by Angela Ramirez:
“After my first baby was pulled out of me with a pair of scissors, I gave birth to two children out of the seven times I was pregnant,” said Asha Said, one of eight patients in Seliani Lutheran Hospital’s Obstetric Fistula Ward, with an averted gaze. Said suffers from obstetric fistula, an abnormal connection formed between the bladder and rectum due to the pressure of the fetal skull during prolonged and obstructed labor. The disease has cost her the lives of her five unborn babies. For almost a decade of living with fistula, Asha relied on the expertise and guidance of traditional healers. despite her successive birth complications, Said admitted that “it took my husband and me eight years to get to a hospital.”
Women with obstetric fistula like Said suffer from infections that lead to nerve damage to the legs, kidney failure, and a strong unpleasant odor that often drives friends and family away, forcing the women into shame and seclusion. “Some women live with fistula for up to 50 years without seeking help,” remarked Kent Johnson, a volunteer nurse from the United States working at Seliani. If treated early, fistula can be corrected surgically, with success rates as high as 90 percent. Nevertheless, many Tanzanian women do not seek proper medical help due to monetary constraints and the inaccessibility of hospitals in rural areas.
Surprisingly, financial difficulty is sometimes a lesser impediment to proper treatment in rural areas than the immense faith that Tanzanian tribal people place in their local traditional healers. revered men and women claim access to divine knowledge and offer home remedies for all medical conditions, which discourages women like Said from reaching hospitals for prenatal and post-natal care, thereby threatening their health.
“A white cross across your chest and healing amulets will cure any disease,” said Marion, a member of the ancient Hadzabe tribe in Northern Tanzania. This hunting-gathering tribe has relied on tree trunk oil and other natural balms for thousands of years to treat medical problems. When asked directly why those suffering women did not seek help at a hospital, her silence revealed the strength of tribal healers in her isolated society.
Aware of the need to merge tradition and modern medicine, Seliani Lutheran Hospital is structurally designed for those accustomed to life outside of a city. With open air hallways and scattered buildings on a property surrounded by trees, patients do not feel they are in a hospital. “They feel at home,” said Johnson. Tall Massai men dressed in red robes carrying wooden walking sticks dot the forested areas of the hospital. Seliani looks more like an outdoor camp than a medical facility. “It’s not just about preserving and promoting indigenous cultures, but about improving healthcare within a nontraditional framework,” insisted Johnson.
Recovery at Seliani is as much a state of mind as it is of spirit. Patients with “one foot in Christianity and one foot in tradition,” as Johnson noted, can make use of the on-site chapel and priests. Like traditional healers do, Seliani treats disease not only as a physical ailment, but a spiritual one as well. Modern medicine is not imposed upon the patients but incorporated into their belief system.
The existence of a single hospital employing this nontraditional approach to fistula care offers a glimmer of hope for the future but hardly guarantees victory in the national battle against fistula. While recent government efforts have succeeded in providing some of Tanzania’s rural areas with small health “dispensaries,” this expansion in facilities has not been accompanied by a program to train health professionals competent to staff them. According to dr. Charles Sweke, obstetrician and gynecologist at Seliani, making progress will depend on “training traditional healers who are in direct contact with pregnant women.” The merging of cultural beliefs and faith in tradition with modern medicine will surely prove an important weapon against obstetric fistula for thousands of rural women in Tanzania.
Angie Ramirez ’12 is a Political Science and International Studies major in Davenport College. Contact her at angela.ramirez@yale.edu.