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Obstetric fistula: Fighting stigma in Tanzania

Worldwide, somewhere between 50,000 and 100,000 women are affected by obstetric fistula every year.

What's more, the World Health Organization (WHO) estimates that more than two million young women in Asia and sub-Saharan Africa live with untreated obstetric fistula. As a teenager, Keflene Yakobo, from Simuyu region in Tanzania, was one of them. Now 25 and fully recovered, she's an ambassador in her community, combatting stigma and helping ensure that no woman has to go through what she did.
Keflene Yakobo (pictured above with her parents, first from right) got married at 17 and was pregnant by the time she was 19.
"As soon as I found out I was pregnant, I started attending antenatal clinic," she remembers. "For the entire term there was no problem identified or suspected. I was happy, waiting for my newborn. During the last month of my pregnancy, I decided to stay at my parents' home so that my mother could support me. When the labour pains started, my mother took me to the Traditional Birth Attendant (TBA) who lived seven kilometres away. As it was my first pregnancy and I was used to seeing expectant mothers being taken to the TBA, I was calm, thinking all would be well.
"By the time we reached the TBA's house, I was in terrible pain: I was just praying that the baby would come out safely. Finally, after three days of waiting in pain, only the head of the baby emerged. My mother hired a car to rush me to the nearest health centre, which was in Magu, 22 kilometres away. I was completely unconscious and still the TBA insisted we remain at her place, without considering the horrifying condition that I was in.  
"We managed to reach the hospital, where I was operated on. Sadly, the baby was already dead - and my condition was not good. The doctors successfully managed to perform the operation and I was hospitalised for five weeks due to abdominal sepsis. When I returned home, my husband came: not to see me, but to inform my parents that he would no longer live with me because of the fistula."

A tough time in my life

"It was a very tough time in my life," remembers Keflene. "People laughed at me, I could not join any social gatherings, I could not attend church. I couldn't even visit my friends, and some other community members were speaking ill of me behind my back due to my condition.
"In November 2011, I was informed by a doctor at Magu District Hospital that my condition was curable. The doctor linked me to a focal person who could provide more information. I went to Seliani Hospital in Arusha, where my injury was repaired." 
Two weeks later, Keflene was released from hospital. At this point, Amref Tanzania stepped in, providing Keflene with psychosocial counselling, equipping her with entrepreneurial skills, and introducing her to community support groups. With this support, Keflene has resumed her social activities, like attending church and community meetings. She is now an ambassador for fistula in her community, helping to combat the stigma that many patients face. She is supporting herself by selling food and keeping sheep, using the skills she learnt during her entrepreneurship training. She has also remarried, and has a healthy baby.
"It is so important that Amref Health Africa and other organisations are raising awareness of fistula," says Keflene. "I believe many people are suffering and abandoned by their spouse and community because of fistula, despite the fact that it's completely curable."
Amref’s fistula programme creates an inclusive environment for obstetric fistula prevention, treatment, and social re-integration for patients and their families. It not only increases awareness among affected women and other community members, but also provides psychosocial support and entrepreneurial skills, creating self-help groups and providing training for the medical staff who perform fistula repair services.

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