to CCBRT statistics, the number of fistula survivors who have received treatment countrywide has risen considerably.

Informing the public

"Awareness raising campaigns continue to help women and girls of Tanzania overcome a debilitating condition that leaves significant numbers suffering in solitude and shame," says Mariam Khan UNFPA Representative.

Yesaya Mwakifulefule, who heads the Vodacom foundation, seemed proud of the program's success and noted "we will not end our support until all fistula survivors are treated."

Tanzania's government launched its own National Fistula Program in 2005. The program has contributed to the prevention and treatment of obstetric fistula to thousands of women across the country.