On work:

Obstetric fistula: injury of childbearing; hole between birth canal and bladder and/or rectum developed after several days of obstructed labor; the baby usually dies and the woman is left with chronic incontinence – she cannot control urine and/or feces flow through her vagina. She is often abandoned by her family and shunned by the community due to smell…as she is also likely to be young and poor to begin with, she is unable to support herself....

Traumatic gynecologic fistula: results from direct trauma: violent/gang rape, thrusting of guns barrels, beer bottles, sticks or other objects into the vagina, cultural injuries (female genital cutting, for example), gynecologic surgery. Common in conflict-ridden areas where rape is used as a systematic weapon of war – such as in the Democratic Republic of Congo.

90% of fistulas can be easily repaired for $200-300, but misconceptions of it being difficult, lack of trained doctors, and lack of incentives to operate (fistula clients are poor and unable to pay), and general lack of acknowledgement of the issue in many societies perpetuate the problem.

Fistulas are rare in developed countries but occur in many developing countries due to poor maternal health care, young age of mother, etc….EngenderHealth in Uganda works with the Ministry of Health, foreign surgeons, and local hospitals to train local surgeons and subsidize the cost of repair for clients. Other fistula work include radio prevention messages and promoting men as partners to balance gender equity.. The majority of work by EH is actually in family planning (condoms, IUDs) and integration of AIDS services into reproductive health services.

During this first week of work, I read numerous documents, reports, analysis about the Ugandan health sector, maternal health, and fistula. Over the next few weeks, I will travel to hospitals outside of Kampala on site visits, spend some time developing a fistula client database for a hospital that just received a laptop, assist with and document fistula repair training camps for nurses, surgeons, and counselors, and interview fistula clients for donor reports.

On life outside of work:

I am living with a family Joseph (GYPA) introduced me to – they are really sweet people who treat me as their own daughter. I was planning on braving matatus to work, but luckily a woman in the office lives close to the family and is kind enough to drive me everyday. There really isn’t “public transport” here, but plenty of matatus (minibuses) that have defined routes but no defined timetables or stops – one must be able to discern, from the shouts of the conductor out the window, where it is going, squeeze into a seat, yell “Mumsawo” when the desired location is reached, and hustle out of the vehicle ASAP while plopping coins in the hands of the conductor. Unless, of course, one is a “muzungu” (white person) – in which case exploitation and paying triple or quadruple is common. Riding matatus is an art – I haven’t quite mastered doing this on my own yet..but will hopefully be independent by the end of summer…without getting lost too many times….

Having power only half the time is definitely something to get used to…although EH has a generator and the family has a pretty powerful gas lamp…I am getting used to the dark though. The drastic power cuts really only started last fall, and are expected to continue for a number of years until dams are fixed (Lake Victoria is running dryer and older dams aren’t providing enough power). The street I work on is full of NGOs, and the nicer and more expensive restaurants/stores around reflect that….as my boss put it, some expats can live and work here and never experience actual Ugandan life. Personally, I am still trying to get used to the air quality, which has supposedly gotten worse in recent times due to drought…use of diesel and leaded fuel can really be toxic….

Otherwise, I am really enjoying my time here. Ironically, I came to Africa with three outfits, lots of meds, and was prepared to “rough it”. The family I am staying with is upper class and won’t allow me out of the house with wrinkled clothing, nevermind wearing an article twice before washing…in fact, on my first day of work, the girls (the two sisters I share a room with) had me wear one of their suits to “look smart.” They find it curious that I don’t shower every day, insist that I eat 5 meals a day, and are so sweet as to check up on me multiple times a day to make sure I’m ok. Tomorrow we’re going to their village in Mbarara (also where their housekeeper is from), and I will don a traditional African dress alongside the family in a ceremony to meet potential in-laws.