As storytellers mobilizing support through narratives, we are acutely aware of our responsibility to do so without jeopardizing the privacy or dignity of the people we serve.

Today marks International Day to End Obstetric Fistula, and we’ve been reflecting on an important question: How do we, as fundraisers, clinicians and global health advocates, talk about fistula without imposing our own narrative and excluding women from their own stories?

Photo credit: Sala Lewis

How do we talk about fistula?

Obstetric fistula is one of the hardest global health topics to discuss. Women living with fistula are some of the most vulnerable in the world. Each has survived a prolonged, obstructed labor, which could have killed them, only to survive with lifelong morbidities.

Women who survive obstructed labor often lose their baby. The babies that survive can suffer lifelong neurological disease caused by reduced oxygen levels during labor. These babies may suffer paralysis and developmental deficits. In addition to the chronic incontinence that comes when a fistula develops, the women who survive this dangerous labor often experience foot drop, infertility, internal scarring that prevents normal sexual relations, and post-traumatic stress disorder.

When a woman returns home with a fistula she is constantly leaking urine, feces, or both. As a result, she will often face stigma and rejection from her own family and community. Every day, we see the devastating effects harsh words from misinformed family and community members have had on the women who receive free, comprehensive treatment from our sister organization in Tanzania, CCBRT.

“Some of [my neighbors] said having children caused this, others told me I was being cursed by witchcraft”. ~ Fadhila

“My step father influenced my young siblings by telling them that my condition was contagious and that they should keep away from me. They were always laughing at me.”    ~ Mercy

In addition to surgical and physical rehabilitation, CCBRT provides counselling and therapy to address the emotional and psychological scars left by fistula, and conducts national awareness raising campaigns to battle the misconceptions surrounding the condition.

Fistula in her words

We asked twenty women and girls undergoing treatment at CCBRT how they identify themselves and prefer to be identified – they chose words like ‘mama’, ‘businesswoman’, ‘entrepreneur’. Not one person wanted to be thought of as a ‘patient’ or a ‘victim’. The women and girls we serve do not want fistula to define them or their place in their community.  It is imperative that we tell these women and girls’ stories on their terms.

Photo credit: Sala Lewis

The power of an international platform

Kupona and our partners are in a privileged position, able to raise the voices of women and girls who often struggle to make themselves heard even before they are faced with severe trauma. We are inspired by the strength and resilience of those we meet, and strive to communicate that when we amplify their stories.

“In meeting women and learning the stories of what they do to support their families, and how much they have overcome, I am amazed by their strength. I have met women like Christine. A woman of great self-worth, she built her life with little support, and today she stands tall because she found the care she needed with a skilled surgeon. I will always remember her – not as a victim, but as a strong, empowered woman who is a role model, and my hero.” ~ Kim Keller, Johnson & Johnson

We also try to hear our words as they would sound to women who have lived with fistula. Our goal is never to be sensational or graphic; it is always to elevate the voices of these women and girls, allowing them to share their stories in their own words.

“Women with fistula have suffered so much, so deeply.  Many have been voiceless for too long, hiding their injury in shame. The very least we can do is choose our words carefully when it comes to discussing their condition or sharing their story, to be as respectful as we possibly can.” ~ Kate Grant, CEO, Fistula Foundation

As global storytellers, we are custodians of other people’s stories. We still have so much to learn, not just from these women, but from their families as well.

“While many women with fistula are abandoned by their husbands, in every fistula center you will find many husbands who support their wives, bringing food, clothes and news from home, talking to the nurses and doctors and celebrating the day that their wives are able to make the trip home. These men, whose stories are invisible and whose needs are not understood, are certain to have much to teach us. Imagine the value yet to be tapped if we were to expand our storytelling to include these husbands, from whose resilience and creativity we have much to learn.”
~ Dr. Lauri Romanzi, EngenderHealth

Want to learn more about respectful storytelling and how it impacts our discussion of fistula? Check out our Storify with highlights from the #HerWords Twitter Chat, held on International Day to End Obstetric Fistula, featuring thoughts from partners, clinicians, storytellers, and organizations fighting to #EndFistula.

Quality is Key: How lean management is transforming services at CCBRT

At Kupona Foundation, our priority is improving access to quality healthcare for people living in poverty in Tanzania. Globally, it is estimated that 5 billion people do not have access to safe surgical and anesthesia care. Our sister organization, CCBRT, is one of the leading providers of quality surgical care for people with disabilities in Tanzania.

A triage nurse and patient at CCBRT. Photo by Sala Lewis.

To improve access to CCBRT’s services, Kupona supports comprehensive efforts to address the barriers patients face to getting the treatment they need. Patients receive subsidized care so they can seek treatment regardless of their financial circumstance. CCBRT’s innovative application of mobile technology removes the burden of the cost of travel to the hospital for particularly vulnerable patients. Nationwide awareness campaigns educate communities to dispel the myths and misconceptions around disability and promote the medical services available to those in need of care.

When these barriers are removed and patients present for treatment at CCBRT’s hospital in Dar es Salaam, the first priority is to ensure that treatment is of the highest possible quality. But as demand for services continues to grow, meeting this demand with limited resources without compromising quality is one of the team’s greatest challenges. In 2012, CCBRT embarked on a journey of continuous improvement, adapting principles of lean management to help improve efficiency and eliminate waste.

The Challenge: Increasing demand for quality healthcare
Dar es Salaam is Tanzania’s largest city, and one of the fastest growing cities in the world. The city’s population is expected to increase by 85% to 6.2million by 2025. With healthcare infrastructure built to serve ~750,000 people, rapid growth puts the sustained provision of high quality healthcare in the city at risk. At CCBRT Disability Hospital, high demand for services and long wait times resulted in 80+ clients being turned away daily. Patients at CCBRT come from all over the country to seek specialist care, some travelling for days. In communities where ~65% of people live on less than $1.25 a day, and their ability to earn enough money to feed themselves and their family is directly tied to their health, accessible, affordable and timely medical attention is the key to helping communities thrive. Turning people away simply isn’t an option.

Triaging eye patients in CCBRT’s Eye Outpatient Department

The Solution: Lean management
When trying to meet increasing demand without compromising quality, healthcare facilities can learn valuable lessons from the manufacturing industry. Pioneered on the car production lines of Toyota Motor Company, lean management helps organizations to produce the highest quality ‘product’, at the lowest cost, with the shortest lead time, ultimately resulting in greater value for clients. When these principles are adapted and applied in the healthcare setting, their value takes on a new dimension: ensuring patients get the highest quality treatment, for the lowest cost, in the shortest amount of time: particularly critical in low resource settings like Tanzania.

CCBRT’s first major quality improvement initiative focused on the Eye Outpatient Department. After weeks of very specific planning, and with the support of a three-year, £430,000 grant from the Human Development Innovation Fund and advice from lean experts in the United States, CCBRT closed down their Eye OPD for an entire week, implementing a total overhaul of patient flow and processes including: changes to the physical layout of the department, introduction of an electronic ticketing system, and adjustments to processes to reduce bottlenecks and waste.

The changes increased the team’s capacity to serve patients. They saw a 72.5% improvement in the number of patients returned without service, and increased the number of patients served by more than 21%.

CCBRT is still in the relatively early stages of a long term transformation. The focus is now on expanding to the next phase of improvements. With a budget of $150,000 per year, we aim to roll out the principles across other clinical departments, starting with operating rooms, and to establish a central improvement office to institutionalize the changes that are underway.

Working toward ‘True North’
The ultimate goal of any lean transformation is to achieve what we call ‘True North’, the compass point that guides an organization from where they are now, to where they want to be. CCBRT’s True North is focused on outcomes defined around quality and safety, client satisfaction, staff engagement, and financial responsibility. Progress toward that True North will be measured by indicators including mortality and morbidity rates, the infection rate, patient wait times, and number of patient complaints, the rate of absenteeism among staff, ‘profit’ margins and the health of financial reserves.

Every improvement initiative will drive toward True North, designed to ensure that every patient, regardless of their ability to pay, receives the high quality treatment they need from trained specialists. With further investment, we can continue to not only improve the quality and accessibility of CCBRT’s services, but also contribute to a growing evidence base that will allow other frontline healthcare providers to learn from our experiences, and ultimately make high quality surgical care more readily available to the 5 billion people across the world who need it most.

Interested in learning more? Contact us. Attending the Unite for Sight Global Health and Innovation Conference in New Haven, CT in April? We will be giving a Social Impact Lab presentation on the power of lean management in healthcare. Stay tuned for more information.

Collaborations for the empowerment of women recovering from obstetric fistula

Last weekend, Kupona’s Executive Director, Abbey, attended the African Diaspora Network’s African Diaspora Investment Symposium (ADIS 2017) in San Jose, CA. This engaging two-day event served as an opportunity for leaders and influencers from Africa and the rest of the world to connect on issues and opportunities that will support the continent’s further development. Abbey was honored and excited to bring Kupona’s perspective to the ‘Women Entrepreneurs in Africa’ panel.

Abbey (far left) presenting at ADIS 2017

Reflecting on the panel, Abbey shared, “When I was given the opportunity to speak about inspiring examples of female entrepreneurship in Africa, I immediately thought of the Mabinti Centre. Established in 2006 by Kupona’s sister organization, CCBRT, Mabinti serves as an integral part of CCBRT’s comprehensive obstetric fistula program. Mabinti focuses on the socio-economic empowerment of women following their clinical treatment for fistula. A case study of effective integrated development, the model leverages the virtuous cycle of health as the key to empowerment, and economic empowerment as the key to continued health.”

The Mabinti Centre empowers 10 new female entrepreneurs every year, training women recovering from the surgery they received at CCBRT Disability Hospital to correct obstetric fistula, a devastating injury caused by complications during childbirth. Every year, 10 women graduate from Mabinti with their self-confidence restored, and return to their communities as active, empowered entrepreneurs and ambassadors for fistula treatment. An additional eight women are employed at Mabinti in the production unit, which has generated over $320,000 in product sales since 2014. The revenue generated through this project supports the continuation of CCBRT’s broader obstetric fistula program, which reaches over 1,000 women annually. 

The images below demonstrate the impact of entrepreneurship far better than words. Looking at these women now, it’s hard to imagine that most of them have faced significant trauma. Many have lost a baby in a traumatic delivery, were abandoned by their husbands and families and deeply stigmatized by their communities. We are proud to support efforts that unlock their potential, and empower them to build a bright future for themselves and their families.

Photo by Sala Lewis

Photo by Sala Lewis

Photo by Sala Lewis

Kupona is very grateful to Almaz Negash, Founder of the African Diaspora Network, for the invitation to share the impact of Kupona and Mabinti at ADIS 2017, and to Dr. Musimbi Kanyoro, President and CEO of Global Fund for Women, for facilitating the ‘Women Entrepreneurs in Africa’ panel. We were honored to be a part of this stimulating, honest discussion about the challenges and opportunities facing the African continent, and we look forward to exploring opportunities for further partnership and collaboration.

To learn more about supporting the the socio-economic empowerment of women at The Mabinti Centre, please contact us at info@kuponafoundation.org.

Thank you for your support in 2016

Happy New Year! In 2016, your generosity touched the lives of thousands people. This past holiday season, our supporters gave over $18,000* to support our work in Tanzania, meaning that in 2016, the Kupona community came together to give over $960,000* to the empowerment of people and communities living in poverty in Tanzania.

At Kupona Foundation, we believe that every individual in our community has the power to change the lives of people like Jane. You have the potential to impact the healthcare of future generations through your support of training for medical teams. You can ensure every expectant mother we serve can enter a clean, safe, equipped delivery room to be assisted by a fully trained team.

We believe it because it’s already happening. Your generosity over the holiday season alone translates to:

• Life changing, comprehensive treatment for 26 women like Jane who are living with obstetric fistula.
• 273 hours of hands-on training and mentoring for medical teams on Dar es Salaam’s busiest labor & delivery wards.
• The safe delivery of 34 babies in a clean, equipped facility.

We are resolved.

Our New Year’s Resolutions for 2017 are simple. We will give you more opportunities to provide high quality healthcare to more people in Tanzania: to equip more healthcare teams to save lives in Dar es Salaam, to empower more women and girls to build bright futures for themselves and their families, and to get more children with disabilities into school and playing with friends.

We are resolved to build on our momentum, working closely with our sister organization, CCBRT, and to make an impact this year that will ripple out to touch millions of lives in the years to come. We cannot do it without you. Will you continue to stand with us?

Thank you for all of your support, and best wishes for a healthy, happy 2017.

*Unaudited figures, subject to change.

You went above and beyond in 2016

It’s highly unlikely we will be forgetting 2016 any time soon. Politically, socially, economically, it has been a year of momentous change, yet, at Kupona Foundation, there was one constant: your support for people and communities in Tanzania.

You were creative, generous, and you changed thousands of lives. You unlocked opportunities for some of the poorest and most marginalized people in Tanzania, and gave them access to the high quality healthcare they needed and deserved.

Selina and her newborn son Photo by Sala Lewis

In 2016, you donated dollars, time, and photos to help people like Selina. You gave healthcare workers access to critical training and mentoring, and helped us to renovate and equip healthcare facilities. You hosted pasta dinners, golfed for good, purchased handmade items from The Mabinti Centre and artwork from the Drawing Out Fistula Exhibition. You even climbed Mount Kilimanjaro! You attended and supported cocktail receptions, meetings, and mixers. You raised awareness, and shared our story on social media. You were a passionate force for good, and we are so grateful for your support.

Photo by Sala Lewis

Your gift is more than a donation. It’s a life changing surgery, a first consultation, a healthcare worker trained to deliver high quality care. It’s a child’s restored sight, an expectant mother’s peace of mind, a baby born with clubfoot who will be able to run and play. And that’s why we’re asking you to join us once more for a final push before 2016 comes to a close.

Here are a few examples of what your generosity can do:

• $67 provides an hour of training for a maternal health team, equipping them to give high quality care to expectant mothers and their newborns.
• $160 provides clubfoot treatment for one child, allowing him to run and play.
• $300 restores a child’s sight, allowing her to go back to school.

A one-time or recurring gift can be made through our website, or by mailing a check payable to Kupona Foundation to our mailing address below. Don’t forget to amplify your impact by asking your employer for a match.

Join us, and close out 2016 with the gift of hope.