CCBRT and Kupona Foundation in Dar es Salaam, and the importance of educating the community
When Mary, one of Kupona Foundation’s Advisory Board members, moved to Dar es Salaam a few weeks ago the CCBRT team offered to show her around her new home. So last weekend Mary and Alexandra, CCBRT’s International Communications Manager, set off on the Dar Reality Bike Tour. They were expecting a day of new experiences, sights and sounds. They weren’t expecting to experience a close-up reminder of how important CCBRT’s work is within the community.
Dar es Salaam is a city full of culture, intriguing sights and sometimes unpleasant but always interesting smells! As an expatriate, it can be easy to feel out of touch with the reality beyond your own social circle and work environment. International restaurants boast prices that are not affordable for most Tanzanians. That’s why we decided to sign-up for the Dar Reality Bike Tour, which takes you on a 15km (~9 mile) ride through neighborhoods that are off the tourist track.
We are both fully aware of CCBRT’s presence and reputation within the community, but neither of us was prepared for how close we would get to the work that we do at CCBRT while biking through Dar. Tandale is one of the most impoverished areas of Dar es Salaam. The river that runs through the neighborhood is polluted, smells terrible, and has an unhealthy-looking green tinge. Malaria and cholera are common in this area. Sadly, many of the already impoverished residents had their homes damaged or destroyed by recent heavy flooding in the city.
During our ride through Tandale, we were introduced to a Traditional Birth Attendant (TBA) named Sofia.* Sofia is known as the ‘wise woman’ within her community. She often provides services free of charge and has delivered most of the babies in the surrounding area – primarily because the people in the community do not trust the services at the nearest hospital and believe that they will be unable to afford hospital care (Note: These are attitudes that CCBRT is working to address in partnership with government health facility management in Dar es Salaam). We were surprised to hear that Sofia had never faced complications in any of the deliveries that she had conducted, and that she had never delivered a baby with an impairment. We worried that, as Sofia does not provide antenatal care to the women (she only supports deliveries), women would not have access to the medical care they needed should complications occur during pregnancy. But Sofia assured us that she encourages women with difficulties to go to the government hospitals.
Sofia’s adamant stance that she had never faced a complication during a delivery surprised us – about 15% of births have dangerous complications – so we dug deeper. When we asked Sofia if she knew what obstetric fistula was, she shook her head, ‘no’.
Despite the extensive awareness raising and capacity building done by CCBRT and its partners in Dar es Salaam, there is still a long way to go before we reach every member of the community and ensure that women who are living in fear, shame and isolation are getting help, and that pregnant women in the community are accessing the skilled health services that they need.
Sofia is a trusted and respected member of her community, so we gave her a brief description of the causes and symptoms of fistula and encouraged her to refer women to CCBRT. We reminded her that treatment is free of charge, so women wouldn’t need to worry about the cost of treatment. We are under no illusion that one discussion with two foreign visitors will be enough to change Sofia’s actions. But we hope that we made a small inroad into improving awareness in the community.
CCBRT conducts awareness-raising sessions with TBAs across the country. As these sessions continue, TBAs like Sofia will become better educated about the subject of fistula. Our first-hand experience this weekend reinforced the need for continued support for awareness-raising. At Kupona and CCBRT, we try to share stories of hope, but often weave in stories of tragedy – the reality that we are working so hard to change. We view our experience as a positive indication of the impact that you can have. As two individuals who believe very much in Kupona and CCBRT’s work, we wanted to thank everyone who has donated to these important activities in the past and to urge you to remember the value of these awareness-raising activities in the future.
Alex and Mary
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*Name changed to protect privacy