Mengistu Asnake Sendayo Dargo
“As I was pregnant out of wedlock, I had never attended any health center or told anyone about my situation. Besides, I did not go to health centre for delivery. I went into labour for three days at home. I thought the prolong labour was a sign that I was giving birth but the baby had already died. Consequently, the obstructed labour caused a rupture in my bladder, or fistula. My injury subjected me to three months of urine leakage,” said Sendayo Dargo, a resident of Mehoni village, western part of Tigray.
Rubbing salt into the wound, her situations stir up village gossip and derision. “I had to go through isolated and stressful time. I spent three months being immersed in physical and psychological anguish. My life is turned upside down,” she only paused for moment to shed her tears recalling her ordeal.
Sendayo thought there was not treatment for her injury till someone told her she could get a repair at Mekele Hospital. Her father took her there and she was successfully repaired, finally. After the repair she received various trainings and rehabilitated in her community. “I am well aware of the causes, consequences and the availability of treatment for obstetric fistula,” she said, “I want fellow citizens to get firsthand experience from me. This is the reason for me to involve in awareness raising activities,” she said.
In Ethiopia, where about 2.9 million women give birth each year, 9,000 mothers develop obstetric fistula. Those who do not get treatment live a miserable life with a condition that isolates them socially from the rest of the community. Because of the leakage of urine and sometimes faeces, the victims smell. The good news is that fistula is both preventable and treatable. However, lack of awareness, cultural prejudices, inaccessibility of health centres, among other factors, impede medical interventions.
It is true that awareness play important role in the prevention of health problems such as fistula. Sendayo is now a member of women’s Development Army in which she is an Ambassador for Fistula. She and her fellow post-recovery women involve in awareness creation activities in their locality. They play due role in enhancing the prevention of incidence of new injuries by disseminating pertinent information that could prevent maternal mortality and morbidity.
Mekan Health Post, where Sendayo works along with her fellow members of Women Development Army, is one of the places recently visited by Technical Advisory Committee of The Integrated Family Health Programme (IFHP) and other stakeholders. IFHP is a USAID funded health programme implemented by Pathfinder International (PI) and John Snow Incorporated (JSI) in partnership with the Consortium of Reproductive Health Associations (CORHA) and other local partners. In the meantime the Committee visited various health management structures, health facilities and households in western part of Tigray State.
The visiting team conducted a series of visits to: Endamehoni Woreda Health Office, Meswaeti Health Centre, Mekan Health Post integrated activities and households, Kukufto Health Centre, Raya Azebo Woreda Health Office Michew Hospital cervical cancer prevention and other activities and Demere Meles Health Center LAFP/IUCD services and other MNCH activities, meeting with the health extension worker, the leader of Women Development Army and community members.
Briefing the visiting team, Head of Mehoni Wereda Health Office, Goytom Aleme, said in the just concluded Ethiopian fiscal year efforts were intensified to enhance institutional delivery and in doing so 96 per cent of pregnant mothers attended antenatal care in health centres. Despite the fact that skilled delivery coverage increased significantly in the Woreda, seven per cent of pregnant women deliver with assistance of health extension workers at home as they could hardly reach health centres due to the distance. And eight per cent of pregnant women deliver at their home without skilled birth attendants.
With regards to modern family planning use, Goytom said significant achievement was made. At the moment the coverage of modern family planning methods reaches 61 per cent. The number of Long Acting Family Planning (LAFP) users has improved from time to time. For the time being, the users of LAFP reach 19 per cent. To sustain the success attained in the Woreda, IFHP provides health service practitioners with various capacity building trainings. They trained on family planning and HIV service integration with particular emphasis on the Prevention of Mother to Child Transmission (PMTCT) and Anti-Retroviral Therapy (ART) use, he said.
Dr. Mengistu Asnake, IFHP Head and Pathfinder Country Director, said the program supports the Ethiopian Public Health System on Reproductive Health (RH), particularly on Family Planning (FP) and Maternal, Newborn and Child Health (MNCH). The programme focuses on increasing the use of high impact FP and MNCH practices, products and services. The programme operates in 301 woredas of Amhara, Oromia, Southern Nations, Nationalities and Peoples Region (SNNPR) and Tigray, and to a lesser extent in Benshangul Gumuz and Somali States. The programme has been implemented in line with government’s priorities and goals set for the health sector.
He said significant achievements are registered in IFHP project implementation regions. Commendable successes have been registered in intensifying efforts to prevent causes of maternal morbidity and mortality by improving access to family planning and maternal health care. These initiatives such be further strengthen consolidating cooperation with stakeholders and addressing identified gaps.
Concerning the visit to Tigray, Dr. Mengistu said the quality of services being provided across all sites visited were laudable. He appreciated the high level of commitment, dedication and motivation of the health practitioners and leadership. “The coordinated activities of the community, the Health Ambassadors, the Women Development Army, the health extension workers and the Health Centre leadership to reduce the burden of maternal and child morbidity and mortality is promising and worth to extend to other parts of the country,” he said.
He urged all stakeholders to address some of challenges in relation to the high turnover of trained health practitioner, shortage of water and electricity in health facilities. These challenges inflict efforts to provide quality services.
According to the Head of Mehoni Woreda Health Office, Goytom Aleme, there are commendable lessons learnt from implementing the health programme. He said community based financial and food crop contribution for the delivering mothers is the best practices of his Woreda to ensure the health of mothers. Besides, there is Child birth day ceremony at 6 months to remind to start complementary feeding to children. The involvement of religious leaders and treated cases fistula Ambassadors to support skilled delivery is encouraging. The availability and use of traditional ambulance per village as well as experience sharing inter and intra health facilities are some of the best practices worth to share. However, Goytom stressed the importance of enhancing the active participation of stakeholders to address some of the problems including lack of rooms for delivery services in some health centres.
It is worth noting that the active involvement of the community would play paramount role in coming up with succeed interventions to save the lives of millions of mothers and children. The participation enables them to own their health and enhance efforts to improve the accessibility and quality of health to all. To this end, it is critically important to beef up their involvement with pertinent knowledge, skill and attitude.
Sendayo Dargo who received various trainings after recovering from fistula can be a good example for the importance of involving skilled individuals and community leaders to augment effort to ensure the health of women and children. She is now working along with her fellow members of Women Development Army promoting the importance of immunization, antenatal and skilled delivery uptake, and infant and young child feeding practices in their community. They teach members of their community particularly women in the remote parts of their locality to protect themselves from obstetric fistula. They need further support to heighten their activities to bring maternal, infant, and child morbidity and mortality numbers down.