Testimony from Dr. Joseph Ruminjo

Good afternoon, ladies and gentlemen.

My name is Joseph Ruminjo, and I am the Clinical Director of the Fistula Care project.

The project is managed by EngenderHealth and supported by USAID, and is now working in 11 countries. The project works with over 60 health facilities, and USAID support has enabled more than 15,000 fistula repair procedures so far. My brief comments will focus on how strengthening local capacity for fistula treatment and prevention is the way forward. One successful strategy is partnering at different levels in order to transform women’s lives. 

You have just heard Sarah tell her powerful story. In order to treat the millions of women like Sarah around the world, the entire international community must come together to support fistula programming.

This requires collaboration with individual champions.

It requires working with communities.

It requires ownership at the facility and national levels.

And it requires the support of international coordination.

At all of these levels, we are working in partnership to build local capacity to support not only the treatment but, crucially, also the prevention of this devastating condition.  

I will now give a few specific examples of how building partnerships at the various levels is helping to transform women’s lives:

At the Community level—in Guinea, for example:

• Women and men are organizing together to support the pregnant women in their communities, working vigilantly to ensure that they get emergency care and transport when they need it.

At the health facility level—in Bangladesh:

• The availability of transportation can mean life or death for a laboring woman. One of our in-country partners, Ad-din Hospital in Dakka, has set up satellite stations for vehicles around the city to transport women experiencing pregnancy complications requiring emergency care.

Partnership at the National level:

• It is critical that we support the talented, hard-working, and capable surgeons who are working on the ground. They need continued training, professional opportunities, and the moral support of interacting with one another.

• For example, just last month, the Democratic Republic of Congo brought together 15 surgeons, representatives from the Ministry of Health, national advocates for women’s health, and international partners to review and strengthen a national strategy that will outline protocols, standards, and guidelines for fistula services and will share experiences.

At the International level:

• Working to strengthen the infrastructure and capacity for fistula repairs and prevention around the world. For example, EngenderHealth has worked in collaboration with UNFPA on fistula since 2001. EngenderHealth is also proud to be a member of the International Society of Obstetric Fistula Surgeons, a professional association for fistula surgeons across Africa and Asia with more than 100 members who are known to be providing fistula repairs routinely.

The goal of partnership at the international level is to develop tools that can strengthen systems, build capacity, and measure outcomes. All of this is to enable women like Sarah to have increased access to fistula treatment.

We know what works on the ground. The delivery of services is really the hard part. And it’s partnerships at all of these levels that allow us to deliver services effectively.

We’re at a major turning point.

The political will, commitment, and funds from the U.S. government thus far have transformed the lives of more than 15,000 women and families.

We are very pleased to see the commitment expressed in HR 5441.

I urge us to use the momentum to take this forward.

Testimony from Josephine Elechi, the First Lady of Ebonyi State in southeastern Nigeria and the founder of the Mother and Child Care Initiative

Good afternoon, Ladies and Gentlemen.

My name is Josephine Elechi, and I am the wife of the Governor of Ebonyi State in southeastern Nigeria. It gives me great pleasure to be invited to this briefing and to have the opportunity to share my experience with such a distinguished audience.

For those of you who may not be familiar with Nigeria, we are the most populous nation in Africa. We also account for 10% of all maternal deaths worldwide. This is a terrible statistic that I am intending to change. And today, I’m going to speak about a successful program called the Mother and Child Care Initiative that is making vital strides towards improving maternal and child health and addressing obstetric fistula in Ebonyi State.

From an early age, growing up in a small village, I saw firsthand the severe challenges that Nigerian women faced because of pregnancy and childbirth. I witnessed women who died trying to give life and saw what that did to the children and families who were left behind without a mother. I also learned about obstetric fistula, a hole that can develop between the bladder and the birth canal following obstructed labor. I was moved by the stories of women with fistula who were performing their God-given role to give life. What happened was not their fault; it was our fault. Society was allowing it to happen. I was filled with compassion towards the incontinent and shunned fistula sufferers.

So, when my husband became the Governor of Ebonyi State, I was in a position to advocate for better maternal and child health. As many of you in the audience know very well, good governance is about serving the people and helping our constituencies thrive. Hence, I decided to use my position and influence to create the state-wide Mother and Child Care Initiative, also known as MCCI. The progress we have made to date is due to the collective strength of partnership, quality services, and improved community awareness.

The MCCI was born out of partnership. One of the first things I did to ensure that fistula surgical repair was made available in Ebonyi State was to bring together members from the Ministries of Health, Women’s Affairs, Planning, and Education and the State teaching hospital to form the MCCI in 2007. I would not have succeeded if this were merely a personal project. One major outcome of this effort was the establishment of the South East Regional Fistula Center in December 2008. Located in Abakaliki, our state capital, this is a fully equipped hospital with 100 beds, a full-time fistula surgeon, and four trained fistula nurses. This repair center represents a unique collaboration between numerous partners, including the state government, local government areas, the Fistula Care project supported by USAID, and others. In the long term, we hope the national Ministry of Health will take the reins of the fistula center, which is located on the grounds of a state teaching hospital. In addition, we are trying to advocate for continued provision of quality repair services at no cost to fistula patients. The MCCI is also leveraging partnerships to address additional maternal and child health issues, including breast and cervical cancer and HIV/AIDS.

Before we implemented the MCCI, we needed to understand the magnitude of the fistula problem in the state and to also make the case for bringing preventive and repair services to women. At first, the leaders and people in Ebonyi State did not consider fistula to be a local problem, believing instead that fistula occurred mostly in the North. The MCCI chairman and fistula surgeon, Dr. Sunday Adeoye, conducted screening campaigns around Ebonyi State and in one month, to the shock of many leaders, he had identified 400 women with fistula. These are women who are not able to fully contribute to their families and be productive members of society due to their debilitating condition.

Finally, I want to talk about one critical component to the success of the MCCI. In Ebonyi State, there was very limited awareness of, as well as myths and misperceptions in the community about, fistula, which was a challenge. For example, many women living with fistula did not believe that they could be cured. In addition, a common misperception was that fistula was a shameful indication of marital infidelity. The MCCI conducted community education campaigns to raise awareness of repair services. Also, after the first repaired women began returning to their communities, transformed, other women suffering with fistula emerged to present themselves for repair at the center.

To stem the tide of new cases of obstetric fistula and reduce the burden of maternal mortality, I am now working to formulate and implement policies which will make motherhood safer in Ebonyi State. Prevention is key to ending fistula, and I hope you are encouraged by the progress that I am sharing with you today. The MCCI is a testament to the wonderful, strong collaboration we have with local partners and with the Fistula Care project, the USAID, and others such as UNFPA. There is much more to do, and I hope that you will stand with me to ensure that women, not only in Ebonyi State but everywhere, can live full, productive lives free from fistula and in good maternal health.

Thank you very much.