20 December 2012

Tanzania: Dr Lilian Mselle - Muhas' First Ph.D. Graduate

Lilian Teddy Mselle made history at Muhimbili University for Health and Allied Sciences (MUHAS)'s sixth graduation ceremony held recently.

She was the only student to be conferred with a Doctor of Philosophy (PhD) by research since the university opened its doors years ago. Dr Mselle is the first PhD graduate from a School of Nursing in Tanzania and the first PhD graduate from the MUHAS School of Nursing.

She joins seven other Tanzanian nurses with PhDs. She got her PhD in Clinical Nursing (Reproductive Health) on December 8, 2012, after having started her research in 2008. She is also in possession of a Masters of Philosophy in Health Promotion, University of Bergen in Norway (2004 - 2006), Bachelor of Arts (Sociology) from the University of Dar es Salaam (1999 - 2002), Advanced Diploma in Nursing Education, University of Dar es Salaam (1996 - 1998), Diploma in Nursing, Muhimbili School of Nursing (1986 - 1990).

Lilian obtained her secondary education from Kigurunyembe Secondary School, in Morogoro (1982 - 1985) and primary education, Bungo Primary School, (1975 - 1981). Dr Mselle who has a background in social sciences and health promotion worked as a nursing officer at Muhimbili National Hospital, and a nurse tutor at Muhimbili School of Midwifery. She is now the Head of the Department of Clinical Nursing at MUHAS School of Nursing.

It was all excitement from her colleagues for making history in the nursing profession in Tanzania and a pride to the School of Nursing at MUHAS. She was conferred her PhD by MUHAS Chancellor and former President of the United Republic of Tanzania, Alhaj Ali Hassan Mwinyi, at a ceremony that was also attended by the Minister for Education and Vocational Training, Dr Shukuru Kawambwa.

The Dean at MUHAS School of Nursing, Dr Sebalda Leshabari, joined lecturers at the school to congratulate Dr Mselle for her academic achievements. She qualified for PhD after successfully completing her dissertation research on obstetric fistula, a severe birth complication in Tanzania.

The research was titled: Availability of maternal services in Tanzania: The magnitude of obstetric fistula in Tanzania and its challenges. The objective of her study was to determine the attitudes and experience of women who have suffered fistula during labour and delivery, experiences of women living with fistula as well as their lives after treatment. The study was conducted between 2008 and 2010 at CCBRT and Temeke District hospitals in Dar es Salaam, Mwanza based Bugando Referral Hospital and Mpwapwa District Hospital in Dodoma Region.

A total of 28 women suffering from fistula, six men (who are husbands to women suffering from fistula), five midwives and nurses as well as 151 women living with fistula were selected for the research. Fistula occurs to women following delayed medical treatment and prolonged labour that results into the rupture of the birth canal.

According to her study, limited midwifery services in health facilities compared to the number of women attending antenatal clinics needing emergence services, the long distances and poor infrastructure to health centres complicates the problems further. The problem is serious in rural areas where transportation is a big challenge.

It was also revealed during the study that about 60 per cent of the women interviewed had no say in deciding on when and where to take pregnant women for health care. The decision lies with the husbands and mothers-in-law. After reaching health centres they also face problems of delayed attendance, lack of care, delivery kits and medicines, and rude language and treatment by health attendants as well as nurses.

According to the study findings, 36 per cent of the 28 women interviewed had lived with fistula for more than six years. About 25 per cent of the 151 women who responded to research questionnaire had lived with fistula for more than three years. Every year, more than 2500 women develop fistula, mainly in rural areas where access to emergency obstetric care is limited.

The study reveals that 96 per cent of pregnant women who attended antenatal clinics in 2010, only 50 per cent of them give birth at a health facility, meaning that the rest of the women gave birth at home with the assistance of untrained traditional birth attendants (TBAs). Fistula accounts for about five per cent of all pregnancies that occur in developing countries, including Tanzania, according to WHO reports.

Dr Mselle says, "Women who lived with fistula experience deep losses, loss of body control, loss of their social roles as women and wives, loss of integration in social life, loss of dignity and self-worth. Their experiences of living with fistula influence their reintegration into their families and communities after fistula repair." Fistula treatment is now available in many health facilities free of charge but the challenge remains on information to the target beneficiaries.

"Not many pregnant women access these services because of lack of information," she says, adding that discrimination is another reason that put women off from seeking fistula treatment. Even after treatment, women who have suffered fistula find it difficult integrating with family members. The study findings revealed that 51 per cent doubted whether their husbands would accept them after being cured.

About 50 per cent of those cure also doubted if they would ever have children again. The study findings revealed that social, economic, cultural factors and health systems are vital in preventing and addressing problems related to fistula among women. Dr Mselle recommends in her study findings that there is need to strengthen health systems particularly in the rural areas where most of the low income bracket people live.

Availability of resources, proper information and public awareness can help reduce cases of fistula among women in the country. Families of women cured from fistula need counseling so that they could provide the necessary support to the cured member of the family.

They will be important factor for the women to cope with life and reclaim their eroded self esteem. She also recommends on the need for health professionals to adhere to ethics when executing their duties. Importantly, fistula treatment goes hand-in-hand with psychological and economic empowerment of women. It calls for improvement of health systems at all levels and put in place strategies that guarantee women's empowerment, Dr Mselle recommends.

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