Dar es Salaam, Tanzania — Anastasia Majasho's journey with obstetric fistula began during her second pregnancy. Prolonged labor led to complications, and despite a previous cesarean scar, a vaginal delivery was attempted. This resulted in a ruptured scar and the tragic loss of her baby.
Following surgery, Anastasia began leaking urine uncontrollably.
Initially confused and discouraged, Majasho received little explanation or support from her local healthcare providers. But a lifeline was thrown when another woman who had overcome a similar ordeal shared her own story of successful fistula repair at Comprehensive Community Based Rehabilitation Tanzania (CCBRT), a renowned hospital specializing in fistula repair surgery in Dar es Salaam. Majasho's local doctor finally confirmed the fistula diagnosis and, to her immense relief, explained that the treatment would be free.
At 29 years old, with newfound hope, she traveled to Dar es Salaam. She walked into CCBRT hospital for the first time with great anticipation.
She was initially overwhelmed by the vast number of women, all facing the same struggle. But this feeling quickly transformed into a sense of belonging. Majasho's spirit was revived as she listened to the success stories of other patients and received unwavering support from the staff.
Majasho's surgery was successful, and her story now serves as a beacon of hope for countless women suffering from fistula in silent shame. Her story is a powerful testament to the life-changing work of CCBRT, shattering the silence around fistula.
A hidden agony
Obstetric fistula is a devastating childbirth injury that affects millions of young women, primarily in Asia and sub-Saharan Africa. This condition, which leaves women unable to control their bladder and bowels, is caused by prolonged, obstructed labor where the baby's head gets stuck in the birth canal, cutting off blood flow to the mother's soft tissues and creating a hole - fistula - between the bladder or rectum and the vagina. Surgery is the only cure.
Untreated fistula can lead to constant incontinence, kidney damage, ulcers, frequent infections, and the inability to have children. The successful surgery offered Majasho a path to healing, but the dream of having another child remained just out of reach.
The consequences of obstetric fistula extend beyond the physical, with many women facing shame, isolation, social rejection, and even accusations of witchcraft or promiscuity. The tragedy deepens as many grieve the loss of their babies while dealing with constant leakage, making it difficult for them to reintegrate into their communities.
Hope restored after Fistula
Founded in 1994, CCBRT is a Tanzanian NGO dedicated to improving healthcare, particularly for people with disabilities and those needing rehabilitation services. Under the leadership of CEO Brenda Msangi, the organization has grown from a community-based focus to become the country's leading provider of disability and rehabilitation services.
"At CCBRT, safe childbirth is a right, not a privilege," Msangi said. "Sadly, many facilities lack the infrastructure to accommodate women with disabilities, making childbirth an ordeal. We've heard stories of women denied care or shamed for wanting to deliver. CCBRT ensures our facilities are accessible and our staff trained to provide compassionate care to all mothers-to-be, regardless of ability."
Msangi revealed a heartbreaking statistic: "85% of the babies die" during childbirth with obstructed labor." However, CCBRT offers hope," she said.
"We understand some women who have undergone fistula repair surgery may still be concerned about future pregnancies," Msangi acknowledges. "We want to alleviate these concerns by offering free childbirth services to these women as well."
She emphasizes, "It's a medical condition, not a curse." Due to a lack of awareness, some women may attribute it to witchcraft, leading to further isolation.
In addition, Msangi said the healthcare facility also takes a comprehensive approach, offering life-changing services like eye surgery, prosthetic limbs, and physical therapy. "Imagine a child with cerebral palsy regaining some functionality or a woman with a disability receiving a custom-made wheelchair for better mobility. This is the impact CCBRT makes every day," she said.
"Our mission is clear - to serve the most vulnerable people in Tanzania," said Msangi.
Challenges - beyond incontinence
Several factors prevent women from seeking help for fistula. As Msangi points out, prevalent "myths and misconceptions" surround the condition, along with cultural stigma leading to shame. Financial limitations are another hurdle. The cost of traveling to a medical center and lengthy recovery stays pose significant barriers. Furthermore, Msangi acknowledges the lack of decision-making power for some women, saying that "cultural norms often require a male family member's approval for healthcare decisions."
She further highlights the ongoing battle against Female Genital Mutilation (FGM), a practice outlawed yet persisting as a factor in fistula prevalence.
Msangi said that the organization tackles these challenges head-on.
Through their network of over 500 "community ambassadors," they go directly into villages, dispelling myths and raising awareness about fistula. Financial limitations are eliminated by providing free surgery and transportation assistance, ensuring women can access treatment regardless of their means.
But the fight doesn't stop there. Cultural barriers are also addressed.
"Imagine a 65-year-old woman needing her son's permission for treatment. This exemplifies the deep-rooted challenges," she said.
The ambassadors break down stigma with a simple, reassuring message: "Listen, this condition is treatable. It's a medical problem, not something to be ashamed of." Their dedication extends beyond education. They go the extra mile, arranging bus tickets or rides on boda-bodas (motorcycle taxis) to ensure no woman is left behind because of transportation difficulties.
Msangi recounts heartbreaking stories of women ostracized from their communities, denied basic rights, and even experiencing depression or anxiety after seeking help. Despite the immense challenges, she highlights the remarkable success of her organization, having helped countless women across vast regions, including neighboring countries like Mozambique and remote regions.
For Msangi, the solution lies in prevention through "improved maternal healthcare services" with skilled professionals and well-equipped facilities.
She outlined a two-pronged attack to conquer these healthcare challenges.
First, education is crucial. Many women suffer silently, unaware that the healthcare system has failed them. Msangi passionately argues, "They shouldn't blame themselves! We need to break the silence and educate communities." Second, resource mobilization is essential. Msangi stressed the need for stakeholders to support facilities like CCBRT. "Together, we can equip these facilities and reach more women," she declares, "transforming their lives and proving that recovery is possible."
Msangi applauds Tanzania's strides in maternal healthcare. She points to President Samia Suluhu Hassan 's leadership, highlighting, "When she took office, prioritizing maternal health was her first message to parliament. Her commitment is clear, and we've seen real progress."
Beyond hospital walls
While CCBRT provides excellent hospital care, its dedication extends to comprehensive community outreach programs.
The Mabinti Centre, established in 2009, offers fistula survivors in Tanzania more than just physical healing. It's a pathway to reclaiming their lives. They train women in valuable skills like screen-printing, sewing, and business management, equipping them to "start their businesses and achieve financial independence and a sense of empowerment ".
The centre itself hires some graduates.
Over three months, the Centre offers a comprehensive program that addresses both physical and emotional needs. Participants gain practical skills like "screen-printing, sewing, batik, beading and crochet," allowing them to create beautiful and marketable products. They boast a well-respected brand for their "quality handmade bags, accessories, and toys," all created by program participants. The Centre doesn't stop there. They also provide "critical entrepreneurial skills, such as budgeting and communications," to equip the women for success as business owners. They foster a safe and supportive environment where women can heal emotionally, rebuild their self-esteem, and learn essential life skills like decision-making, HIV/AIDS prevention, and nutrition. Here, they rebuild not just their businesses, but their lives.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Income generated from these sales not only supports the centre's operations but also allows CCBRT to identify and treat more women suffering from fistula, creating a powerful ripple effect.
After graduating, each woman receives a business starter kit, equipping them with the tools and knowledge they need to return home and rebuild their lives. The Mabinti Centre's goal is for graduates to earn a minimum income that can support themselves and their families.
Msangi believes that with ongoing support and teamwork, this program can significantly improve the lives of countless women in Tanzania.
Campaign to end fistula
For two decades, a worldwide effort spearheaded by the United Nations Population Fund (UNFPA) has been working to end fistula. UNFPA launched the Global Campaign to End Fistula, a campaign that fights to prevent, provide comprehensive treatment (including surgery), and help survivors reintegrate into society. This global initiative operates in 55 countries, employing a four-pronged approach: preventing fistula, ensuring treatment access, reintegrating survivors into society, and advocating for change. Their work is grounded in core human rights principles, promoting equality, participation, and accountability.
Since 2013, the United Nations has observed International Day to End Obstetric Fistula on May 23, aiming to raise awareness and garner global support.
While progress has been made, reaching the goal of eliminating fistula by 2030 requires increased efforts.
