Seeing Tanzania Through An Obstetrician’s Eyes
Heidi Flagg, MD, shares her experience running and traveling with Team EMC in Tanzania.
Heidi Flagg, MD is an Obstetrician/Gynecologist in New York City, Cofounder of Spring Street OB/GYN and attending physician at NYU Langone Medical Center. She traveled to Tanzania with us to participate in the Kilimanjaro Marathon and to visit healthcare facilities in the area.
Ascending yet another hill with an even better view of Mount Kilimanjaro, I found myself in awe, overcome with emotion, even in tears, in a state of disbelief that I was running the Kilimanjaro Half Marathon and fully inspired. The day was getting warmer, we were at altitude and before me was the longest distance I had ever run. All my training (I use this term loosely) had been on snow, ice, well below freezing and at sea level. None of that seemed to matter.
I was swept up in a sea of people — most of them Tanzanian. Bringing only mediocre running talent to the table, what brought me across the finish line that day was my belief in EMC’s mission. My motivation to keep going came from a young Tanzanian girl who ran beside me for several miles in her school uniform and flats and two 20-year-old Tanzanian boys, Titan and Baruck, attending the “university in Kilimanjaro” combined with the usual grit and determination that has gotten me to where I am today. The emotional spectrum I spanned during that race was as varied as the terrain — up, down, flat, rocky, cool, hot, unbearable, hopeful, and relieved.
This spectrum was mirrored the following week as we traveled throughout Tanzania visiting EMC grantees, hospitals, community centers and medical clinics. As an OB-GYN practicing in New York City I was overwhelmed by the challenges we witnessed and questioned my purpose there. What do I do? How can I help? Do I just grab gloves and get to it? Do I put together a few presentations and provide some training? Do I approach the nutritional deficiencies I have now seen in both Haiti and Africa (Calcium in Haiti, Iron in Africa) that are at the root of so many preventable problems? I knew I’d need to delve deeply into cultural issues like, how food is obtained, grown, prepared, and distributed. For example, in Africa the Maasai men eat the meat, but women and children are excluded. Maybe I could approach the transportation issue. How does one get to a medical facility when it is 5 miles away or perhaps 100? How about the family planning and birth control angle? Where do I even start? Educating the patient? Will they listen? Is there any room for this in their religious, cultural framework? Overwhelmed, I was almost in a state of paralysis when contemplating these layers of complexity and where to begin.
And then there was hope — the fistula clinic at the CCBRT hospital in Dar Es Salaam.
An obstetric fistula is a “hole in the birth canal” that results from obstructed labor: when the baby does not deliver and causes 6 percent of maternal deaths worldwide (WHO). 50k-100k woman/year and 2 million women worldwide are affected by fistula. 90 percent of them have lost their babies. These women leak urine, feces and sometimes both. They have no running water to clean themselves, their husbands leave them, their community shuns them — they have no life. Grim. What prevents this problem? A C-section (I have to laugh and/or cry as this is a pejorative term in my patient population- a topic for another day).
Along with other EMC team members, I stood in the doorway of an open, covered space where rows of Tanzanian woman sat in their clean blue hospital gowns. Some had catheters in place, awaiting fistula repair. CCBRT does an amazing job spreading the word to rural areas that surgical repair is available. They even provide transport to the hospital with a voucher system sent thru cell phones. They do an excellent job at performing surgery. Then, while these women recover, they’re taught to sew, which provides them with a skill that helps them integrate back into society with greater ease. In fact, each patient is provided a sewing machine upon discharge from the hospital.
I wanted to reach out to each woman I saw — to sit with them, talk to them, hug them. But instead, they sang for us and a couple of them got up and danced (J-Lo and Ms. Miley Cyrus) and then we were put to shame at that moment. I fought back tears and tried to stay focused on asking the staff questions as they toured us through the hospital.
The woman in charge of educating women undergoing fistula repair gave us a brief review of what she explains to patients after surgery. From what I could tell, CCBRT covered every angle: culture, transport, education, and services to make their fistula repair successful. One of the post-op instructions was, “no sex for 3–4 months.” My first thought was, ”Are they telling the men this?” Are their families here to go over these instructions and advocate for these women once they return home? How many fistula repairs are unsuccessful for this one reason? I’ve had this same challenge with patients in New York City. Unless you describe in detail what you mean by “pelvic rest,” the interpretation by the patient and others can vary.
The final part of our tour took us through the construction site for an obstetric hospital meant to serve an estimated 20 thousand deliveries per year. The space was beautiful with wide open, airy areas, ramps that led to upper floors, sinks for hand washing, separate spaces for family and friends to wait. Throughout all the health centers we visited, staffing and lack of trained personnel were major challenges as it will be when attempting to staff this new facility.
From my myopic view of NYC, to say we struggle with the same challenge is almost embarrassing. But, the fact is, in the United States we have the same problem (different context, different expectations and different magnitude). I left Tanzania that week with many questions about how best to help, but reassured that despite the challenges, there is hope. Hope permeates the EMC mission, helped propel me through 6 miles of uphill running and across the finish line at 13.1 miles, and motivates me to remain committed to EMC’s work.