FROM Joyce Msafiri's assured manner in the delivery room of Ulaya Health Centre in Kilosa District, an observer would never guess how far this former fistula sufferer has come.
Now a certified village midwife, 30-year-old Joyce assists in childbirth, saving the lives of mothers and babies and providing them valuable emotional support.
Joyce's empathy derives from her own story as a fistula survivor. Joyce has overcome the deaths of two of her three children, abandonment by her husband, and two childbirth-related injuries to become a trusted health care professional.
"My treatment and my education have given me a new life, one full of hope," she says. Joyce's first pregnancy ended in tragedy. Without access to medical care in the remote village of Malolo, she saw her baby die in childbirth. "From my village, it takes a whole day to reach the Ulaya Health Centre walking," she says.
As a result of the prolonged labour, a fistula developed. Even so, she became pregnant again. Another difficult labour ended with a stillbirth and a second fistula.
Soon after Joyce's husband divorced. She was referred to the Kilosa District Hospital, a facility that receives training and funding for its fistula repair and prevention programme from Engender- Health.
Two operations were needed to repair Joyce's fistulas. In gratitude, she volunteered to work at the hospital as a nurse attendant.
The doctors at the district hospital soon noticed Joyce's extraordinary ability to correctly identify the birth complications and problems of incoming patients, as well as her thoroughness in the critical task of monitoring the catheters of women recovering from fistula repair surgery.
Perhaps most valuable was the indispensable counsel and emotional support she was providing to fistula sufferers, sharing with them her story of healing and renewed hope. Sensing that her potential as a health care provider, the doctors enrolled Joyce in a midwifery school.
Two years later, Joyce graduated first in her class of 50 and became a village midwife. She has since assisted at more the 120 deliveries throughout the district. Caring for patients and providing help in translation has earned Joyce the affection and admiration of the hospital staff, patients and the community at large.
Emotionally and physically healed, Joyce is now a trusted midwife. "All that matters is that I help my fellow women and their children, that they will not know the suffering of so many others," she says. Obstetric fistula, say experts, is a devastating injury caused by prolonged obstructed labour.
Traumatic fistula is a similar injury caused by brutal rape. Both result in the steady leakage of urine and/or faeces, and survivors often face social isolation and abandonment. Approximately two million girls and women in the developing world endure this debilitating condition.
This number, according to EngenderHealth, is believed to be a severe undercount, due to the stigma associated with fistula. EngenderHealth works to prevent and treat obstetric and traumatic fistula in 10 countries.
Through training, education, and support to fistula repair services, the organisation is empowering local health care provides to address critical needs in their communities.
Fistula prevention and treatment is a major component of Engender- Health's Safe Motherhood Programme, which provides technical assistance and training in areas including emergency obstetric care, prevention of unintended pregnancy, and HIV prevention among pregnant women.