A young girl living on the edge of the Sahara Desert lives in a land that rarely sees rainfall and temperatures can range from 86°F to 122°F regularly. Her family lives off what little land they own and have to survive on less than $2 per day. If her family is able to send and support her, the girl may be able to attend school intermittently for a few years. The legal age of marriage is 15 years old, and if she didn’t attend primary school, the chances of her being married before she is 18 years of age are close to 70%.

She marries at this young age, before the growth of her bones and her nutrition are able to sufficiently and safely carry a child. Yet, she becomes pregnant. Living far from a health facility and not being able to get to health care in time or afford appropriate care, she can lose 1, 2, 3, or more of her pregnancies. During one of her pregnancies, the baby gets stuck in the birth canal and is unable to be born. She cannot access help in time and is left with a dying fetus as well as pressure from that fetus resting on her vagina, bladder, and rectum. This sustained pressure can cause destruction of the tissues and create an abnormal passage, or an obstetric fistula between these organs, causing her to leak urine or feces incessantly.

Smelling like urine that is constantly leaking onto her clothes or onto the ground around her, the girl is left outside her home to live with the animals. At times, the destruction of her tissues leaves her with nerve damage to her lower limbs. Being left immobile and afraid to go out, her limbs can become contracted and atrophy. She feels alone and isolated, scared for herself and her surviving children.

emBOLDen Alliances had the fortune to meet one such girl when she had become a woman (“Halimatou”). Halimatou had had 8 pregnancies, of which she had lost four. During her ninth pregnancy, the baby was stuck in the birth canal. This baby also died, and she developed a severe fistula causing her to leak urine constantly. Halimatou had sought help at health facilities where they were unable to repair her condition surgically. She had come to this new fistula center in search of hope, one more try to find a “normal” life.

What she found was a comprehensive fistula center run entirely by West African staff, where women just like her were able to gather together, share their stories, and find a home amongst each other. They cared for each other’s children when a mother went in for surgery. The older woman, like Halimatou, comforted the younger women, and the younger women, in turn, helped the older. While at the center, they were taught how to read and write; some learned how to knit and to sew. Most of all, they could envision a better life and learned to dream again.

On examination, Halimatou’s damage was unfortunately beyond repair, yet the Hospital Director immediately saw how helpful and kind she was to incoming and current patients. In a new role as a staff member, she was welcomed and treated with respect. With pride, she worked tirelessly to help others. This woman, who was considered “incurable” after 7 surgeries and who would leak urine for all her days to come, found her new home and regained her dignity. Halimatou found her hope and was helping those around her find it too.

Niger has one of the highest rates of child marriage in the world and women often lack access to timely and sufficient maternal care. The low education completion rates for girls, high rates of child pregnancy and lack of access to health care add up to high rates of obstetric fistula, a preventable condition.

The West African staff of this obstetric fistula care facility was doing an incredible job with their clinical and basic literacy programs, but saw the need to improve their hospital operations, logistics, programming, and inventory. They wanted to do more with their resources, be sustainable in order to help others, and scale up their work to increase their reach and impact.

EmBOLDen Alliances partnered with the staff on their administrative needs, such as human resources, tracking of expenses, and a three-year budget to match a scale-up of programs. We worked with them to inventory all medical supplies and put into place a system, customized to their needs and facility, to track supplies across all areas of the center and thus, avoid stock-outs. Together, we analyzed and integrated data and reporting from all programs, starting with clinical and basic literacy, and included outreach, prevention, and social reintegration/livelihoods.

In short, our partnership helped this West African Team do what they were already doing better and more sustainably, so they could reach more women like Halimatou. They could also measure and demonstrate that their programs were impacting knowledge and awareness amongst communities, helping to convince village elders to keep girls in schools, and promoting job possibilities for the patients to support themselves and their families. The women patients had a better chance to then keep their own girls in school and break the cycles of poverty, lack of education, early marriage, and obstetric fistula.

Halimatou’s strength in the face of these injustices is a humbling lesson. The power of individuals and local communities to change their own lives can be limitless. Labels of “shunned” or “pariah” can be changed to “contributor,” “role model,” or “leader.”

This is why, as a global nonprofit organization, emBOLDen Alliances works with communities most in need of assistance. Rather than arriving with pre-formed strategies created in a distant land, we arrive prepared with questions, listening, experience and plans to partner, create tailored tools together, and then step back.

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Copyright emBOLDen Alliances 2016.  Art by Bill Rohs, www.artbillrohs.com.