There is a common adage shared with incoming public health students and with those listening in on important conversations being had in the arena:
One day, a group of fishermen were at their work midway down a river in a small village. A man suddenly drifted past them on the current, in clear distress and near to drowning. The fishermen were able to rescue him, and as their day settled and they prepared to cast their lines again, they were stunned to find another drowning victim passing them by. This went on for hours and hours, into the night, with more and more people washing past them, each in grave danger. Eventually, the fishermen sent someone upstream to see if they could discover where all of the drowning victims were coming from. A bridge was found to have been damaged, with people unaware and falling through. The bridge was repaired in short order, the falls into the river stopped, and the exhausted fishermen were thankful for less eventful working days to come.
This story focuses on “going upstream” to find the source of problems, and its lesson is crucial to practitioners and advocates for women’s health. There are 2-3 million women estimated to be living with fistula across the globe, with 50,000 -130,000 new cases occurring annually. The surgical capacity to repair all of these fistulas doesn’t currently exist. Organizations like Hope for Our Sisters can’t ignore the women currently living with fistula – our hearts ache for these precious sisters and we will always seek to help them by funding fistula surgeries.
But we are an organization uniquely sent to find the problems upstream and start repairing the fragile bridges, the weak infrastructure, that is causing fistula in the first place.
The risks for fistula begin when any female is a small girl: if she is undernourished or if she cannot attend school, she is at risk. If, as a teenager, she is married and becomes pregnant too young, she is at risk. If, as a grown woman, she lives too far from safe delivery options and has minimal prenatal care, she is at risk — with every pregnancy that she undertakes.
We can consider this continuum of a woman’s life, from girlhood to motherhood, to flow like the river in the story. There are many, many points along the river where we can intervene. Someday, we hope to dip our hands into new pools and be shown by our partners how to help in new ways. But at this time, for the women with whom we currently partner, the needs we are best equipped to address are education about safe delivery and fistula prevention, and ensuring that finances and providers are available for safe vaginal or surgical (cesarean) deliveries.
Fifty percent of our funding in 2018 went to preventative care. In 2019, we plan to provide at least 50% towards prevention. We are committed to bringing fistula to an end. We continue to fund the education of surgeons through the Pan-African Academy of Christian Surgeons (PAACS), who can provide maternal care in our partner countries of Angola and Democratic Republic of Congo (DRC). We provide maternal health funds in Angola and DRC so that cost is not a barrier to care for any woman coming to our partner clinics for help (the poorest women are often the most at risk for fistula). We will continue to support the Ultrasound Empowerment Program in Angola, Fistula Education and Awareness sessions in Angola and Nepal, and Sexual Gender-Based Violence groups in DRC. Our ears will always be open to new ways to stem the tide of women suffering from fistula – we envision a world in which fistula is eradicated because maternal health care, globally, is so sound that no woman would ever be put at such at risk.
There is so much work to be done in 2019 and beyond. There are so many who still need to be reached, so many who are risk of falling from the bridge, into the river below, and drowning. Where we build bridges, women thrive.
Thank you for building with us by investing in preventative care for women.
Guest blog written by Cara Brooks, Hope for Our Sisters Board Member and Partner in Hope