Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

another hospital in order to get help. (Patient at
Bugando, age 19) One woman who waited for
two days at a hospital prior to receiving a
caesarean section described a situation where
“some of the patients gave the doctors money in
order to get fast attention,” (Woman from Songea,
age 20) during which time her labor pains
stopped. In another case, a woman said that the
TBA “agreed that we could go to hospital after
realizing that the baby was dead.” (Patient at
Bugando, age 21)
Different Choice Made
Nearly all of the women who responded to the
question “Would you have done anything
differently” 14 said that they would have gone to
the hospital earlier. A minority of the women in
the study said that they would have followed the
advice they received during ANC about delivering
at a particular site. Other responses included
setting aside money to go to the hospital and
receiving help earlier.
Delay in Transport - A Deadly Barrier to
Women’s Health
Most of the women who reported on delays in reaching a skilled
provider or an appropriate facility said that the delay was caused by
a lack of transport. One woman from Ukerewe explained that she
had no money to hire a vehicle, so they transported her on a bed
placed on two bicycles. Another woman reported that she had been
taken to the hospital on an office chair placed on a bicycle. A
woman from Songea reported that she took a district vehicle, which
was owned and operated by the district government. The vehicle
dropped her off at the bus stop because it could not go further,
since the driver had other things to take care of. She remained at
the bus stop for six hours, since all of the buses were full. Finally, a
truck stopped there, but before it reached the mission hospital, it
broke down. The woman and her attendants had to spend the night
where the truck broke down. They finally found transport in the
morning and reached the hospital in the afternoon.
Reactions Regarding Delays
Of the family members interviewed, five explicitly
mentioned that they thought something could
have been done differently during labor and
delivery. Of these, almost all spoke of getting to
the hospital earlier, either before or right after the
beginning of labor.
It was clear from some statements of family
members that they felt a sense of guilt for not
having done more to prevent the problem. For
example, one husband said that his wife sustained
her fistula because he made a mistake calling the
pharmacy attendant and the TBA, rather than
going directly to the hospital. Had he known there
was a problem, he would have taken her to the
hospital and, therefore, likely prevented the fistula.
He also explained that he faced other constraints.
He had wanted her to be transferred to a hospital
and stay there until she delivered because she had
been sick during her pregnancy. However, he had
no money for the hospital charges and no one else
at home to take care of the family. Therefore, it
had not been possible.
“Money determines
where one gives birth,
because if you go to
the hospital before
going into labor, it
means you have to stay
with someone or rent
a place to stay close to
the hospital, and that
costs money.”
(Patient at Bugando, age 28)
One set of parents said that they longed to reach
the hospital in time so they could save the life of
the baby. Another mother said that there had been
negligence on the part of her husband, who had
refused to send their daughter to the hospital early
(though the husband did not directly admit this).
In another case, the father realized the danger of
14 Nineteen women responded to this question.
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