Christy's Diary: Update from Tanzania - Day 1

South Africa was fantastic--so glad I was able to get off the set and spend some time seeing great programs in action while there. Since I was already on the African  continent, I decided to make my way up to Tanzania. It's only four countries away from South Africa but a full day's travel. I left Cape Town at dawn and arrived into Kilimanjaro Airport in the evening, twelve hours later, as the sun was setting. There is nothing like the golden hour here...

I first visited Tanzania back in 1991 for a photo shoot with British Vogue.

I then returned in 1999 to climb Mt. Kilimanjaro, fulfilling a promise I'd made to myself on that first trip when I fell in love with this place...but even then I couldn't stay away. I came back in June 2009 to film, NO WOMAN, NO CRY and have been itching to get back ever since.

I decided to highlight Tanzania in the film after I had seen its current President, Jakaya Kikwete speak at the United Nations a few years ago. He gave a powerful speech about Millennium Development Goals 4 (to reduce infant mortality) and 5 (to improve maternal health and reduce maternal mortality by 3/4 by 2015) and his commitment to achieving them in his country. I was impressed. MDGs 4 and 5 are the two goals that have made the least progress of the 8 established in the year 2000. Kikwete's leadership is indeed promising because political will is often sited as the most critical in making lasting progress in all areas of global health, especially those regarding girls and women.

With the help of some of our friends who work in Tanzania; Jhpiego, Columbia University's Averting Maternal Death and Disability (AMDD), CARE and The White Ribbon Alliance, we were able to narrow down our sites on the Arusha region, near Kilimanjaro. And with the assistance of White Ribbon Alliance's Northern Zone Coordinator, Mackrine Shao-Ruymanyika, we identified a clinic in Ol Danyo Sambu, about 35km outside Arusha at the foot of Mt Meru.

We researched many aspects of maternal health for this film but what I had set out to do in making NWNC was to examine the major barriers for girls and women in accessing emergency obstetric care around the world. In selecting a country like Tanzania in sub-Saharan Africa, we wanted to illustrate the shortage of health care workers in this part of the world (there are fewer than 5 doctors per 100,000 people).

In the process of making the film, I came to know several inspiring women.

In Tanzania; Rahel, Janet, Lightness and Agnes. In Bangladesh; Monica, Yasmine, and Sabina. In Guatemala; Linda, Petronilla, and Orfa and last but certainly not least, Jenny in the US. Since completing the film this past spring, we have remained in contact with the women we met here in Tanzania through Mackrine, who sends us updates every so often.

In the last few months we at Every Mother Counts have been meeting with several other organizations who are all trying to fill some of the current gaps in addressing women's needs. One of those organizations is Doc to Dock. A recent meeting with Doc to Dock inspired me to come back and visit both the clinic and regional hospital - where we spent so much time - to see if we could be of any help in addressing their needs.

We collected Mackrine on the way out to Ol Dayno Sambu and reached the clinic around 9:30AM. Rahel greeted me outside with a big warm hug and we went in to take a look around. At first glance, the clinic looked pretty much as it did when we left it in 2009. With women sitting in the waiting area with their children, all waiting to see the nurses or Doctor, who just so happened to be here today. However, upon closer inspection we could see that there were a few improvements. The biggest was a solar panel outside which has given the staff here access to electricity, which they did not have just a year ago. They also gave us a tour of a new lab behind the clinic which was incomplete and without equipment.

When we were last here, there was a new maternity room that stood empty. But today, it had several hospital beds stacked inside and a new delivery table that the nurses were very excited about. Yet still, the room is virtually useless for an even more simple need- because the building has no windows or curtains, the wind and dust fill the space and make it unsterile and impossible to keep clean. During our visit we did an assessment of what the clinic had and did not have to compile a report for our friends at Doc to Dock so that we can launch an effort with EMC supporters to help address some of those needs. Stay tuned at EMC on that one- we hope to get it off the ground soon!

After we finished up at Ol Danyo Sambu, we headed further up the road to visit Agnes, who was not featured in NWNC but someone we spent a lot of time with after meeting her on the first day of the shoot. (We're about to launch educational modules one of which tells Agnes' story- they'll be online in February). Agnes had shared her story with us about how she lost her baby over ten years ago after a prolonged and obstructed labor that resulted with an obstetric fistula.

Fistulas are a common and tragic morbidity associated with maternal mortality, particularly common in sub-Saharan Africa. (Obstetric fistula is an injury sustained during prolonged and obstructed labor and childbirth.) For each maternal death there are roughly 20 women who suffer lifelong disabilities incurred during pregnancy and childbirth.

When we first met Agnes she was very small, clearly undernourished and ashamed of herself and her condition. Her husband had all but abandoned both her and her daughter, Naishiye,  and they were both shunned from the community. Most women who have the harsh misfortune of enduring such complications in childbirth, if they survive them, become social outcasts. All the clinic could offer Agnes was some advise on how to wrap herself in order to minimize the soiling. We learned while we were here in 2009 that there was an initiative at one of the hospitals near Arusha that offered free fistula repair surgeries.

When we left Agnes, we knew that a date had been set for the surgery. Meeting her again was like seeing a new woman. She greeted me with a big hug and was beaming as we walked back to her house to catch up. We learned that because Agnes had waited so long to seek help, the repair was more of a challenge. The biggest challenge, was leaving Naishye alone for the weeks that she was away. Naishye told us how difficult it was for her to fend for herself. She was scared for her mother and did not understand why she had been made to suffer for so long.

Since the surgery, the family had been reunited and Agnes and her husband were trying to conceive. In many cases this is not possible with a fistula but the doctors had not ruled it out. She is praying for a son... that she will give her husband a son.

It felt so awesome to return to Ol Danyo Sambu after spending so much time there. When we were filming at the clinic every day for 12-14 hours we got to know the staff well and came to see their daily challenges, as if they were our own. We'd go to bed each night not knowing how long we'd sleep because we might get a call that someone was in labor. We came home to the farm where we were sleeping each night covered in dust and aching from the hours we put in... And those days are typical days for these health care workers...

Now driving back to Arusha covered in dust and exhausted but feeling energized once again by the dedication of these women to the families they care for, despite all their limitations.

Tomorrow morning we'll be heading back to visit the regional hospital in Arusha where this clinic refers its emergency cases...