This is one of the stories from the September 2012 issue of International News. Claire Herrick and Alison Fiander recorded the stories of women with fistulae at the Comprehensive Community Based Rehabilitation in Tanzania Disability Hospital in Dar es Salaam. In this article, 12 of the women share their personal stories of obstetric fistulae and the treatment they have received.
Use the table below to access the other stories in this issue.
The Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) Disability Hospital in Dar es Salaam is one of the largest hospitals in Africa dealing with disability. In 2002 CCBRT started a fistula service, which is continuing to expand today. The community of patients on the ward is in itself a source of healing for many. In 2007, women with fistulae began recording their stories to share with women to come in the future at the suggestion of Claire Herrick, an American doctor training in obstetrics and gynaecology.
In 2011 several patients offered to have their stories translated and shared globally in order to raise awareness of fistulae across national and economic borders and their stories are presented here. Most of the patients have received no education or have only completed primary school. You will notice that the Kiswahili has no punctuation marks, and is as written by the patients themselves or another of the literate patients recording a story for a fellow patient. We hope that the translation conveys the correct meaning and have included a short medical summary.
In 2012 CCBRT introduced holistic care into its fistula service, which includes elements of health education, counselling, occupational therapy, physiotherapy, singing and life skills. ‘Therapeutic story telling’ is now a regular activity on the fistula ward at CCBRT.
‘Mimi naitwa Konsolata nilipatwa na ugonjwa wa fistula baada ya kujifungua mtoto akiwa kashakufa lakini niliposikia huduma ya CCBRT nikajiuliza mwenye nikasesma kumbe linatibika nikaja CCBRT nikatibiwa lakini mimi naona kula vile mtoto alikuwa mkubwa na akafia tumboni anavyotokea alinichana sana wakanishona wakaniambia nikae na mpila siku 20 siku ya kutoa nilianza kutokwa na mkojo nikisimama nikicheka nikikohoa lakini sasa nimepata hudumu CCBRT nashukuru sana. Asante sana Mungu.’
‘My name is Konsolata. I got this condition called fistula after I gave birth to a child who had already died. When I heard about the services at CCBRT, I couldn’t believe that my condition could be treated. I came to CCBRT and was treated. I see how my baby was too big and when I delivered, it tore me apart. They did my surgery and had me keep the catheter for 2 weeks. The day it came out, urine started to leak when I stood up or if I laugh or sneeze but I have received good treatment here at CCBRT. I’m very thankful. Thank you very much – may God bless you very much.’
Konsolata is 19 years old. She completed primary school and then worked as a housegirl. In her first pregnancy she spent 4 days in labour at a district hospital in Dar es Salaam. After 4 days she was transferred to Muhumbili National Hospital and was delivered of a stillborn baby weighing 5kg by caesarean section. Her fistula was repaired successfully in July 2011.
‘Kutoka mkowa wa Dar es Salaam. Nimepata ugonjwa wa VVF kwa sababu ya uzazi niliumwa uchungu usiku wa tarehe 6 March 2011 nikapelekwa hospital ya manispaa ya Temeke usiku uleule nikapokelewa nilikaa wodini kadri mtoto anapotaka kutoka niliishiwa nguvu wakanisaidia kuvuta mtoto kwa mashine hatima yake hakutoka ulipofika usiku wa tarehe 8 March 2011 nikafanyiwa upasuaji mtoto amezaliwa amekufa na kupata maumivu makali hivyo nilijikuta nimepata fistula. Asante.’
‘Zaituni from the district of Dar es Salaam. I got this condition of VVF (vesicovaginal fistula) after I went into labour on 6 March 2011. I was sent to the Temeke Municipal Hospital that night and admitted. I stayed on the ward and when the baby was about to come out, I lost my strength. They helped me by pulling on the baby with a machine. At the end of it all it was the night of 8 March 2011. I delivered by a procedure. My baby had died and I had very severe pain. This is how I got fistula. Thank you.’
Zainabu is 27 years old. She completed primary school and now has a small business. In 1999, aged 15 years old, she had her first pregnancy and had an assisted vaginal delivery after being in labour for 2 days. Later that year she had both vesicovaginal and rectovaginal fistulae repaired, together with an end colostomy. Although successful, she started to leak urine again over the past year through a small recurrent fistula, following development of urethral stenosis. This was successfully repaired in July 2011.
‘Naitwa Naomi natokea mkoani Dodoma wiliyani Mpwapwa kata ya berege kijiji cha mkanana sina mtoto nimepata ugonja huu kwa sababu ya uzazi niliumwa uchungu tr 28 May 2011 asubuhi nikapelewkwa hospitali ndogo kesho yakee 29 May 2011 asubuhi saa 3 nikashinda hapo nikalala kesho yake 30 May 2011 nilishinda hapo mpaka saa 9 jioni wakapiga simu hospitali ya wilaya mpwapwa gari kaja kunibeba gari nilifika saa 11 jioni tulifika saa 2 usiku usiku uleule nikafanyiwa opalesheni mtoto akawa bahati mbaya nilivyowekewa mpira sikutolewa nilikaa na mpira siku 9 nikatolewa siku ya kwanza nilikuwa sijisikii kukojoa nikaenda chooni nitachuchuma mkojo unatoka muda mrefu unakata siku ya pili tarehe 11 June 2011 ukaanza kumwagika nikamwambia nesi akaniwekea mpira nipata habari ya kwamba huo ugonywa wa VVF dokta akasema VVF unatibika akapiga simu huku CCBRT tarehe 28 June 2011 nilisafirisha hadi hapa. Nilivyokuwa huku hospitali nilikuwa niko peke yangu nililia sana hivyo kwa nini huu mkobo unatoka wenyewe kwa iliniuma sana utaangalia umefanyiwa upasuaji mtoto umekosa tena mkojo unamwagika ukiangalia wenzako wamefanyiwa wote upasuaji wanao watoto mkojo haumwagiki kwa kweli niliumwa sana ten asana kili nikaa nalia kwa nilala machozi kwa kweli nimelia sana nilipofika hapa nikawakuta wenzangu ndo nikajua kwa sio mimi peke yengu. Asante - Thanks very much.’
‘I am Naomi. I am from Dodoma region in the district of Mpwapwa near the village of Berege. I don’t have any children. I got this illness because of giving birth. My labour started in the morning of 28 May 2011. I was sent to the local hospital. The next day, 29 May 2011, I spent the whole day there. I was there through 30 May 2011 until 3 in the afternoon. They called the Mpwapwa District Hospital and an ambulance came to get me. The ambulance arrived at 5pm and we arrived at 8pm that night. I had an operation. The baby was lost. A catheter was put in me and left in for 9 days. The day it was taken out, I didn’t feel the urge to urinate. I went to the bathroom and squatted and the urine just came out for a long time. The second date, 11 June 2011, it started to spill. I told the nurse and she put in the catheter again. I heard that this condition, called VVF by the doctors, can be treated. The nurse called here to CCBRT on 28 June 2011. I travelled here. When I was in the hospital I was by myself. I cried a lot. Why is this urine just coming out by itself? It hurt me very much. You will see, you have had an operation, there is no baby, and your urine is leaking all over. If you look at everyone else, they have had their operations, they have children, and urine is not spilling all over them. I truly was in so very much pain. All the time, I was crying, I cried myself to sleep. I cried so much. When I arrived [at CCBRT] I found my fellows and I finally knew that I was not alone. Thank you so much.’
Naomi is 19 years old. She completed primary school and was working as a farmer when she went into labour with her first baby. After 2 days in a health centre she was transferred to a district hospital where she underwent caesarean section for a stillborn baby. Her fistula was successfully repaired on 11 June 2011.
‘Mimi Rehema Mamoto nilipata ugonjwa wa VVF mwaka 2007 tarehe 12 Febuary 2007. nilipata uchungu muda wa siku tatu mtoto alikuwa amefariki tumboni wakanisafilisha Dodoma mjini nilifika jioni mtoto akakosa peke yake akiwa amekufa tukarudi nyumbani dio nikaona mkojo unatoka tena wakanipeleka Dodoma mjini wakanipokea nikalazwa hospitali ya nikaa mwezi mmoja wakanipima wakasema hatuwezi rudini nyumbani tukakaa nyumbani tukaanza kusikia maredioni wanatangaza kwamba ugonjwa huu unatibika CCBRT nauli nilikuwa sina mwaka 2011 mungu akanisaidia bahati zuri baba mdogo anaishi Deresaam mleteni ndio nikaja CCBRT wakanipokea wamenitibu ila bado sijapona namsbiri tena kufanyiwa mara ya pili namwomba mungu anisaidie awasaidie madaktari watakaponitiu. Asante imani yangu yote ipo nitapona katika jina la yesu.’
‘I am Rehema. I got this condition of VVF in 2007, on 12 February. I had labour pains for 3 days. The baby had already died inside. They sent me to the city of Dodoma. After delivery I returned home and indeed the urine stared to come. They sent me again to Dodoma where I was hospitalised for a month. They examined me and told me, “we can’t do it. Go home”. We went home again, but on the radio we heard they were announcing that this condition is treated at CCBRT. I didn’t have transport money. In 2011, God helped me. By good luck, my uncle lives in Dar es Salaam. I came to CCBRT and they welcomed me here. They treated me but I haven’t healed yet. I’m waiting for another procedure. I pray the second time, God will help me and help the doctors so they can treat me. Thank you. I believe completely that I will heal, in Jesus’s name.’
Rehema is 23 years old and completed primary school. She was working as a farmer during her first pregnancy. When she went into labour she stayed for 24 hours at a dispensary before being transferred to the district hospital where she had a vaginal delivery of a stillborn baby. Her vesicovaginal fistula was repaired on 25 July 2011.
‘Mimi naitwa Stella nasanya nilipatwa na ugonjwa huu wa VVF baada ya kufanyiwa oparesheni ya kutoa uvimbe kwenye mfuko wa uzazi na kwenye mrija wa kushoto. NImefanyiwa mwaka jana mwezi wa tano tatizo lilinianza siku ileile kwa sababu nilipokuwa nimewekwa mpira mkojo ulikuwa unamwagikia kitandani baada ya kuruhisiwa nilikaa miezi nmitatu nikarudi tena nikafanyiwa tena mwaka jana mwezi wa kumi tarehe 12 napo ikawa kama mwanzo mwingine ulikuwa unapita kwenye mpira mweingine kitandani lakini niliruhisiwa hivyo hivyo moyo ulininiuma sana kwa vile sikupona nikaamua kurudi kijijini Mbeya-Mbozi baada ya kusikia tangazo kwenye rediokuhusu CCBRT kumbe mdogo wangu akawa nay eye amelisikia tangazo hilo akaamua kunitumia nauli nikaja huku ninamshukuru sana mdogo wangu kwa kutumia nauli nilipokuwa nyumbani nilijiona kama niko pekee yangu mwenye kuugua ugonjwa huu wa ajabu. Lakini nilipofika hapa nimewakuta wenzangu nimefarijika sana tena sana maana nimeteseka sana mpaka nilijihisi kama nimepata mkosi gani katika jamii yaani nilikuwa ni mtu wa kulia tu lakini sasa tangia nifike hapa CCBRT nijisikia amani kwanza napenda kushukuru kwa huduma zenu madaktari kwa kunipokea kwa moyo wa upendo mungu awabariki sana ten asana na mwenyezi mungu awaongezee uzuri mara mia imani yangu inaniambia kuwa pale mtakaponigusa tu kibofu changu na kukishona nitapona tu nampaka sasa mkojo unaniuma kwenye kibofu naenda tu kukojoa ila bado inatoka tofauti kwenye kibofu mwengine unatangulia ndio unanisumbua sana. Asanteni sana.’
‘My name is Stella. I got this condition called VVF after having an operation for fibroids in the uterus and the left fallopian tube. This was last year in May. The problem started that very day, because when they put in the catheter, urine spilled all over the bed. After I was released, I waited for 3 months and then returned again. I had another operation on 12 October and it was like the beginning, some urine coming through the catheter and some spilling on the bed. But I was released like that. My heart hurt very much as I had not healed. I decided to return to my village. My little sister heard the radio announcement about the services at CCBRT and she sent me money for transport, so I came here. I am so grateful to her for sending me the transport money. When I was at home, I felt like I was all alone in suffering from this strange disease. But when I arrived here, I found many like me and felt so much better. I have suffered so much, to the point that I saw myself as having some kind of curse. In my community I had become someone who just cries, but now since coming here to CCBRT I am at peace. First I am grateful for the doctors’ services, receiving me here compassionately and lovingly. May God bless them very much, and continue to increase their skills and knowledge a hundred times over. My faith tells me that the surgery will be successful. Right now the urine bothers me a lot. Thank you very much.’
Stella is 31 and had a small business before her trouble started. She has never been pregnant and had a hysterectomy for large fibroids, which resulted in damage to her bladder and a vesicovaginal fistula. She had already had an attempted repair at another hospital but was left with a residual fistula. She was awaiting surgery when she wrote her story in August 2011. Her operation was successful and she has gone on to the Mabinti project based in Dar es Salaam to learn vocational skills. While on the ward it was discovered that Stella had a gift for singing. She now returns once a week to give singing lessons to the patients on the VVF ward.
‘Nimehanza matatizo haya baada ya kujifungua. Nimehumwa huchungu tele 22 June 2011. Nimejifungua talehe 23 June 2011. Kwisha kujifungua haja ndogo sipati nimewekewa mpila nikatokea kwenye mguu haja ndogo sihisiki kuniuma hinatoka kwenda hospitali kupimo nimehambiwa ni kistula nimelazwa talee 18 July 2011 nimetokea mkowa wa pwani wilaya ya kibaha.’
‘I am Mwahija. I first had this problem after delivery. Labour stated on 22 June 2011. I delivered on the 23 June 2011. Since delivering, urine has been a problem. I had a catheter placed. I can’t feel my urine. I came to the hospital to be examined. I was told I have a fistula and was admitted on 18 July 2011. I’m from Pwani region, Kibaha district.’
Mwahija is 30 years old, completed primary school and now has a small business. Her third labour was obstructed and took more than 24 hours before delivering a large baby. She went to a dispensary during labour where she stayed for 19 hours before being referred to a health centre. She sustained considerable damage with rectovaginal fistula, circumferential vesicovaginal fistula and vaginal stenosis. Her fistulae were successfully repaired in July 2011.
‘Mimi Maliamu nilipata ugonjwa wa VVF baada ya kujifungua niliumwa uchungu muda wa masaa kumi na nne nikajifungua hospitali Lushuto mtoto alikuwa amekufa tumboni ilikuwa talehe 19 May 2011 nikakaa siku yote ugongwa wa VVF nikarudi tena hospital nikaambiwa hapa ugonjwa huu hatuwezi tutakupeleka kuna hospitali moja inaitwa CCBRT nikasafilishwa na nesi nikafikishwa hospitali yenyewe nilipoona wenzangu nikajipa tumaini. Kwamba nitapona nikashurkuru. Asanteni sana.’
‘I am Maliamu. I got a VVF after delivering. I was in labour for about 14 hours. I delivered at a hospital. The baby had already died inside. This was on 19 May 2011. Three days later I was leaking. I returned again to the hospital and they told me, “we can’t do anything. We will send you to a special hospital called CCBRT.” The nurse brought me here herself. When I saw my fellows it gave me hope that I will heal. I am so grateful. Thank you very much.’
Maliamu was 20 years old when her first baby was delivered stillborn in hospital. She sustained a fourth-degree tear which was repaired successfully in July 2011, but was left with severe stress incontinence because of damage at the bladder neck. In February 2012 she underwent a second procedure for stress incontinence.
‘Mimi naitwa Selestina. Natoka Morogoro kisaki vijijini nilikuwa nasoma form two baada ya kusoma nikawa sijaendelea namasomo kwa sababu nilipata mimba nikiwa shuleni. Nilipojifungua ndiyo nilipopata VVF nilipata tarehe 8 March 2011 nikiwa hospitali nilikaa daaya ya mwezi mmoja. NIkaluhusiwa kuludi nyumba nikawa na VVF. Nilikaa baada ya muda mrefu tuliposikia kama ugonjwa VVF unatibika nilifurahi sana tarehe 12 nimekuma hospitali nilipokewa vizuri na manesi nami nimefurahi kuwaona wenzagu wenye ugonjwa kama wangu nami ninamshukuru mungu naendele vizuri tangu nipate operesheni nitategemea nitapona tu. Asanteni sana.’
‘My name is Selestina. I am from Morogoro, in the village. I was in form 2. I didn’t continue my studies because I got pregnant when I was at school. When I delivered, I got a VVF. This was on 8 March 2011. I stayed over a month at the hospital. When I was released to go home, I had a VVF. I stayed a long time at home. When we heard that this condition of VVF is treated, I was very happy. I came to the hospital. The nurses welcomed me nicely and I was happy to see others with this condition. I am grateful to God and I am doing well. Since I got my operation, I am hoping I will be healed. Thank you all very much.’
Selestina is 16 years old. She became pregnant while still at school. She was in labour for 4 days in a dispensary before being transferred to the regional hospital where she underwent a caesarean section for a stillborn baby. Her vesicovaginal fistula was repaired successfully on 12 July 2011.
‘Mimi naitwa Scolastica kutoka Dar es Salaam nimepata ugonjwa wa VVF kwa sababu ya uzazi niliumwa uchungu kwa muda siku mbili nilipelekwa hospitali ya manispaa ya Mwananyamala mchana saa 6 mchana nikapokelewa nilikaa wodini kadri ya siku mbili siku ya tatu nikajifungua saa moja asubuhi nilijifungua kwa njia ya kawaidia sikufanyiwa upasuaji hivyo nikajikuwa nimepata fistula. Nilizaliwa mwaka 1992. Asante.’
‘My name is Scolastica, from Dar es Salaam. I have this condition, VVF. I got labour pains for 2 days. I was brought to the municipal hospital around noon. I sat on the ward for about 2 days. On the third day, I delivered around 7am, a vaginal delivery, not an operation. Then I found I had a fistula. I was born in 1992. Thank you.’
Scolastica is 19 years old and a secondary school student. She went to a district hospital in Dar as Salaam in labour where two days later she delivered a stillborn baby. She was left with a large infected vesicovaginal fistula, foot drop from nerve damage and severe anaemia. She was admitted to CCBRT and treated with antibiotics, blood transfusion and underwent fistula repair a month later. On discharge from hospital she was still troubled by stress incontinence and was instructed to continue pelvic floor muscle exercises and come back if she was not better in six months’ time.
‘Naitwa Yusta natokea kigoma nilipata ugonjwa huu mwaka 1974 kwa ajili ya uzazi nilizaa mtoto akaa bahati mbaya uliniuma sana ukiangalia mtoto sikupata tena nimepata VVF mwaka huu 2011 ndio nikasikia kwamba ugonjwa huu unatibiwa nilisikia redioni nikaja hapa niliwakuta wenzangu wengi sana kwa kweli nilifalijika sana nilivyo kuwa nyumbani niliona kama nipo peke yangu sasa hivi nipo kwenye matibabu ninamategemeo nitapona kwa jina la yesu kwa kweli huu ugonjwa ni mbaya sana. Asanteni sana.’
‘My name is Yusta. I am from Kigoma. I got this condition in the year 1974 because of childbirth. I had a baby but it died. It hurt so much to look at children I didn’t have another. I got VVF. Then this year, 2011, I heard that this condition is treated. I heard it on the radio, then I came here and I found many others like me. This was such a big comfort, as at home I had felt so alone. Now here I am after surgery, waiting to heal, praise Jesus. This is truly such a terrible condition. Thank you all very much.’
Yusta is 56 years old and from the west of Tanzania. She suffered an obstructed labour, aged 19. She spent two days at home before being sent to hospital where she underwent caesarean section for a stillborn baby. Although she says it hurt too much to have another baby, after a long gap she subsequently delivered six live children. She’d been leaking urine for 37 years before hearing that the condition could be treated. Although the fistula was closed, she was left with severe stress incontinence and asked to continue with pelvic floor muscle exercises. Upon review in clinic she continues to improve.
‘Naitwa Joisi hili tatizo la mikojo lilinianza mwaka sabini mimba ya kwanza nilipasuliwa hospitali ya kiyomboi kwa operesheni ndogo toka hapo nikaenda hospitali ya haidumu nikatibiwa mkojo nikawa vizuri baada ya hapo miaka ikapita mine tu fistula ikarudi tena nikabeba mimba ya pili mwaka 1973 nikapelekwa hospital ya singida nikafanyiwa operesheni ya kumbwa mtoto wa kiume baada ya miaka saba akafariki baada ya hapo nikabeba mimba ya tatu mwaka 1976 mimba ile ikaharibika baada ya miezi 5 baada ya hapoa mwaka 1978 fistula ikarudi tena nikapekwa kisemsi moshi baada ya hapo nikafanyiwa operesheni kumbwa nikapona vizuli tu baada ya hapo mwaka 1980 nikabebea mimba ya nne nikapalekwa hospitali ya singida nikaenda nikafanyiwa aperesheni kumbwa mtoto wa kike bahati mbaya yule mtoto akafaliki baada ya hapo fistula ikarudie tena nikaenda hospitali ya Bugando Mwanza nimetibwa sikupona nikaletwa CCBRT. Mwisho wake niko CBRT nayibiwa.’
‘My name is Joisi. This urine problem started in the year 1970. The first pregnancy, I delivered by caesarean at Kiyomboi hospital. A short while later I went to Naidumu Hospital where I was treated for the urine problem, and I was healed. After that four years passed and the fistula came back. I was pregnant the second time in 1973 and was sent to Singida hospital. I had an operation and had a little boy. Five years later he died. A while later I had my third pregnancy in 1976 but this pregnancy passed after 5 months. Later, in 1978, the fistula returned again. I was sent to KCMC hospital in Moshi and had a big operation. I healed pretty well. After this, in 1980 I had my fourth pregnancy and was sent to Singida hospital. I had a caesarean section and had a little girl but unfortunately she died. After this the fistula came back again. I went to Bugando hospital in Mwanza and was treated but I didn’t heal, so I was brought to CCBRT. So at this time I’m at CCBRT and I am undergoing treatment.’
Joisi is 56 years old and despite four pregnancies has no living children. Her first delivery became obstructed and after 5 days at home the baby was delivered in hospital stillborn. Her second child was born by caesarean section but died aged 5 years. She later lost a pregnancy at 5 months and a daughter born by caesarean section died shortly after birth. Her fistula has recurred a number of times and each time she has sought treatment for the condition. This time the problem was severe stress incontinence and she underwent a stress incontinence procedure, which was partially effective. During her admission she always had a smile and was one of the most cheerful women on the ward.
‘Mimi Mwanavita. Tatizo hili la VVF limenipata wakati wa kufanyiwa operesheni ya kutolewa kizazi ambacho kilikuwa na uvimbe mkubwa ambao ulinifanya niwe na maumivu makali. Nilikubali kufanyiwa zoezi hilo la operesheni baada ya kulazwa tarehe 24 May 2011 kwenye hospitali ya Bombo Tanga nilifanyiwa operesheni tarehe 16 June 2011 baada ya wiki moja ndio nikaanza kuona ninaanza kuloana nilikaa baada ya mwezi mmoja ndio mikaja CCBRT kwa ajili ya operesheni hii ya kibofu cha mkojo pia baada ya vipimo ikashindika na kwa ajili ya kinga zangu za mwilikuwa chini kwa hivyo itabidii nirudi nyumbani kwa muda halafu nitarudi tena kwa ajili ya operesheni hiyo sijajua kama itawezekana au la ikishindikana kabisa basi nitakuwa mwenye majonzi kwa kufeli zoezi hili la operesheni hii hiyo ndiyo historia fupi ya kuhusu VVF jinsi ilivyo Napata yaani nilifanya kukatwa kibofu cha mkojo baada ya operesheni nimepata ushauri nikiwa CCBRT nitlazwe tarehe 25 July 2011. Asante kwa upendo wenu na ushauri wenu.’
‘I am Mwanavita. I got this problem of VVF when I had an operation to take out my uterus, which was very big with fibroids and causing me a lot of pain. I agreed to have this operation after being admitted to Bombo Tanga hospital on 24 May 2011. I had the operation on 16 June 2011. After one week I started to notice that I was leaking. I waited for a month and then came to CCBRT in order to get the bladder operation. However my body’s immune system levels were very low so I had to return home for a while. I came back for the operation, not knowing if I would be able to have it or if it’s not an option. If I cannot have the operation I will be extremely sad to have missed the chance to be healed. This is indeed my brief story of VVF and how I got it. My bladder was cut during the operation. I was counselled to come to CCBRT and was admitted on 25 July 2011. Thank you for your care and your counselling.’
Mwanavita is 47 years old and HIV positive. She sustained a fistula after a hysterectomy for fibroids early in 2011. She’s had five children but four died under one year of age. Her CD4 count is currently too low for further surgery. She will continue to take medication and return to CCBRT for review.
Dr Claire Herrick, Obstetrician and Gynaecologist, Gallup Indian Medical Center, Federal Indian Health Service, New Mexico
Professor Alison Fiander, Chair of Obstetrics and Gynaecology, Cardiff University, UK and Technical Advisor, Obstetric Fistula Programme, CCBRT, Tanzania