In 2017 Friends of Nigeria opened up a new initiative to promote Maternal Health in Nigeria.  Specifically we are seeking to combat obstetric fistula, but in the process the groups we are supporting address broader maternal health issues.

This article by Mimi Budd (15) 65-67 appeared in the Fall 2017 Newsletter.
 

The FON Board of Directors has voted to launch a fundraising and public awareness project to address maternal health, with a focus on obstetric fistula and family planning.

Obstetric fistula, the devastating childbirth injury that leaves women and girls incontinent, often stigmatized and isolated from their families, usually results from prolonged labor that without prompt medical intervention affects the vagina and rectum or bladder, causing a hole in a woman’s birth canal that leaves her with chronic incontinence, and in many cases, the loss of the baby. The resulting range of injuries can be daunting for health professionals who are working with limited resources. USAID and others have documented countless cases of incontinent women who because of inadequately treated fistula are stigmatized among their peers and by society in general. Put simply, the women are often unable to continue with normal life. Data from the National Strategic Framework for Elimination of Fistula in Nigeria indicate that the country bears 40 percent of the world's fistula burden, yet 90 percent of these cases go untreated.

Obstetric fistula, the devastating childbirth injury that leaves women and girls incontinent
 

Family planning is also a major problem that affects maternal health. Nigeria, the most populous country in Africa, is expected to overtake the US to become the world’s third most populous nation by 2060 with a population of nearly 475 million. Fewer than one of every five married women uses family planning, according to USAID. An additional 16 percent of women want to delay or limit childbearing but are not using contraception. Limited access to family planning prevents women from safely spacing their pregnancies, fuels unsustainable population growth, and puts the health of women and children at risk.

“As an organization mainly comprising volunteers who served in Nigeria, FON is in a unique position to work with partners on fundraising in Nigeria and the U.S. We will also help spread the word that obstetric fistula prevention and repair and family planning need closely coordinated solutions to make an impact,” said FON Vice President Jim Clark, who announced the organization’s Maternal Health Initiative.

Clark is active in Rotary International, an organization already focused on maternal health and reproductive rights in Nigeria. “Our collective experience in West Africa has provided FON members with insights and a unique platform to bring these closely related issues to the attention of our friends, neighbors and colleagues so that we all may take action. FON officers and members have already begun informal discussions with Rotary in an effort to secure partnerships on these issues,” Clark noted.

At the October Board meeting, President Greg Jones reestablished a grants committee, focusing on maternal health, consisting of Board Members Ned Greeley (Chair), Mimi Budd and Mike Goodkind. The committee has begun discussing possible FON involvement with several organizations and will continue to explore further partnering options. The committee and the FON Board encourage member recommendations.

A 2016 report by the Secretary General to the United Nations General Assembly on efforts to end obstetric fistula states that the three most cost-effective interventions to reduce maternal mortality and morbidity, including fistula, are: (a) timely access to high-quality emergency obstetric and new-born care; (b) the presence of a trained health professional with midwifery skills at childbirth; and (c) universal access to family planning.

The report further states that universal access to family planning also contributes to saving women’s lives and improving their health by preventing unintended pregnancies, reducing the number of abortions, timing and spacing pregnancies to maximize their health and the health of their babies, and lowering the incidence of death and disability related to complications of pregnancy and childbirth, including obstetric fistula. Family planning may also contribute to reducing the risk of recurrence of fistula in future pregnancies of fistula survivors.

The organizations that FON is exploring, or already supporting, are working to implement these interventions. For example, EngenderHealth, a U.S. NGO that is a leader in the field of maternal care in Africa, is working with a large USAID grant to promote fistula care and prevention and family planning. A designated unsolicited donation to FON from a generous friend made it possible for FON to donate $5,000 to EngenderHealth.

Rotarian Action Group for Population and Development (RFPD) is a project of Rotary International led by German Rotarians that has partnered with Nigerian organizations in-country to promote obstetric care. The board is reaching out to FON members who are also Rotary members to explore the establishment of further partnerships to provide funding. Moving forward, the board with member involvement will seek out other organizations, including those that may be headquartered in Nigeria, to support as appropriate.

Readers interested in additional information relating to these issues are encouraged to visit the FON website (select Links from the INFO menu) or go directly to the Links page, https://friendsofnigeria.org/Links/ -- in either case, click on the Maternal Health link. For a particularly poignant look at the obstetric fistula crisis, see the Nicholas Kristof Op-Ed Piece in the March 20, 2016, New York Times, titled: “The World’s Modern-Day Lepers: Women with Fistulas.”

“That title is a call for action,” noted Greg Jones. “As Returned Peace Corps Volunteers who love Nigeria and Nigerians, we will certainly want to do all we can to change this situation.”

This article by Mimi Budd, (15) 65-67, appeared in the Winter 2018 Newsletter.
 

FON’s 2018 fundraising effort has raised over $15,000 to date to support the Maternal Health Initiative. Announced late last year, the initiative addresses fistula repair and family planning as well as other health related issues of compelling concern to Nigerian women.

“This is the most successful fundraising effort in our history,” said FON President Greg Jones. “FON members stepped up with enthusiasm in a very short time. Funds are still being collected and a new round of support is vital to make this effort a strategic success.”

At a meeting on January 4, the Board approved a $10,000 grant to support DOVENET, an on-the-ground NGO headquartered in Abakaliki, Ebonyi State. EngenderHealth, a USAID-funded program with whom DOVENET partners, was awarded a $5,000 grant in December made possible owing to a generous donation by a friend of FON who expressed a passionate concern for the issue (see Fall 2017 Newsletter). EngenderHealth implements the Fistula Care Plus (FC+) project in Nigeria and several other countries.

DOVENET stands for Daughters of Virtue and Empowerment Initiative. It is a woman-led Community Based Organization in Ebonyi State in the former Eastern Region of Nigeria. It works with the National Obstetric Fistula Center in Abakaliki, one of the most prominent groups working on fistula issues in Nigeria. DOVENET has 8 staff members and more than 400 trained volunteers across the wards of Ebonyi State with three volunteers per ward. It is not faith-based. The DOVENET team focuses on creating awareness of family planning, fistula prevention and treatment, and reintegration services, according to founder and Executive Director, Chief Mrs. Ugo Nnachi in Abakaliki.

Mrs. Nnachi told FON that DOVENET activities include community dialogues, town hall meetings, home visits/pregnancy monitoring, church outreaches, edutainment including movies and drama, capacity building and training for other Improving and Promoting Community Health organizations. The group also works in five neighboring states.

Mrs. Joy Eze, DOVENET consultant and resource person, speaking to community members of the Amaozanu Autonomous Community, Ezillo Ward, Ishielu LGA, on the importance of family planning methods.

DOVENET volunteers reach out to women potentially needing fistula care and family planning services. The volunteers conduct home visits and go house-to-house to identify and refer women for services. Referrals are followed consistently to ensure that a woman reaches a health facility. Volunteers track each woman through referral forms and registers to ensure appropriate feed-back to volunteers and staff and to ensure follow up based on a woman’s needs according to Nnachi.

DOVENET staff follows the progress of women during and after surgery. Staff and volunteers follow up with women to provide counseling and ensure they are reintegrated into their communities. Although currently DOVENET does not provide job or skills-acquisition training, staff members do refer women who need skills acquisition to government-run community development centers in their Local Government Areas.

FON’S Fistula Initiative Committee provided an extensive review of DOVENET and its staff before recommending that the organization receive a FON grant. USAID and EngenderHealth staff in both New York and Nigeria provided positive recommendations for the organization. FC+ staff in Nigeria spoke positively of the DOVENET staff’s commitment, dedication and understanding of donor policies, requirements and procedures. Ned Greeley, committee chair and a former USAID official familiar with colleagues in Nigeria, described staff and volunteers as hard working and timely in their reporting. The Fistula Foundation, operating in Ibadan and Northern Nigeria, also endorsed the organization. DOVENET has received funds from the World Bank, in addition to USAID. DOVENET’s contract and funding through EngenderHealth terminates in June 2018, creating an opportunity and challenge for FON to support the continuity of DOVENET’s efforts.

In a phone conversation in early January, President Jones said Nnachi ex-pressed her gratitude and said FON funds will enable the staff and volunteers to reach out and help more women. “She was emotional when she described the positive impact fistula repair can make on a woman previously isolated and hopeless,” Jones said. “It was incredibly gratifying to hear that we are able to make a quantifiable difference that is so appreciated.”

The Fistula Initiative Committee expects that two San Francisco Bay Ar-ea residents, Angela Testani and Dick Morten, who are scheduled to travel to Abakaliki in February, will provide on-the-ground information about DOVENET and FON’s grant. Committee member David Strain has worked with them on projects to supply medical equipment to Ebonyi and to drill a well in Abakaliki. Angela, an academic medical center nurse who has visited Abakaliki twice before, and Dick, an RPCV from Sarawak and active in the NorCal Peace Corps Association, are traveling this time to complete the well. Both are active in the Catholic Archdiocese of San Francisco, where they became friends with Father Edward Inyanwachi, who spent years in the Bay Area. Fr. Edward, now a priest in Abakaliki, formerly served on FON’s Board and has expressed encouragement for FON’s fistula initiative.

Meanwhile, the Fistula Initiative Committee is continuing a search for partners and has received preliminary information about another well-regarded fistula repair and family planning effort in Ebonyi State led by Chidinma Peace Mbanasor. She also works in conjunction with the National Obstetric Fistula Center in Abakaliki where her emphasis is on facilitating job and skills acquisition for women after their fistula repair has been completed. The goal is to better integrate women back into their home communities with skills that enable them to support them-selves. Potentially, a job skills initiative would complement the work of DOVENET’s medical focus.

This article by Mimi Budd, (15) 65-67 appeared in the Spring 2018 Newsletter.
 

Just four months before the scheduled end of DOVENET’s USAID-sponsored funding, the bright yellow and turquoise t-shirts on volunteers from the Abakaliki-based NGO proclaimed the newly created “DOVENET/FON Fistula Initiative Project.” “Rarely, if ever, in FON’s history has a grant been heralded as so central and timely to the program of one of our recipients,” said FON President Greg Jones, describing the $10,000 grant awarded earlier this year to the DOVENET-FON Fistula Project.

“I am deeply grateful to Friends of Nigeria for considering DOVENET for this collaboration,” said Ugo Nnachi, founder and Executive Director of DOVENET. “We are committed to ensuring a rewarding partnership.” She also thanked the EngenderHealth Fistula Care+ Project, the long-term USAID-funded partner that since 2015 has supported many of DOVENET’s activities, unfortunately, it is scheduled to end its funding this year.

Since 2005 DOVENET has operated and received funding from a variety of sources, including the World Bank and the Nigerian government. FON’s funding comes at a time when the money can be applied to a vital project central to DOVENET’s mission, Nnachi explained.

The t-shirts echoed the FON-supported “Community Mobilization and Awareness Campaign” and were worn by the volunteers being comprehensively trained in maternal health issues and in the skills needed to raise awareness of fistula prevention and repair, as well as family planning and other health related issues of compelling concern to Nigerian women in Ebonyi State.

Nnachi said the goal of the DOVENET-FON Fistula Project in Ebonyi State is to reach over 50,000 women (and men) in 30 communities in the five Local Government Areas (LGAs) by the end of June. To date 45 volunteers have been trained.

DOVENET team member, Nnenna Aghachukwu Chima, training volunteers in fistula awareness
 

Recently DOVENET focused its efforts on early marriage, female genital mutilation and the high teen-age pregnancy rates – all highly cor-related with fistula in Ikwo LGA. DOVENET continues to increase its services in Ebonyi LGA and other Local Government Areas, and Nnachi said, the organization hopes to expand services to neighboring states, where FON could play a supporting role in the future through additional funding. DOVENET has requested an additional $10,000 donation to sustain current services in Ebonyi state. DOVENET’s current annual budget is only $85,512 (NGN 30,760,000).

DOVENET approaches fistula and family planning, as well as other maternal health issues, from several perspectives. They educate families and community members to prevent fistula and they identify and refer women with fistula for treatment by physicians trained in the intricacies of fistula surgical re-pair. Volunteers are a key component of outreach, which includes home visits, town hall meetings, community dialogues in churches and schools, and mentoring sessions.

Before volunteer training sessions began, DOVENET staff visited the five targeted LGAs (Ebonyi, Onicha, Afikpo North, Afikpo South, and Ohaukwu) to enlist the support and cooperation of various traditional leaders, community chiefs, youth leaders, women leaders and health committees. “Buy-in” from local leaders is crucial because of the role these individuals play in encouraging local participation in the programs. “We rely on our community partners to distribute accurate information and to ensure smooth implementation of our programs,” Nnachi noted.

DOVENET helps fistula clients reintegrate into their communities where they often face hardships owing to their condition, which carries significant social stigma. DOVENET collaborates with the appropriate health and welfare officials and with the National Obstetric Fistula Center in Abakaliki, one of the foremost groups working on fistula issues in Nigeria.

Project activities are being monitored and progress will be reported to FON on a regular basis, Nnachi said. San Francisco Bay Area residents Angela Testani, Dick Morton and his wife Madeleine, met with Nnachi in Abakaliki this past February. They were joined by Father Edward Inyanwachi, a former FON board member who previously lived in the Bay Area and is now a priest in Abakaliki. Testani reported that she was favorably impressed with DOVENET operations following discussions, tours and a power point presentation on the history of the organization, its partnership with EngenderHealth, and the pro-grams offered. Testani wrote to FON that one of the major challenges is staff transportation to outlying areas and to bring village women to centers to receive treatment and services. Testani said she expects to provide FON with a status update after she visits Abakaliki in August.

The FON Fistula Initiative Committee continues to explore other partnering options to promote fistula repair and family planning, including the possibility of partnering with Rotary Chapters where FON has members.