Upload
rakesh-rajani
View
992
Download
1
Tags:
Embed Size (px)
DESCRIPTION
A photographic exhibition presented by Maggie Bangser at her talk upon receiving a honorary doctoral degree from Amherst College in 2009.
Citation preview
An estimated 2 million girls and women live with fistula
worldwide. Each year there are an additional
130,000 new cases.In other words: every four
minutes somewhere in the world a girl or woman
gets a fistula.
Sources: World Health Organization, 1998L. Lewis Wall, The Lancet, 2006
I never heard of fistulabefore I got one.
I thought I was the only woman in the world leaking urine and faeces.
Now I know there are so many other girls and women with fistula!
An unknown problem
photos: Mwanzo Millinga
70 percent of the girlsand women in the
’Risk and Resilience’study got their fistula atthe age of 20 or older.
For many, this wasnot their first delivery.
Source: Women’s Dignity, EngenderHealth,et al., 2006
Don’t think fistula is onlya young girl’s problem.
I got fistula when I was 29 years old.I am 54 now, and am so happy I will
finally get surgery and be dry.
photo: Mwanzo Millinga
The majority of the women in the fistula study isolated
themselves from other community members,
remaining in their homes as much as possible and
forgoing public events like funerals, celebrations and
visiting neighbours.
Source: Women’s Dignity, EngenderHealth, et. al., 2006
“I feel shame. They laugh at me.They turn their lips up, and others
leave the moment I enter to take my tea with them.”
The disgrace of fistula
Although fistula makes itdifficult for women to
participate actively in their community, they are not
abandoned. All the women in the fistula study
received some form of help from their family or
community.
Source: Women’s Dignity, EngenderHeallth, et. al., 2006
My husband has paid foreverything – the bus, the hospital, the medicines….He saved my life,
but it will take him years to pay back the loans.
Alone,but not neglected
One out of three Tanzanians report that
their family did not have enough clean water over
the past year.
Source: Afrobarometer 2005
“Imagine you have fistula. You have to walk six hours to get one bucket
of water. Now, you have to decide how you are going to use the water
– for washing, drinking, bathing, and cooking, or for yourself.”
Precious water
photo: Mwanzo Millinga
The majority of thewomen in the fistula study
wanted to deliver their baby at a health care facility of some sort.
However, fewer than half set aside money – ranging
from USD 3.50 to 50.Preparing for delivery was
difficult, due to lack of money and the hospital
being too far away.
Source: Women’s Dignity, EngenderHealth, et. al., 2006
Being ready
I was prepared for my baby – I’d saved some money, I knew where to
go and my husband asked a neighbour to bring me there on his
bicycle. All women in my village should have a plan like this.
If only I had been told that my blood pressure wastoo high, I would have gone to
the hospital for delivery.
Sources: Ministry of Health (RNC/NMCP) JHPIEGO, 2004Demographic and Health Survey 2004/05
photo: Sala Lewis
Theory vs. reality
According to the official guidelines of the Ministry of Health and Social Welfare in Tanzania, antenatal care services should include: physical examination from head to toe; check for blood count, blood pressure and urine; screening for syphilis and HIV; provision of tetanus toxoid vaccination; anti-malaria medicines and iron supplements; health education, including information about pregnancy, labour and delivery.However, reality is often different. For example, out of every ten of the poorest women in Tanzania, only four have their blood checked during antenatal care. For the wealthiest women, almost 9 out of 10 receive this service.
More than half of the poorest women in
Tanzania say they face big problems in accessing
health care because the facility is too far away and
they need to take transport to get there.
Source: Demographic and Health Survey2004/05
When my family realized I neededprofessional help, I had to walk
four hours to the main road.There I waited for a bus, but only
one passed and it was already full.
Access tohealth services
Sources: World Development Report 2006National Institute of Medical Research, Ministry of Health and Social Welfare, 2006
The nearest hospital to my village is40 kilometers away. I can get to the local health
centre, but it cannot do operations at all.
Safe delivery
In Tanzania, one woman out of every 66 who give birth, will die. In the USA, one woman out of 5,882 dies during childbirth. A caesarean section can save the life of a woman who has an obstructed labour. In Tanzania, 65% of government hospitals provide caesarean section, but no health centres or dispensaries provide this life-saving service.
In rural areas of Tanzania,there is usually one
medical officer caring for 45,000 people or more.
In Ruvuma region,there is just one doctor for 250,000 people. In Dar es
Salaam there is one doctor for 14,700 people.
In Germany there is onemedical doctor for every
280 people.
Sources: Ministry of Health Personnel Census 2002, draft
World Development Report 2004
I was lucky.I got to a hospital with a nurse and a doctor who took good care of me.But I know women from my village
who have died during childbirthbecause no one could help them.
Professional help
photo: Dorthe Friis Pederson
The maternity ward was packed with women – on beds, on the floor, everywhere. There were only five
nurses. I saw one woman deliver without any help.Source: World Development Report 2004
How healthcare ranksTanzania spends $12 per person per year on health. This compares to approximately $6,000 in USA, $3,100 in Australia, $70 in China, and $33 in India.
Sources: UNFPA Tanzania budget estimates, 2006
Money well spentSpending 8 percent of Tanzania’s annual health budget on required delivery kits, skilled health workers, and emergency obstetric care would ensure all pregnant women a safer childbirth.
What is more important – education, water, infrastructure, or healthcare? The budget is limited
and we have to make choices. Difficult choices.
photo: Dorthe Friis Pederson
Source: World Development Report 2006
“Our income has decreased because only myhusband is working. There are times when we don’thave food. Washing daily is costly, you must buy the
soap. This money could be used for other things.”
Less income, more expenses
Almost half of Tanzanians live on less than 1 dollar a day; almost three quarters live on less than 2 dollar a day.In poor families, everyone has to contribute to thehousehold income.
Source: Demographic and Health Survey 2004/05
Money determines where one gives birth.I didn’t have enough money to deliver in a health
facility, so I delivered at home.
A costly service
Half of the poorest women in Tanzania say that getting money for treatment is their single biggest obstacle while seeking health care. Twenty five percent of thewealthiest women also experience this problem.
More than 60 percent ofTanzanians believe that
the current government isfighting corruption well.At the same time, if you ask 7 Tanzanians if they
paid some kind of bribe to get medicine or medical
attention in the past12 months, one person
will say ‘yes’.
Sources: Afrobarometer 2005
“The nurse at the facility told me,‘If you don’t pay Tshs 15,000 (US$15)
you will never get a blood transfusion. If you have to die, better die.’ ”
Unhealthy practices
photo: Dorthe Friis Pederson
Very few people are aware of their health rights. It’s important that they
know, so they can demand them.
The right to informationWidely disseminated messages about health rights – including respectful treatment by health workers, and mechanisms of complaint – can enable citizens to demand their rights and hold government accountable.
One man’s voiceSpeaking out against bad health services is risky. You will be remembered. But individual acts of courage can bring change to thousands.
How can the clinic staff deny a desperate young woman
transport for the sake of US$ 6?
photo: Dorthe Friis Pederson