Good work to improve health globally is still happening, despite the news about funding cuts and the end of USAID. And every human being, especially those without the “luck of latitude,” should have access to lifesaving health care. Although work has been affected, there are many local nongovernmental organizations still doing great work; they have not stopped, and deserve support now more than ever.
An example is Ethiopian-based and -led Healing Hands of Joy, which we both work for here in the Pacific Northwest. The grassroots organization has a goal to eliminate fistula — a debilitating childbirth injury — by 2030 in Ethiopia. But it will take a concerted effort to make this goal a reality. Progress is at risk because of recent cuts to aid. However, it is not the end of the story. Groups like HHoJ, small, efficient and on the ground, continue to do vital work that makes a huge difference in people’s lives.
A patient’s story
Here’s an example: After getting married at 15, Nigisty Gebregziabher, who lives in the Tigray region of Ethiopia, became pregnant. She lost her baby during childbirth, and because of prolonged, obstructed labor, developed an obstetric fistula, an opening between the bladder and/or rectum and the birth canal. Thanks to modern and accessible emergency obstetric care, this injury no longer occurs in the U.S.
Sick and frustrated by the unrelenting incontinence, Nigisty was ostracized by her community, as typically happens to women with obstetric fistulas in Ethiopia. In most cases, babies do not survive. An estimated 40,000 women in the country live with untreated obstetric fistula, and the number continues to grow. But it does not need to — obstetric fistula is preventable, and surgical treatment is free if women can get to care.
Nigisty was forced to live in isolation and shame for years. But her life turned around when she underwent surgery and connected with HHoJ.
With counseling, rehabilitation and a small business grant, Nigisty got a fresh start. She bought a cow and was able to earn an income and feed her family. She also became a passionate Safe Motherhood Ambassador, educating her community and especially pregnant women and health workers about how to prevent and treat obstetric fistulas. Nigisty is now a change agent in her community, a sustainable and tireless resource.
She is one example of thousands of survivors who then turn around and drive change in their own communities. Who better than a survivor like Nigisty to persuade other rural women to walk miles for prenatal care and ensure they deliver in a health center? This is not a handout, it is a hand up. A little goes a long way.
Organizations like ours need funding to bring an end to this devastating injury. Resources help scale up and provide the services that communities in sub-Saharan Africa have come to rely on as they work to strengthen their own health systems.
Let’s support solvable problems
Working in Ethiopia as a physician, consultant and educator for 15 years, one of the authors, Dr. Tim Teusink, has seen firsthand the devastation that obstetric fistula causes in women.
Not only do mothers lose their babies in childbirth — 70% of babies born to fistula patients do not survive — but they also have to grapple with the chronic health and social challenges that follow.
This childbirth injury disproportionately affects women in areas with limited access to health care, and still, over 40% of women in Ethiopia give birth at home out of necessity.
Obstetric fistulas were once common in the U.S., but the invention of anesthesia and improvements in obstetrical care meant that American women had access to cesarean sections by the early 20th century and the condition is no longer prevalent. Today, C-sections are the most common major surgery in America and account for one out of four births.
According to the World Health Organization, there are 50,000 to 100,000 new cases of obstetric fistula worldwide every year, and 2 million women with the condition in developing countries remain untreated. It seems an injustice that any pregnant woman experiences this devastating and preventable injury.
Our vision includes not just rehabilitation from obstetric fistulas, but prevention through maternal health education and improved health care infrastructure, and support for ostracized and isolated women to reintegrate into society.
The key to success is empowering community members themselves, and having program staff from the community and decisions made with community input. For example, our Safe Motherhood Ambassadors are survivors with experience and training as maternal-health peer educators. They know their community and will even walk very long distances to help a pregnant woman or find a suspected fistula case.
So far our 3,500 volunteer ambassadors have collectively supported the safe delivery of more than 28,000 babies and prevented many childbirth injuries by helping women get to care. The ambassadors are empowered to speak openly about coping with obstetric fistula, and through our partnerships with the Ethiopian Federal Ministry of Health and other government entities, they are educating more women about the importance of prenatal care and how to access safe childbirth services.
We are working to improve the health infrastructure for pregnant women. This means providing portable ultrasounds and training at local health centers for better prenatal care and identification of high-risk pregnancies and possible obstructed labor. This also means working with the local community to provide maternity waiting homes so that women who live far from medical facilities can be close to a hospital as delivery nears.
A little support for cost-effective programs builds self-sufficiency and empowered communities and goes a long way. If the change in foreign aid concerns you, find ways you can make a difference. There are many great organizations doing a lot with a little.
Success can be fragile, but that is not a reason to give up. After years of work, we and other organizations had lowered the number of cases of obstetric fistula in Ethiopia by an astonishing 80% in the Tigray region. It can be done.
With recent conflicts in Ethiopia, we are seeing the effects of sexual violence used as a weapon of war. An estimated 120,000 women were raped in the most recent conflict in Tigray, and the prevalence of obstetric fistula skyrocketed to 4,000 new cases annually due to the destruction of clinics and the fear of traveling for care. Peacebuilding is critical to health all around the world.
A global responsibility
In the face of the growing vacuum in global health funding by governments, we have serious concerns about the long-term viability of women’s health organizations.
Even with foundations like the Helmsley Charitable Trust, which has as part of its mission the well-being of children and families in remote communities in sub-Saharan Africa, vital work is at risk. We are thankful for visionary philanthropists, like MacKenzie Scott, who have funded fistula surgeries globally, or the Seattle-based Gates Foundation, which responded to recent government cutbacks by committing $200 billion by 2045 to reduce preventable deaths globally and recently announced a significant investment in maternal health.
Healing Hands of Joy represents the best of what international partnerships can achieve: an organization mobilizing to make motherhood safer; a diaspora moved by its difficult past and challenged future; community ownership and expert staff; and survivors turning their greatest shame into their greatest strength.
It is also a reminder that progress is not permanent. Threats always loom.
But if we don’t act, then nobody will.
When women are left behind, the world does not move forward. And that would set us all back.
