Chambika: One man’s journey to helping fistula patients

Before her death in 2014, Frank Chambika’s mother went through a disease nobody knew about and no one could help. His father ended up abandoning the family due to lack of understanding of his wife’s condition.

He left the family of five children to fend for themselves and started a new family in 1998.

Years later, Frank realised his mother would have gotten treatment and completely healed had anyone known she was suffering with Fistula. He still recalls the worst days of her life and how she faced extreme stigma.

Frank Chambika, 35, is now a Fistula Ambassador, hailing from Rukwa region and he has dedicated his life to supporting women suffering from Fistula in his area.

Frank, now a father of four, learned about Fistula in 2015 after he got an opportunity to be trained by the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) after being connected by a friend with the aim of being attached for a volunteering job as Fistula ambassador.

“During the volunteering training by CCBRT, I learned that my mother suffered from Fistula and the possibilities to treat it were available. I felt indebted to be a bridge for other women with the same problem in my community,” says Frank.

Despite being a petty farmer and a married man with four children, Frank has invested his energy and money, spending more than what he is being given to get women from different villages, going house to house on his bike to seek them the help they need.

“I have been able to collect more than 400 women with Fistula from Rukwa region for the past seven years now. Just last year, I referred 28 women with Fistula to get help,” says Frank.

However for Frank, he thinks that is a small number as he was busy taking care of his sick child for about six months.

In creating a balance between his farming activities and mobilisation activities he says, in a month, he set aside two weeks to go to different villages look for patients.

“It is through village to village, house to house, village gatherings, market areas, and health centres that I get an opportunity to talk to different people about Fistula and that is how I get connected to patients,” says Frank.

After identifying them, Frank contacts CCBRT who helps him to arrange for transportation from where the patient is to Dar es Salaam for treatment.

A CCBRT Fistula ambassador is any trained personnel in the community or a community healthcare worker who volunteers to identify and refer fistula patients to health centres that provide fistula treatment.

Dr James Chappa is a Fistula Surgeon at the CCBRT and he says obstetric fistula occurs when pressure from the baby’s head compresses the mother’s soft tissue in the birth canal which obstructs blood flow. Without blood, the tissues die and a hole forms between the bladder and the vagina or the rectum and the vagina.

A woman with obstetric fistula has a wild and uncontrollable spillage of urine or faeces or both, through vagina.

According to Dr James Chappa, Frank has recorded a very big number of patients from his region compared to Fistula Ambassadors in different regions. He became number one to have many patients for last year.

He shares that despite all the effort he puts into this, he encounters several challenges that affect his work. Poor road infrastructure is one of the major hindrances as it makes it difficult for him to reach some communities, especially during the rainy season.

He reaches patients using his bicycle and accessing many areas remains a challenge as most Fistula patients live in areas with very limited healthcare services.

“There are days when my bicycle is not working. I do make use of public transport but it still limits me in reaching new patients,” he says.

While he was fortunate enough to be given an introductory letter from the District Medical Officer in his area, not having and identity card from CCBRT is another challenge for him. This gives him a hard time being recognised in some places without the help of local leaders in some villages.

He says a lot of patients have never travelled out of their districts since birth and this makes it very difficult for them to to trust him if he does not have identification.

Abdul Kajumulo, Communication Specialist at the CCBRT shares that they do have a challenge in issuing identifications as they have about 3,000 volunteers countrywide and monitoring how they will use the IDs is not easy.

“We worry about how IDs may be used as some might misuse them under CCBRT name. This is why we connect them with the DMOs to be provided with introduction letters,” he adds.

Frank also requests mobility support in terms of a motorcycle each district that will be kept at the DMO's office and be used with a well-defined schedule among the volunteers.

“This will ease our work as transport has been a major obstacle in reaching patients as most of them live far from the townships. We were grateful for the incentive allowance from November last year; they increased the incentive from Sh10,000 to Sh20,000 when an ambassador refers a fistula case to CCBRT,” says Frank.

Frank is happy to put smile on the faces of many women in his community. He is loved and respected for his job. He says that it is his full time job.

Oscar Sembeje is the Fistula Coordinator at the CCBRT says so far, they have trained about 3,000 ambassadors but the country has only 300 active ambassadors.

In January this year, CCBRT trained more than 100 ambassadors from various regions in mainland Tanzania. The training is usually to educate the ambassadors on the signs of those diseases and the things to consider before arranging for a travel to CCBRT.

“We educate the ambassadors that if a woman had her child via natural birth and had fistula, she has a waiting period of 40 days and if the birth was through a caesarean section, then she has to wait for three months for her to be able to come for treatment. In the meantime, she is advised to go for malaria check-up and Haemoglobin test. If both tests are okay the ambassador is allowed to arrange for patient transport to CCBRT for treatment,” says Sembeje.

CCBRT hospital started using the network of ambassadors to identify fistula patients in the communities and to inform them that CCBRT provides free transport to and from the hospital, free medical expenses, accommodation and food.

Other methods that CCBRT uses to inform and identify fistula patients include using regional and national radio stations, distributing flyers, community outreach activities, text messaging, and television and newspaper advertisements.

In Tanzania, annual incidences of obstetric fistula range between 1200–3700 and of those, less than 1400 receive treatment, leaving thousands of women with this condition untreated each year.

In most cases, fistula can be treated with surgery, but many women in Tanzania cannot afford the cost of accessing medical help. Using cell phones, Tanzania’s largest provider of fistula surgery – Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) – is breaking down this barrier

From when it started treating fistula, CCBRT and satellite facilities have treated more than 10,000 women living with fistula, enabling them to re-establish clean and respected identities as well as reinstating their productive and reproductive capabilities.

More than 90 percent of fistula patients were completely healed and went home to unite with their families, equally participating in the community, family and personal social and economic activities. Fistula treatment contributes to the United Nation’s Sustainable Development Goals numbers 1, 3, 5,8,10 and 17.

CCBRT does not end in treating fistula but also empowers them to improve their social and economic lives through its holistic care approach and Mabinti Training Centre.