Learn more about Fistula and the work of the Fistula Foundation.


Spreading Awareness About Fistulas in ZambiaFistulas in Zambia are still a devastating problem for impoverished, young mothers despite being preventable. An obstetric fistula occurs when a mother endures prolonged (oftentimes up to five days long) labor in which obstruction occurs. This obstruction then cuts off the blood supply and causes tissue death. Tissue death leads to holes between the vagina and bladder or rectum. Without treatment, fistulas can mean a woman will “uncontrollably leak urine, stool or sometimes both” for a lifetime. The Fistula Foundation and other organizations seek to help women suffering from fistulas in Zambia.

The Cost of Fistula Surgery

The fistulas come with a myriad of infections and chronic pain and can even cause nerve damage to the legs. While fistulas in Zambia are completely preventable and treatable, there are significant barriers to care for mothers. The surgical costs range from $100-400, an expense that is often far higher than what the majority of patients can afford.

4 Factors That Increase the Risk of Fistulas

  1. Malnutrition: Persistent malnutrition is linked to the development of a smaller pelvis, which increases the risk of an obstructed delivery, potentially leading to the formation of a fistula.
  2. Child Marriage: Early motherhood means the narrower pelvises of underdeveloped girls make an obstructed delivery more likely.
  3. Lack of Education: When young women are pulled out of school for marriage and childbearing without proper knowledge about their bodies, the delivery process and their reproductive systems, health consequences ensue. A lack of proper reproductive health education leads to a lack of awareness about the preventability and treatability of fistulas.
  4. Poverty: Poverty augments the chance of food insecurity, younger marriage, childbearing and sacrificing a woman’s education for family duties. Even more importantly, poverty makes access to healthcare that much more difficult. Fistulas are also more prevalent in births that take place outside of medical facilities as women undergoing an obstructed delivery are unable to get a C-section or emergency medical assistance.

In wealthier countries that properly address these four issues, fistulas are virtually unheard of, showing that poor health outcomes and poverty are inextricably linked.

Stigmatization of Fistulas in Zambia

While the medical ramifications of fistulas are devastating, these consequences come in conjunction with complete social ostracization and shame. Husbands often view the typically stillborn births that come with fistulas as a failure of the mother. It is very common for husbands to shame and abandon their wives, labeling the woman’s medical issues as personal failures.

Doctors often do not adequately inform women with fistulas that they have a legitimate medical issue. The abandonment from their husbands is soon joined by the same treatment from family and friends. The isolation and stigma increase the risk of depression among women suffering from fistulas. Lack of proper awareness and education means fistulas have become a source of shame. Hence, many women suffer in silence for decades, even until death.

Spreading Awareness Through Radio

In 2017, the Fistula Foundation, a nonprofit dedicated to providing impoverished young women with proper and free medical attention for fistulas, launched a radio program to educate communities about fistulas in Zambia. The program reached extensively into many provinces of Zambia and mobilized many women to seek proper medical care to repair their fistulas at the six Zambian fistula care centers the organization established to perform the reconstruction surgery for free.

In 2019 alone, the Fistula Foundation performed 319 fistula repair surgeries, all free of charge. In total, the Foundation has aided in the provision of 774 surgeries. The Fistula Foundation also partnered with the famous Zambian singer Wezi to air a song about the dangers of fistulas. The spread of this song, through both radio and CDs, has created a surge in Zambian women seeking treatment. As a direct result of Wezi’s song, 56 women have sought treatment.

Grassroots Activism

In conjunction with the awareness campaigns and Wezi’s song, the Fistula Foundation has encouraged grassroots movements like the Safe Motherhood Action Group (SMAG) to work with community volunteers to spread awareness to help prevent fistulas and end stigma. SMAG leads discussions within communities about the dangers of child marriage with regard to the increased rates of fistulas in young mothers, the necessity of keeping girls in school and the importance of delivering children in medical facilities. SMAG has implemented more than 3,000 community outreach programs, reaching more than 90,000 people with crucial information about fistulas and interconnected social issues.

The Fistula Foundation heavily relies on community leaders to spread the word, designating them the “entry points” to communities and change. The organization’s work highlights the importance of creative community engagement and education initiatives in promoting proper care and destigmatization of fistulas in Zambia.

Jaya Patten
Photo: Flickr

Health System in Malawi

The topic of healthcare has become a worldwide focus in recent years. A push toward government-funded health services has indicated a shift towards the mentality that healthcare is a universal human right. Malawi, one of the smaller countries in southeast Africa, has a low gross domestic product, with 51.5 percent of the population living in poverty. With life expectancy at 64.5 years, the health system in Malawi needs improvement.

The Ouagadougou Declaration

In 2008, the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa was adopted by African Region Member states, which includes Malawi. This declaration focused on nine major issues within healthcare: health governance, service delivery, human resources, health financing, health information systems, new technologies, community ownership and participation, partnerships for development and funding for health research. The Ministry of Health in Malawi is responsible for the implementation and the regulation of these health entities.

Health System in Malawi

Currently, Malawi operates a three-tier health system. The first tier is primary healthcare. This sector is in effect to meet the needs of general medical care, which includes community and rural hospitals and maternity units. The second tier consists of district hospitals. These see patients who receive a referral from their primary care physician to receive specialized services. This includes laboratory work and rehabilitation services. The final tier is tertiary care provided by central hospitals. This tier covers extreme conditions that require highly specialized care such as treatment for specific diseases. The linkage for these services comes through an elaborate referral system that trickles down the health system.

Although the 2008 doctrine worked to lay out different measures to ensure the quality of health service delivery in Malawi, major health concerns still persist. HIV/AIDS continues to be the number one cause of death in Malawi: 21.7 percent of deaths in 2012 were linked to HIV/ AIDS. Acute Respiratory Infections account for 8.6 percent of deaths, while Malaria accounts for 40 percent of hospitalized individuals.

Issues With Funding

A large cause of a lack of quality health services in Malawi comes down to funding. Approximately $93 is spent on each person in Malawi annually, which is around 11.4 percent of the overall GDP. The U.S. spends around $10,000 on healthcare per capita annually.

Due to these issues, the focus for healthcare in Malawi has been working on minimizing the burden of disease, increasing cost effectiveness, providing more widespread access to the poor and implementing proven successful health intervention. Implementation has been laid out through new quality assurance policies, improving standards and accreditation, and improving performance management with the Health Strategic Plan, which was created in 2011. While the government in Malawi works to assure quality health services in Malawi, non-profit organizations are working to help provide those health services. A few of these organizations include Care, which has provided 30.2 million people in Malawi with sexual and reproductive health resources, and the Fistula Foundation, which has given over $300,000 of funding for physician training.

Work being done by the Malawian government and non-profit organizations around the world is helping to improve the health system in Malawi.

– Claire Bryan
Photo: Flickr

How to Help People in AngolaAngola is a large, underdeveloped country in Africa. Despite the country’s wealth from oil and diamond exports, nearly half of the population lives on less than a dollar a day. Unemployment, poverty, and birth rates are high, but the literacy rate and life expectancy are low.

Angola only has one doctor per 10,000 people. Millions lack access to sanitary water and restrooms, and thousands die of preventable diseases such as malaria and bacterial diarrhea.

Without stable incomes, quality educations and proper health care, many Angolans suffer. But, they do not have to suffer forever. The following is a list of how to help people in Angola.


1. Donate to a worthy nonprofit.

Donating to an organization working in Angola is a good solution when you don’t know how to help people in Angola. Dozens of international nonprofits and charitable agencies are currently working in Angola to improve living conditions of people living in extreme poverty. Organizations are always looking for donor support to help fund their projects and change lives. UNICEF, Save the Children, the Fistula Foundation and World Vision are a few.

  • UNICEF has been in Angola since 1976. It focuses on boosting primary health care; providing primary education; and creating a social and legal environment of child protection.
  • Save the Children is another nonprofit dedicated to helping children.   Save the Children has built four free schools and two health centers. It has also implemented a polio eradication project and community development forums.
  • The Fistula Foundation opened a medical center in Angola that provides free fistula surgeries and other maternal health services to women. A fistula is a medical condition that obstructs labor. It is more common in poor areas where women in labor do not have access to a midwife or doctor, like in many parts of Angola.
  • World Vision has given thousands of tons of food, seeds and tools to hungry farm families in Angola. It also offers agricultural training, microfinance opportunities and access to clean water. To top it off, World Vision improves rural Angolans’ health through nutrition education, HIV/AIDS awareness and health care services.


2. Voice support for U.S. Agency for International Development.

 USAID is the United States’ main governmental agency for improving lives in developing nations. It has several initiatives in Angola, including: increasing literacy and entrepreneurship; decreasing the spread of HIV/AIDS; building disaster response capabilities; and supporting democracy.

It takes less than 60 seconds to call your Congressional representatives and urge them to support USAID and policies strengthening the United States’ commitment to developing nations like Angola. A staff member for the representative or senator will take note of each call, email and letter, then make sure the Congressional leader knows which issues are on the minds of constituents.


3. Educate and mobilize others.

The more people who know and care about the problems facing Angolans, the greater the chance political leaders will take heed.

The United States spends less than 1 percent of its budget on foreign aid; many people incorrectly believe it spends a lot more. Dispel the myths and teach others why investing in foreign aid is good for everyone involved. Helping Angola grow its economy will pay off for the United States because it increases Angolans’ demand for American goods and services, which creates jobs at home.

The high level of poverty and suffering in Angola may seem difficult to change, but individuals and organizations are making strides every day to transform lives. There are three simple answers for how to help people in Angola: support a worthy organization in the country; contact your representatives about the importance of foreign aid; and educate and mobilize others to join the effort to improve the standard of living for millions of Angolans.

Kristen Reesor

Photo: Flickr

Astellas Pharma
About 75 percent of women with obstetric fistula have gone through labor that has lasted three days or more. Obstetric fistula affects mostly the poorest women who live in the poorest countries of the world because they do not have access to proper medical help. When a woman’s labor is obstructed she most likely could have intense pain for days before she actually has the baby.

So what exactly is an obstetric fistula?

“The soft tissues between the baby’s head and the pelvic bone are compressed and do not receive adequate blood flow … Her baby likely dies and she is often left with obstetric fistula, a small hole created by constant pressure from the fetus, which renders her incontinent.”

An estimated one million women get obstetric fistula and only 20,000 of those get treated a year. The surgery that these women would need takes under an hour and costs around $450. The need is there for these women to receive medical help and that is why Astellas Pharma EMEA decided to dedicate $2 million to help the cause.

Over the course of three years, Astellas will be partnered with the Fistula Foundation and put that $2 million to work. This is believed to be the largest and most focused effort ever against fistula according to Kate Grant, CEO of the Fistula Foundation.

The money will allow 1,200 women to get surgery in Kenya for this life-changing condition. As part of Astellas heritage, one of the key things that this organization wants to bring to communities is hope.

“Astellas knows the difference good medicines make to peoples’ lives. That‘s why we focus on providing treatments that are a genuine advance on the current standards of care – particularly in disease areas where options are limited.”

Here in the United States, the obstetric fistula was a common term that most people knew about, until the early 20th century. Since the U.S. has the resources for great medical care, there are procedures like a cesarean section, that we can use to prevent fistula. Kenya doesn’t have what the U.S. does, so companies like Fistula Foundation and Astellas are doing something about it.

– Brooke Smith

Sources: ONE, Astellas, Fistula Foundaiton
Photo: Flickr

Global Poverty NGOs
When it comes to what makes an aid organization truly successful, we usually think first about the numbers and the flashy website. How many children in rural areas get an education thanks to this organization? How many mosquito nets are being handed out to curb malaria? And how fancy is that all-important website?

All this is important, at least to a degree. But we often neglect to consider what is behind the scenes. We forget about the fundamental structure that makes global poverty NGOs effective or not. In order to be successful, NGOs must…

1. Work together
Collaboration is key. No organization can be entirely efficient on its own. While working together sometimes proves difficult because so many voices spout so many different opinions, cooperation allows for greater expansion of ideas and more creative solutions.

Additionally, organizations gain more influence and issues are given more weight when there is a large rallying force of NGOs and aid organizations behind the cause. This increased importance can get the public more involved, as well as proving to governments and policy makers that these topics need to be discussed. For example, the United Kingdom Food Group is the largest network in the U.K. that helps organizations working on food issues to share ideas and expertise by working together, thus creating maximum change.

2. Be narrow enough to do good work
In order to put the most into a cause, organizations must be narrowly focused. This allows them to put the maximum resources into one issue and thus enables them to make a difference that is more than a drop in the bucket. For instance, the Fistula Foundation focuses specifically on healing women who suffer unnecessarily from an injury sustained in childbirth. True, the organization could tackle prostitution and sexual health in other capacities, but because it focuses on fistula treatment, it is able to make a substantial difference for the cause.

3. But not too narrow as to only solve one narrow slice of the problem
All things related to global poverty are interconnected. Food security goes hand in hand with the local economy. Water sanitation plays a huge role in global health. Organizations need to understand that no matter what topic they choose to address, it is attached to all other aspects of global poverty. ONE combines its efforts to address reducing global poverty on top of reducing the incidence of preventable disease. In doing so, ONE accepts that disease perpetuates poverty, and remedying one helps alleviate the other.

4. Be easy to get involved with
The harsh reality is that while most of our society sympathizes with the plague of global poverty, it has no time to go out of their way all the time to do something about it. Organizations must realize that if they are to be successful, they must be easy to reach, easy to get involved with and easy to share. NGOs must have key small ways to get involved like buying a T-shirt, sharing a video or donating a few dollars. But on top of this, they must have larger scale methods that are just as easy.

Many organizations like Charity: Water and Nothing But Nets, ask people to donate their birthdays by essentially asking for donations to the cause rather than gifts. It is a simple, brag worthy and effective way to get people involved and raise money for the organization.

5. Be transparent
People want to know where their hard earned money goes when they donate, and they are more likely to be resistant when the paths their cash takes within an organization are unclear. Therefore, organizations must work twice as hard to show that the donations they receive go directly to the projects they advertise. Charity: Water has found a way to be utterly transparent.

The organization relies on private donors and sponsors to support its offices’ operations, thus allowing it to ensure with absolute certainty that the donations it receives from the general public go straight to water projects building pumps in rural villages. Charity: Water even shows you exactly what well was built by your donations and their annual reports are easily found on their website. Basically, it is key that people know directly where their money goes when they donate to encourage confidence in the NGO.

6. Work with the local population
The only way to create stable, lasting change is for NGOs to work directly with the local population in the target region. Without it, practices put in place and infrastructure built can fall victim to tradition and cultural practice, and thus become ineffective. However, by working with the local population, organizations can change the local perspective and approach to the problem. They can employ local workers to run the operations, thus helping the economy in more ways than one.

Rape prevention organizations tend to be particularly effective when they go straight to the local people. For example, Apne Aap is an organization in India that aims to change the perspective of rape in the culture and protect women through sustainable development of a new, empowered mindset. By going to local women, organizations like this are able to find the root of the problem and work toward a solution that will cause lasting change.

7.  Be memorable
Finally, an organization must be memorable in order to be successful. People need to feel that itch to share the video, to tell their friends, to spread the story in order to ensure that the organization gets the publicity it needs to do effective work and the cause gets the vocalization it deserves. For all the flaws the Kony 2012 and Invisible Children campaigns had internally, they were undeniably memorable. Everyone who went to high school in 2012 had the group’s logo as their profile pictures and now knows a bit more about child soldiers in the LRA. This is knowledge that can be spread in order to get more and more people involved.

Overall, no matter what process NGOs take, their work is beneficial. However, there are certain criteria that will make their efforts more effective and provide for longer-lasting, sustainable change. Simple changes to the structure of the organization can increase the general interest in the topic as well as improving the overall success of the organization.

– Caitlin Thompson

Sources: Overseas Development Institute, The Guardian, UK Food Group, ONE, Charity Water, Apne Aap, Edna Hospital, Fistula Foundation, Nothing But Nets
Photo: Flickr