Welcome to the 15th Edition of the TERREWODE newsletter covering July- September 2023. This edition highlights headways in various program areas at TERREWODE and some new developments especially at Terrewode Women’s Community Hospital (TWCH).
We have enriched our holistic and patient-centered obstetric fistula services in addressing the needs of women with incurable fistula (WIFs), especially by undertaking activities to serve women who are not currently benefiting from TWCH treatment services.
During the period, we provided treatment to WIFs condition and started providing urostomy treatment for WIFs. This new development is indicative of TWCH’s steady development into a Center of Excellence in the holistic management of obstetric.
Two of the beneficiaries were discharged with a new lease of life. They were among 82 women and girls who received holistic treatment of Obstetric Fistula at TWCH. On top of that, a total of 45 women and girls received care through our collaboration with Kagando Mission Hospital in Kasese district.
We were privileged to host a number of international partners who included ten members of Expert Advisory Group from the International Federation of Gynecology and Obstetrics (FIGO), and Terrewode Women’s Fund board member, Lynne Dobson, along with a team of seven stakeholders from the U.S. While on a local basis, the Arch Bishop of Uganda Reverend Dr. Kazimba Mugalu visited and prayed for the patients and staff at TWCH and urged government to support the fight against obstetric fistula. We convened a national advocacy event to revamp national efforts to end fistula where stakeholders re-committed to support efforts of TWCH.
Reintegration is one of TERREWODE’S core programme area to enable survivors to be received back into their community with dignity. 122 survivors benefited from this programme, of which 34 were from Central region and 88 from Northern and Eastern regions. The program included training on income generating activity, health education and physiotherapy.
We held a stakeholders meeting to revamp the efforts towards eliminating Obstetric Fistula in Uganda. The event, which was graced by the top officials from Ministry of Health and Ministry of Gender, Labor and Social Development, also marked the fourth birthday of TWCH.
The relief that the women and girls receive as they graduate from our treatment and reintegration programs is a priceless frame, courtesy of our partners.
I hope you enjoy reading this newsletter.
Alice Emasu Seruyange,
Founder and Executive Director,
TERREWODE
TWCH Innovates Method for Patients with Incurable Fistula
Terrewode Women’s Community Hospital was able to pilot a specialized innovation to address the treatment needs of women and girls with incurable fistula. According to Dr. Fekade Ayenachew, FIGO accredited trainer, the treatment dubbed, urostomy, is a surgical procedure that creates a stoma (opening in the abdomen) to divert urine from a damaged or impaired bladder and is provided to women whose continence (ability to control urine) cannot be restored.
Out of the 82 women and girls treated this quarter at TWCH, two were beneficiaries of this treatment.
“It was a seven and a half hour procedures and the patient did well with no need for blood transfusion and smooth post-operative course,” Dr.Fekade remarked.
The TWCH Medical Director, Dr. Mary Aono said, “This treatment is rare and yet necessary in addressing the medical needs of women presenting with incurable fistula. As a Centre of Excellence, TWCH positions itself to serve this category of patients.”
The Executive Director, Alice Emasu Seruyange, noted that providing care for all women and girls suffering from Obstetric Fistula has always been the plan and therefore this is a huge step in the right direction, “While this innovation definitely comes at a cost, it is incomparable to the impact it will have on the lives of women and girls. We will continue to seek collaborations to synergize for this cause.”
TWCH Embraces Training in Specialized Treatment
TWCH has continued to deliver trainings to national doctors on specialized Obstetric Fistula treatment using The International Federation of Gynecology and Obstetrics (FIGO) competency based curriculum. This quarter, Dr. Ian Assimwe, a general surgeon from Arua Regional Referral Hospital partook a three week training program. Dr. Assimwe becomes the third specialist doctor to receive trainings, provided by Dr.Fekade Ayenachew.
“I am happy to be part of this program at TWCH. I have conducted fistula treatment in several hospitals in Uganda and I can assure you that some of these facilities that TWCH has are not found in other hospitals. This hospital provides enabling environment which is good for learning by the specialists, I pledge to create time to come and support this hospital,” Dr. Assimwe remarked
Two years ago, TWCH signed a Memorandum of Understanding (MOU) with FIGO for training of international doctors in specialized obstetric fistula care.
In order to strengthen this partnership, ten members of the FIGO Expert Advisory Group including the President of the International Society of Obstetric Fistula Surgeon (ISOFS), Prof. Sayeba Akhter visited, interacted and toured the hospital. The board members were led by FIGO Executive Director, Gillian Sligner.
From United Kingdom were: Drs, Gillian Sligner, Nasro Mohamed, Lilli Trautvetter and Lily Martin. From Ethiopia were: Drs, Ayenachew Fekade and Yeshineh Demrew; and, one each from Kenya, Dr.Hillary Mabeya, Dr. Vindhya Pathirana from Tanzania, Dr. Sadiya Nasir from Nigeria and the President of ISOFS, Prof. Sayeba Akhter from Bangladesh.
“FIGO is committed to ending the suffering of vulnerable women in the world through training doctors to respond to the need. We are really pleased with the impactful work of TERREWODE. I want to re-assure you that we shall stand with you to achieve the vision of TERREWODE hospital,” Gillian remarked.
Survivors Welcome Entrepreneurship
Zaina Nalubega, 42, a resident of Mpigi District is among the 122 survivors who participated in the social and economic reintegration programme. The focus was on financial literacy including business identification, marketing and pricing as well as calculating start up and working costs.
The common types of businesses included; poultry, modern farming, hairdressing, tailoring, weaving mats, liquid soap making, bakery and cookery projects.
While this training emphasized entrepreneurship, the survivors received additional skills and knowledge in health education including; family planning services, peer counselling, basic physiotherapy exercises and advocacy to support routine patient identification and referral for treatment.
“I am going to use the funds to venture into the business of making and selling liquid soap. After learning the importance of diversifying businesses, I plan on diversify my hairdressing business so that I can increase my earnings,” said Zaina.
Doctor Charles Mupere, the guest speaker at the training, a senior medical officer and psychiatrist at Kira hospital health center IV, called upon the survivors to educate fellow women on the importance of attending antenatal care as recommended to prevent fistula and maternal mortality.
“Survivors of fistula are among the vulnerable groups but do not disassociate yourself from the community like before when you were patients. TERREWODE has empowered you with knowledge during this training to impact on other women”, He said.
The majority of survivors had developed business plans and a clear marketing and financing strategy for their businesses by the end of the seven-day training.
Archbishop Dr. Kazimba Mugalu Visits TERREWODE
“Whoever is here, consider this hospital your blessing. You should be thankful to God for the opportunity and when you return home, preach to other women about these services and share your testimonies as a sign of your love for one another.” Dr. Kazimba Mugalu, the Church of Uganda Archbishop said while addressing survivors at TWCH.
He added, “I am grateful for the care that the TERREWODE team extends to these vulnerable women. Look at the age of these patients-too young! The whole of their future would have been wasted without this timely treatment. We should all join efforts to support the vision of this hospital.”
The Archbishop made the remarks during his maiden visit at TWCH following a guided tour of the facility where he also interacted with the patients in the ward, survivors, staff and one representative each from the TERREWODE Board of Directors, Ms. Grace Nakirrija and Board of Governors, Mr. Robert Olupot. The Archbishop’s entourage comprised Bishop Kosea Odongo of Soroti Diocese, and an elder of Church of Uganda and retired employee, Mr. Stephen Emasu, among other dignitaries.
Dr. Kazimba called upon Government and men to provide support for fistula care at TWCH, “Government should provide resources to sustain services provided at this hospital, and I encourage men in particular to support expecting mothers to seek healthcare during pregnancy and child birth to avoid some of these challenges.”
The Archbishop offered to utilize the church structures to mobilize, raise awareness, and advocate against Obstetric Fistula. He called on Christians to emulate the good work of Jesus’ ministry one of which is caring for the sick.
While delivering the keynote address, the Executive Director, Alice Emasu Seruyange remarked, “Obstetric Fistula is still thriving in Uganda because of mainly teenage pregnancies without timely medical intervention. Due to the inadequacies in the health care system, women who are at risk during pregnancy end up laboring long without emergency Obstetric Fistula care and often succumb to obstetric fistula.”
She hailed the Archbishop for spending time and providing spiritual support to the patients, survivors and TERREWODE Board and staff. “Your visit is historical and a huge gesture that will forever be remembered by the patients, staff and the Board of Directors of TERREWODE,” Alice concluded.
Stakeholders Revamp Efforts to End Obstetric Fistula
TERREWODE organized an event to revamp national efforts to eliminate Obstetric Fistula and improve maternal health outcomes for women and girls in Uganda. TERREWODE recognizes that the United Nations global target of ending fistula by the year 2030, cannot be achieved in Uganda without concerted efforts by all stakeholders.
Among the stakeholders present were the Commissioner Ministry of Health (MOH), Dr. Ronny Bahatungire, Beatrice Okillian, Policy and Advocacy Coordinator, Expanding Social Protection Programme. Beatrice was representing the Permanent Secretary of Ministry of Gender, Labor and Social Development (MGLSD). Others included, Ms. Maria Alesi from Fund for Global Human Rights.
Regional Local Government leaders included; the Resident District Commissioners, District Chairpersons, Chief Administrative Officers, District Health Officers and District Community Development Officers, from Serere, Ngora, Bukedea, Kumi and Kapelebyong as well as the Board of Directors and Board of Governors of TERREWODE.
Dr. Bahatungire applauded TERREWODE for the persistent efforts over the years adding, “Obstetric Fistula is one of the key sections that Ministry of Health has given affirmative action. The prevalence of fistula in our community is a shame to the medical field in Uganda and reflects a vacuum. I urge the medical practitioners to aggressively double their efforts to mitigate the impact of fistula.”
This was following a guided tour of TWCH and presentations showcasing the activities of both TERREWODE and the hospital. During the event, the survivors performed music, dance, drama which featured powerful messages on the causes of Obstetric Fistula, their long-wait for treatment and their painful experiences of living with Obstetric Fistula.
Ms. Okillan, MGLSD, said, “Having interacted with the patients, survivors and other fistula stakeholders today, I fully commit to ensure the needs of women with incurable fistula are included in the social protection intervention of the ministry.”
“Over the course of our operation, the need for an inter-sectoral approach in addressing obstetric fistula has become apparent; for the successful prevention of obstetric fistula, as well as treatment and reintegration of the affected. We cannot afford to continue watching women grapple with stigma and all forms of abuse,” Alice Emasu, the Founder and Executive Director emphasized to the meeting.
The stakeholders congratulated TERREWODE on its success in piloting a specialized Obstetric Fistula hospital, the only facility in Uganda providing holistic, routine and patient-centered treatment to affected women and girls. The stakeholders pledged synergies with TERREWODE to eliminating Obstetric Fistula in Uganda.
Survivors Trained in Local Government Planning and Budgeting
Norah Among, is among the 32 survivors who following completion of TERREWODE reintegration program and demonstration of passion for leadership, were trained in Local Government planning and budgeting. The two-day training, courtesy of TERREWODE, was aimed at building the capacity of survivors in understanding Local Government planning systems and processes including standard conduct of business in district council meetings. The training further supported linkages for survivors to community resources such as leadership, economic and advocacy platforms within their communities.
“From the reintegration training at TERREWODE, I was elected as a Secretary in our parish under the PDM [Parish Development Model], a Government initiative for wealth creation and employment generation at parish levels,” said Among.
Adding, “I cannot imagine how my life would be without this opportunity from TERREWODE. The additional knowledge in budgeting and planning has re-ignited my long lost dream of becoming a better leader in my community. Come 2026, I will contest for woman councilor using the knowledge from this training to promote issues of mothers at health facilities.”
To date, 23 out of the 32 advocates are engaged in income generating activities, 21 occupy leadership positions in community groups, churches and clans as chairperson, secretaries, treasurers and mobilisers and nine holding executive positions in the PDM.
To ensure active participation of survivors in the planning and budgeting process, the District Speaker, Counsellor Stephen Olebe, who was delivering a presentation to the survivors, said that he was ensure that the concerns of fistula survivors are incorporated in district plans and budgets, “I will use my position in the Council, to pass a vote for their leaders to make a submission during the budget conference so that it can be incorporated in the district budget for prioritization of funding. I will share this information with all the district speakers within Teso so that former patients’ concerns are incorporated in the district plans.”
TERREWODE pledges to follow-up on the commitments made by the district leaders present and extend this to all regions in Uganda.
TERREWODE Board of Governors and Directors in a Rare Joint Meeting
The TERREWODE Board of Directors and the Board of Governors for the first time ever convened a joint meeting on the 25th of August, 2023. The meeting reviewed the performance of TWCH over four years of its existence and discussed growth opportunities. During the meeting, the Board of Governors presented their end of four-year term report which highlighted undertakings achieved during their tenure. Thereafter the Board of Governors received instruments for their next term of service including a board charter.
TWCH is Highly Hospitable- Survey Reveals
A survey conducted by Terrewode Women’s Community Hospital from July-September 2023, found that 89% of patients were very satisfied with the reception they received at the hospital when they sought treatment; 88% with communication of the treatment plan; 95% with lighting systems; sanitation 92%; drinking water 93%; meals provided; a balanced diet and served on time, 72%.
As regards to clinical services within the hospital, 90% were very satisfied with laboratory; 90% were very satisfied with nursing care; and, 85% were satisfied with dispensing. While as regards to supportive services; 87% were very satisfied with health education; 84% were very satisfied with counselling and psychosocial support; and, 66% were very satisfied with physiotherapy.
This survey is a periodic assessment to obtain self-reported feedback from patients regarding their experience while seeking and receiving care. The survey, which is conducted every six months, serves as a Continuous Quality Improvement (CQI) activity to identify service gaps requiring improvement.
The sample size was 61 patients receiving services both at the In-patient and Out-patient departments of TWCH, who were purposively selected. The participants were required to state their levels of satisfaction based on a 4-point Likert, contained in a semi structured questionnaire administered by a research assistant using the patients’ satisfaction survey tool. The survey assessed patients’ rating of services at every touch point (Reception & triage, Laboratory, Dispensing, Nursing, among others.
The survey also revealed that despite the counselling services provided, there is still a negative attitude towards fistula surgical procedures by the patients. More so, 15% of the patients reported an inability to fully comprehend their treatment plans which was attributed to language barrier.
TWCH strives to provide holistic patient centered care to all women and girls affected by fistula all over Uganda, and therefore strives to address gaps from the survey to better our services.
Nadunga’s 50-Year Grapple with Fistula
Topista Nadunga, 75, a resident of Sironko district, reminisces her ordeal with nostalgia on how she grappled with fistula for 50 years. Today, her life has changed following successful treatment with a specialized fistula facility in Uganda, TWCH.
During Nadunga’s fourth delivery at the age of 25, she experienced a delay to receive care while at a health facility, dubbed as, the Third Delay. Nadunga recalls her labour starting while she was at Budadri Health Centre. Upon examination, the nurses at the health centre immediately referred Nadunga to Mbale Regional Referral Hospital, having noticed a scar of her previous C-section delivery.
While at Mbale Regional Referral Hospital, the nurse attending to her was unfriendly and rude which subsequently caused her to retain information about her previous deliveries.
“The nurse asked me to go to the ward and exercise to progress labor. However, right before I got into the ward, I felt very sharp contractions which forced me to start pushing the baby,” Nadunga said.
She added that, “Luckily, the night watchman came to my rescue and helped to take me back to the labor suit. I became unconscious and on waking up, I learnt that I had been operated on and was leaking urine uncontrollably. I asked for the nurse where my baby was and she could not even look at me while informing me that my baby had passed away.”
Like the majority of fistula victims, Nadunga did not survive the degrading and inhumane after effects. She lost her marriage and was forced to go back to her parents’ home, leaving her three children behind.
The welcome she received at her parents’ home was short-lived. Her half-siblings particularly the boys, stopped treating her with kindness as Nadunga continuously leaked all over the house.
“I was looked at as garbage and I resorted to staying in the bush during day and only returned home to sleep in the night. But even then my brothers threatened to kill our father if I continued sleeping at home and this forced me to leave home after enduring for over 10 years,” Nadunga recalls.
She added, “I walked for three nights and two days without knowing where I was going. I passed through bushes and hoped that wild animals would help end my pains. I reached the Uganda-Kenya border feeling very exhausted and worn out. A family accepted me in my condition and hired me as a casual laborer for 15Ksh a month, as long as I stayed in their farm.”
After two years of working very hard, Nadunga saved enough money and returned home where she bought a plot and built a house for herself and reunited with her children.
Before going to Kenya, Nadunga sought treatment twice but in vain at Mbale Regional Referral Hospital. In July 2023, her son informed her of free treatment at Terrewode Women’s Community Hospital.
“I had given up on the idea of being healed. Infact, I hesitated but after long phone calls with the nurses of TERREWODE, I was convinced. I will now die a dignified person like the rest of the people. God bless TERREWODE and all its staff,” concluded Nadunga with a wide smile.
Board story picture
Some of the Board of Governors(BOG)posing after the joint meeting, (Middle) is the BOG Chairperson, Dr. Amandua Igbea, standing is his right is Executive Director, Alice Emasu,( Second Left) is TWCH Medical Director, Dr. Aono Mary.
Nadunga Success story picture
Nadunga Topista leaving TWCH after receiving treatment.
Patients survey picture