Tanzanian women who have been ostracised by having obstetric fistula are finding out it can be treated
Mwana FA, a celebrated Tanzanian hip-hop star, stands on the edge of a slum in Dar es Salaam wearing a white T-shirt printed with the message "fistula inatibika" (fistula is treatable) and handing out leaflets. For the past week, he has led a team of 24 in a convoy of vehicles that drew running crowds in eight towns and cities to talk about fistula. The final day of the roadshow on Thursday coincided with the first international day to end obstetric fistula. "We made it look cool," Mwana FA says of the campaign, an unlikely statement about one of the most taboo female health complaints.
Obstetric fistula leaves a woman incontinent as a result of poor or no maternal healthcare. Untreated, it can sentence her to a life of ignominy, thrown out by her husband and rejected by the community. The injury occurs during prolonged labour, when pressure cuts off the blood supply to tissue that withers and dies. The resultant hole allows urine, sometimes faeces, to leak through the vagina, which a woman cannot control. Many women do not know it can be treated.
About 24,000 women live with obstetric fistula in Tanzania, and 3 million worldwide. Estimates suggest fistulas are occurring at a rate of 3,000 per year in the country; only 1,000 are being repaired. The top hospital for obstetric fistula in Tanzania, CCBRT, which carries more than half the national caseload, wants more women treated and offers free treatment, including transport door-to-door. "If you want to reach out to the very poorest, you have to facilitate transport," says Erwin Telemans, chief executive of CCBRT.
Zipola, a 25-year-old former fistula patient at CCBRT, joined the roadshow from Bukoba to Dar es Salaam. On arrival, she addressed 300 people gathered on a building site that will become Tanzania's first dedicated maternal hospital catering for 10,000 difficult births each year. Zipola was ostracised with obstetric fistula for four years before learning about her condition on the radio, she says. She was one of the lucky ones – 90% of women lose their babies when they develop fistula, but Zipola's survived.
Ten years ago, the UN Population Fund started a campaign to end the condition worldwide. "With strong statements, we should be able to reach that target in this modern age," says Tanzania's vice-president, Mohammed Bilal.
The fistula inatibika campaign is targeting men as well as women. "Men are the ones who made the women pregnant," says Mwana FA. Twenty-two well-known female artists have recorded an official song, Kidole Kimoja, meaning "one finger". It refers to a traditional Swahili proverb that advocates teamwork: one finger will not kill a louse.
Ruge Mutahaba is the media executive behind the track. In 2005, Mutahaba founded a talent centre for underprivileged youngsters that became a national centre for excellence in performing arts, the Tanzania House of Talent.
Vanessa Mdee, 24, an MTV Africa presenter, radio DJ and singer, says the response to the song was enormous. "Women are getting the healthcare they deserve. It shouldn't be a privilege," she says.
Khadija Taya, 26, another Tanzanian singer, confessed she didn't know what obstetric fistula was until a few months ago. She explained that women with the condition experience guilt, and chronic low self-esteem. Taya has albinoism, and, in areas of Tanzania, albinos are prized by witch doctors for their body parts. There is similar disinformation surrounding obstetric fistula, she says. Many believe the condition is caused by witchcraft, or sleeping around. "Obstetric fistula can happen to anyone. But people don't know because they hide," she says.
This campaign to end fistula is being helped by technology. Since Vodafone began highlighting the treatment of the condition in 2009, the number of repairs each year has more than tripled.
The CCBRT hospital runs a network of about 500 ambassadors, who notify the hospital of fistula cases, arrange for a woman's travel for treatment, and then receive TZS 10,000 (£4). This all relies on M-Pesa, the African money transfer system that uses mobile phones.
As the convoy has travelled across the country, audiences have risen to their feet when Taya and the Tanzanian All Female Stars perform the fistula song. But how will they reach "the very poorest" with their message, as Telemans hopes? Young film-maker Saleh Gadau has a suggestion. "Mamas have children," he says.