A Guilty Conscience

My fieldwork in Tanzania is now beyond its halfway point, and I believe the time is ripe to provide a brief summary

MHK after her fistula surgery

MHK after her fistula surgery

By Sara Abdullah, MSc-GH '16

Published June 12, 2015, last updated on April 7, 2020 under Voices of DGHI

My fieldwork in Tanzania is now beyond its halfway point, and I believe the time is ripe to provide a brief summary of everything that I have learnt here so far. The aim behind my journey here was to gain context with regards to the stigma that women with obstetric fistula face. I am accomplishing this goal by participating in a project that is currently testing a mental health intervention for fistula patients at Kilmanjaro Christian Medical Center (KCMC) in Moshi. 

My introduction to this world of fistula within the Tanzanian context began with observing the delivery of the mental health sessions of the intervention. As I sat in the back of the room while the study nurse delivered the sessions in fluent Swahili, I began to realize how necessary language is to fully understand something yet how unnecessary it is to interpret basic human emotions. Although I had no idea what either the patient or the nurse were saying, the facial expressions and the inflections, as well as the vivid hand gestures, kept me gripped. The pain stricken expressions of the seventy year old patient clearly conveyed that she had suffered a lot, while her body language indicated her difficulty in recalling many of the details.

After the session was over, the nurse hand wrote details about the session and handed them over to me so that I could type them up in the format required. Typing up the details of the sessions filled in the gaps that the language barrier had left in my understanding, while leaving me appalled at the level of suffering many of these women endure.

This particular patient (MHK) has been kind enough to allow me to share her story as an example. MHK has been suffering with her fistula for the past 55 years. After her child had died due to the obstructed labor that resulted in her fistula, her husband left her and she has been isolated from society ever since. In her sessions, she talked about how for the majority of her life, people have stayed away from her, gossip about her and make her feel unwanted and misunderstood. This all has led to her barely ever leaving her house and often being left without any kind of support. As she got older and word got around that there was an old woman living alone, all her properties and animals got stolen by thieves, further exacerbating her misery. Her story was heart wrenching, yet I soon realized that this was only just the beginning.

As my days working at KCMC passed by, I realized that the patient above was not unique in her suffering and that almost every other patient had stories that followed similar themes. Today, not a day goes by when I don’t count my blessings or where I am forced to examine my own problems and then conclude that they are nothing compared to those faced by many here. This experience has opened my eyes and it makes me want to do more for others, whatever and however that may be.

Another interesting experience was when I decided to travel to Dar-es-Salaam to visit the fistula ward and the surgeons at a hospital. I flew out on a Tuesday and kept a three-day window as the hospital had still not confirmed the date of my visit. I was told that this was normal, as the hospital was known for being vehemently opposed to researchers, believing that as a hospital, their duty was only to treat. Finally after much emailing back and forth, the hospital gave me a time and date to visit and I showed up hesitantly, not knowing what to expect. However my worries seemed unfounded as the staff as well as the surgeons were friendly and open.

I spent considerable time with the outreach director, who showed me around the ward while talking about their outreach efforts in different parts of the country. I then got to meet the lead surgeon, who talked about her experiences as a female surgeon in the country and the patients she meets. She especially talked about how she believed that surgery wasn’t just enough for these women, as many have been through severe trauma and require psychological help. She personally provides group counseling to all of her patients and talks to them individually whenever they need to talk; however she wants to introduce a proper psychiatric system. Unfortunately, this has not happened, as she has faced a lot of opposition from within the administration. We also briefly touched upon the topic of research and she said that although she believes research is necessary, she does not think it should be the priority for the country currently.

I came back from Dar a few days later, still trying to process all that I had learned. Upon my return to KCMC, I had the fortune of running into an administrator from a small district hospital in Karatu. She was an American but had been working in Tanzania for the past five years. We talked about a lot of things, but what really stayed with me was our conversation about capacity building. The administrator talked about how they get a lot of foreign workers in hospitals similar to that in Karatu, but the focus is not so much on training but on working. She explained that the foreign workers come, try and do as much as they can and then leave. Instead, she believes what is really needed is for these foreigners to take a step back and be a teacher and a guide and impart the skills to the locals, which could initiate a self-sustaining movement. The administrator finished with a wry smile, commenting, “We all like to feel needed, and it is easier for us to say that I treated a hundred patients than say I trained one doctor who can now treat hundreds.” Although it might come off as flippant, I personally believe this remark holds within itself a wealth of meaning and has stayed with me ever since.

In conclusion, I feel guilty. I am here for my research and my project; however I have to come to realize that these people need a lot more than just papers and projects. In order for change to happen, we each need to play our part beyond just our research. However, this is easier said than done ... but I know for sure that I am definitely going to try.

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