Fistula in Sierra Leone Presentation to IOFWG Nov 2012 By Regina Bash-Taqi Country Director

1. Fistula in Sierra Leone Presentation to IOFWG Nov 2012 By Regina Bash-Taqi Country Director Health Poverty Action Sierra Leone

2. Country Context Data Unicef 2010 Maternal Mortality Ratio - 860 Life time risk of 1:21 for maternal death Births per year - 226,000 Fertility rate of 5 Adult Literacy – 41% Less than 25% for rural women GNI per capita - 340 USD Also one of the most unequal wealth distributions in the world

3. Health Poverty Action Health Poverty Action works to strengthen poor and marginalised people in their struggle for health– through development initiatives in 13 countries and campaigning for change. Our expertise is the link between poverty and health Our programmes focus on most marginalised and usually means very rural populations.

4. Searching for women with Fistula The comb-through approach 2 NGOs provide all the fistula surgery in Sierra Leone – about 400 – 600 cases per year HPA has developed a NEW more EFFECTIVE Search Method known as the comb-through approach 20 volunteers cover 160 villages over 4 days. Screening done on day 5 On average each search finds about 15 women, a third of which are immediately operable. Each search costs cost about 12,000 USD. Rough costs to carry out across Sierra Leone …500,000 USD

5. Fistula Advocates Story of Fatu A book of pictures telling the story of Fatu is used by women who work with Health Poverty Action as defenders and promoters of rights in relation to fistula in Sierra Leone. Without words, the figures show how Fatu went through a long labor before seeking medical attention, the effect that the fistula had in her life, as she found a cure and as decided to help other women like her. This booklet format has been distributed globally and adapted by many other organisations For soft copies pls email: atdeen@healthpovertyactionsl.org.uk

6. What it means to be a Fistula Advocate Research by Zoe Vowles Person Centred Elements Intrinsic motivation “What they did for me made me glad in my heart. This made me happy to go and hold those meetings, we are happy to be able to help people get this treatment for this sickness; otherwise we would have all died.” Personal Expectations “At first, after the first operation I was there to my people, when they came to come and tell me to go, my papa cried he said sometime they had come to take me and sell me, he told me not to go. My auntie told him, ‘leave her, let her go they won’t sell her, they are not those kind of people.’ I was also afraid, I cried.” (FA5) Re-authoring Telling A Story ““One thing I enjoy about working with them is [...] they always set the examples on themselves. They say I have been suffering from this! I was ashamed; I was shun out by my family, my mother, my husband. Until when I have been repaired now, I can stand proudly and talk to you people, so it is your place to come out rather than making it a secret.” (KI2)

7. Continued Training of Advocates Training of staff in hospitals Monthly stipend to staff about 20USD per month Provision of kit – Fatu booklet and T-shirt

8. Mainstreaming Fistula Message • Play Safe Programme • Play Safe Prevent Fistula • Play Safe Prevent STIs • Play Safe Prevent HIV

9. Mainstreaming Fistula Message • Next Steps for Fistula Programming in Sierra Leone • Comb through 7 districts in North of country • Prolapse surgeries • Pilot Play Safe Prevent Fistula in 1 district • Continue training of advocates in hospitals • Livelihood support to advocates • Explore how to most effectively support those incurable

10. Thank you for listening