Advocacy success story: Burkina Faso broadens access to misoprostol, an essential maternal health medicine

By Brahima Bassane, MD

[Version française ci-dessous]

Brahima Bassane, FCI’s national director in Burkina Faso, is a public health physician.

Postpartum hemorrhage (PPH) — excessive, uncontrolled bleeding after childbirth —remains the leading cause of maternal death worldwide.  In countries like Burkina Faso, where many births still occur at home, the drug misoprostol offers a number of advantages for preventing and treating PPH because (unlike oxytocin, considered the ‘gold standard’ medicine for PPH) it can be easily administered and does not require cold storage. In settings with limited infrastructure and lack of skilled birth attendants, misoprostol may be a woman’s only chance for surviving PPH.

Access to high-quality medicines is part of every citizen’s right to the highest attainable standard of health. But in spite of misoprostol’s proven safety and efficacy, decision-makers in some countries have been reluctant to authorize its widespread availability, or are unaware of the available evidence. Many governments have not included misoprostol in their national essential medicine list (EML), which is often used as the basis for importation, distribution, and marketing of medicines for the public health system.

FCI works to support wider understanding, acceptance, and use of misoprostol for PPH. This year in Burkina Faso, our efforts — with a range of advocacy partners — to persuade government officials to deem misoprostol for PPH an essential medicine were successful. This success story offers a potential model for effective, collaborative, focused advocacy in other countries where misoprostol’s lifesaving benefits are not yet broadly available.

Our advocacy began in earnest last September, when FCI convened a meeting  to share the latest research on misoprostol for PPH and to develop advocacy strategies that would convince the government to take action. These committed and motivated maternal health champions called for the widespread availability of misoprostol, stating that the inclusion of misoprostol in the national EML was an urgent national priority.

Following the meeting, a small advisory committee was assigned the task of reaching key government decision makers. The committee submitted a letter and technical note to the Director-General of Pharmacy, Medicines, and Laboratories (DGPML) requesting inclusion of misoprostol on the EML. A DGPML technical committee then reviewed the submitted application, gathering all available evidence on misoprostol. During this review period, FCI and our partners met again with the Director-General of the DGPML, who stated his support for misoprostol as a critical tool for reducing the burden of PPH in Burkina Faso. FCI and partners also met with the Secretary-General of the Ministry of Health, who affirmed the government’s responsibility for ensuring the availability of misoprostol for PPH at public health facilities. He also came out in support of misoprostol distribution at the community level, and recommended ongoing supervision and training to ensure its correct use.

In February of this year, all of these advocacy efforts paid off: the 2014 revision of the national EML (Liste Nationale Des Medicaments et Consommables Medicaux Essentials, Edition 2014) includes misoprostol both for prevention and for treatment of PPH.

While this is an important step in making misoprostol available in the government health system, FCI and our partners will continue advocating and working to ensure that all women have access to a uterotonic , like misoprostol or oxytocin, for effective prevention and treatment of postpartum hemorrhage. These efforts are critical for countries’ efforts to fulfill the promise of MDG 5 and put an end, once and for all, to preventable maternal death.

Learn more about FCI’s work on misoprostol for PPH here.

To join an online community on misoprostol for PPH, please click here.

 

Réussite exemplaire du plaidoyer : Le Burkina Faso élargit l’accès au misoprostol, un médicament essentiel de la santé maternelle

Par Brahima Bassane, MD– médecin en titre

Directeur national de FCI au Burkina Faso, Brahima Bassane est médecin de santé publique.

L’Hémorragie du post-partum (HPP) — des saignements excessifs, difficiles à arrêter survenant après l’accouchement — demeure la principale cause de décès maternels à travers le monde. Dans des pays tels que le Burkina Faso où un nombre important des accouchements surviennent encore à domicile, le médicament misoprostol fournit nombre d’avantages pour la prévention et le traitement de l’HPP dans la mesure où il peut être facilement administré et ne nécessite pas une conservation à dans un réfrigérateur (contrairement à l’ocytocine qui est considérée comme le médicament ‘de référence’ pour l’HPP).Le misoprostol peut représenter la seule chance de survie d’une femme en proie à l’HPP dans les milieux communautaires qui disposent d’un nombre insuffisant de centres de santé et d’accoucheuses qualifiées.

L’accès à des médicaments de haute qualité est un des droits de chaque citoyen pour lui permettre de jouir du meilleur état de santé possible. Toutefois, en dépit de l’innocuité et de l’efficacité reconnues du misoprostol, les décideurs ont été dans certains pays, réticents à autoriser sa mise à disposition généralisée ou ils ignorent les données disponibles. Plusieurs gouvernements n’ont pas inclus le misoprostol dans leur liste des médicaments essentiels (LME) qui est souvent utilisée comme critère pour l’importation, la distribution et la commercialisation de médicaments pour le système de santé publique.

FCI œuvre en vue de soutenir une meilleure compréhension, acceptation et utilisation du misoprostol pour l’HPP. Au Burkina Faso, nos initiatives —de concert avec un éventail de partenaires du plaidoyer —visant à convaincre cette année les responsables gouvernementaux de considérer le misoprostol pour l’HPP comme un médicament essentiel, ont été couronnées de succès. Cette réussite exemplaire fournit un modèle potentiel de plaidoyer efficace, mené en collaboration et bien ciblé dans d’autres pays où les avantages salvateurs du misoprostol ne sont pas encore largement disponibles.

Notre plaidoyer a véritablement débuté en septembre 2013 lorsque FCI a organisé une réunion en vue de partager les résultats des toutes dernières recherches sur le misoprostol pour l’HPP et de mettre au point des stratégies de plaidoyer qui convaincraient le gouvernement à prendre les bonnes décisions. Ces défenseurs engagés et motivés de la santé maternelle se sont prononcés pour la mise à disposition généralisée du misoprostol en indiquant que l’inclusion du misoprostol dans la Liste nationale des médicaments essentiels était une priorité nationale.

Suite à la réunion, la tâche de prendre contact avec les principaux décideurs gouvernementaux a été confiée à un petit comité consultatif. Le comité a présenté au Directeur Général de la Pharmacie, du Médicament et des Laboratoires (DGPML) une lettre et une note technique sollicitant l’inclusion du misoprostol dans la LME. Un comité technique de la DGPML a ensuite examiné la demande soumise en recueillant toutes les données disponibles relatives au misoprostol. Au cours de cette période d’examen, FCI et nos partenaires se sont réunis avec le Directeur Général de la GPML qui a exprimé son soutien pour le misoprostol comme outil crucial pour alléger le fardeau de l’HPP au Burkina Faso. Cette équipe restreinte de FCI et ses partenaires s’est également réunie avec le Secrétaire Général du Ministère de la Santé qui a affirmé la responsabilité du gouvernement à assurer la disponibilité du misoprostol pour l’HPP dans les établissements de santé. Il s’est également prononcé en faveur de la distribution du misoprostol jusqu’à l’échelle communautaire  tout en recommandant une supervision suivie et la formation afin de garantir son utilisation adéquate.

En février au cours de cette année 2014, toutes ces initiatives du plaidoyer ont porté leurs fruits : la révision en 2014 de la LNMCE (Liste Nationale Des Médicaments et Consommables Médicaux Essentiels, Édition 2014) comprend notamment le misoprostol pour la prévention ainsi que le traitement de l’HPP.

Bien que la mise à disposition du misoprostol dans le système public de santé constitue une étape importante, FCI et nos partenaires continueront à plaider et à œuvrer pour veiller à ce que toutes les femmes aient accès à un utérotonique tel que le misoprostol ou l’ocytocine pour une prévention et un traitement efficaces de l’hémorragie du post-partum. Ces initiatives sont cruciales pour les efforts des pays à tenir leur promesse pour l’OMD5 et à définitivement mettre un terme aux décès maternels évitables.

Trouvez de plus amples informations relatives aux travaux de FCI sur le misoprostol pour l’HPP.

Veuillez cliquer ici pour intégrer une communauté virtuelle sur le misoprostol pour l’HPP.

Community leaders in Burkina Faso leading on women’s and children’s health

Alain Kaboré is Program Officer with FCI-Burkina Faso, based at our office in Ouagadougou, whose previous blogs can be read here, here and here.

In the Sahel region in northern Burkina Faso, a remote, arid area on the edge of the Sahara Desert, maternal and newborn mortality levels are substantially higher than in the rest of country. The majority of women, particularly in the Sahel’s hundreds of small, semi-nomadic villages, still give birth at home, without the help of a skilled birth attendant. Family Care International has been working in the Sahel for several years, in partnership with the UN Population Fund—UNFPA, the national Ministry of Health, and local grassroots organizations, to educate women about their maternal and reproductive health, increase use of the maternal health services that are available at the health center in the provincial capital, ensure that women with childbirth complications are able to access the emergency care that can save their lives, and arrange for surgical treatment for women living with obstetric fistula, a devastating injury that results from prolonged or obstructed labor.

Over the course of this work, it has become increasingly clear that local leaders — clergymen, traditional chiefs, elected officials — have the potential to influence women and their families to utilize available health services and avoid harmful beliefs and practices that are rooted in the religious and cultural traditions. Because these leaders play crucial roles in the promotion and preservation of traditional practices and beliefs, it will be difficult to spark meaningful change — like the abandonment of child marriages — until traditional leaders are educated and mobilized to promote the cause.

Community leaders at a maternal health workshop

FCI has therefore focused on working with approximately 30 religious and traditional leaders in each of the four districts that make up the Sahel region. At a series of training workshops, they have learned about all aspects of maternal health care, and have come to better understand the community determinants of maternal health and the ways that encouraging uses of health services, and particularly skilled attendance at birth, could play a large role in saving women’s and babies’ lives. At the end of the workshops, leaders were asked to implement what they learned in their communities. Some time later, a feedback meeting was organized. Here are some stories that the leaders shared at that meeting:

  • Bani is a rural town in the Seno province, located about 25 miles outside of Dori, the regional capital. After attending an FCI training session, the Imam of one of Bani’s mosques was committed to promoting maternal and infant health. With educational materials in hand, the Imam held awareness meetings at his mosque and in each of the town’s five neighborhoods, where he discussed the importance of prenatal care, of giving birth at the health center, of preventing obstetric fistula, and of treating fistula when it does occur. The Imam also approached Bani’s mayor to arrange for discussions with the members of the town council, brought health workers to meet with representatives of the five neighborhoods and of 16 surrounding villages, and invited the Dori “Khoolesmen” Association (a grassroots group that works in the community to improve maternal and newborn health) to lead discussions at four mosques and 21 adult literacy centers.

    Woman leader spreading the word
  • Diguel is a town located about 37 miles outside of Djibo, capital of the Soum province, and almost 100 miles from Dori. After attending a training workshop in Djibo, Diguel’s Imam also led a series of community discussions, focusing on the critical importance of prenatal care and skilled birth attendance. He spoke about the importance of protecting women health at the end of Friday prayers, at the special Walima marriage ceremony, and at baptisms. During a special prayer for rain, in June 2013, the Imam shared with the worshippers in his mosque what he had learned about pregnancy danger signs, emphasizing the need for husbands and other men to be involved in health issues affecting women and children. As he spoke with the men, the Imam arranged for female community outreach workers to speak with the women in another corner of the mosque’s courtyard. He also spoke with traditional chiefs in order to engage them in these efforts, and is planning to begin visiting families un their homes and to travel into more remote surrounding villages, in order to ensure that lifesaving information gets to those harder-to-reach populations.

One day, when I returned home after a short errand, I met a suffering pregnant woman wandering the street, probably returning from the fields. She was writhing in pain and I quickly recalled the signs of danger that we were shown during the training in Djibo. I went up to the woman and asked her which family she was from. I quickly drove her back to her home and when we arrived I asked for her husband, but he was not there. I then asked if the woman had received any prenatal care; but she had not, so I urged her to go to the health center to get checked out. Our religion teaches us to always care for the well-being of others to the best of our ability. I think, with the knowledge I’ve received from the training, it would be unjust not to use it to help others.

– Imam of Diguel town, Soum province, Burkina Faso

 

  • During May and June, 2013, the radio station of the Ahmadiyya  Muslim community in Dori broadcast  a program called “Health Mission,” covering topics on maternal and newborn health; the Ahmadiyya community also conducted outreach to several villages through its network of mosques.
  • The Sunni Muslim community in Dori held three awareness sessions, after the afternoon prayers in the mosques, concerning women’s health, the responsibility of men in issues of maternal and infant health, and the importance of prenatal care.
  • Leaders of the evangelical Christian community were also engaged in these efforts: 65 pastors from the towns of Dori, Sebba, and Gorom-Gorom attended a training meeting, after which they to shared what they had learned about maternal health with the congregants in their network of churches.
  • Dori’s Catholic Mission participated as well: after the chaplain and priest received training, they conducted 25 awareness programs after Saturday and Sunday masses. They then held programs with three grassroots Christian Committees, including both women and men; two awareness meetings in the rural villages of Karo and Koumbri; and a meeting with members of the Association of Catholic Women.
Bringing lifesaving information to their community

These few examples show these leaders’ commitment to raising awareness in their communities about women’s and newborns’ health, and their potential influence on traditional practices that are deeply rooted in social and religious norms and customs. This commitment is durable and sustainable, and they will continue working – with FCI’s partnership – to make these efforts to encourage healthy practices bring real change in the lives and health of women in their communities.

Burkina Faso: Expanding Access to Misoprostol for Postpartum Hemorrhage

Catherine Lalonde is FCI’s senior program officer for Francophone Africa.

Each year in Burkina Faso, more than 2,000 women die from pregnancy-related complications. Many of these deaths are due to severe and uncontrolled bleeding (postpartum hemorrhage, or PPH) that occurs following childbirth. The vast majority of these deaths can be effectively prevented or treated if women have access to high-quality maternal health care. Essential medicines, such as oxytocin and misoprostol, are safe and effective for preventing and treating PPH; however for many women in Burkina Faso, and in countries around the world, these essential medicines are not available or easily accessible. Access to misoprostol, a safe and effective medicine for preventing and treating PPH, is particularly important in developing countries, and especially in rural areas, because (unlike oxytocin) it requires neither refrigeration nor injection: it can be used even in poorly-equipped health facilities and home births.

Home births are still very common in Burkina Faso
A third of all births in Burkina Faso still take place at home; in poor villages on the edge of the Sahara, this figure exceeds 60%

In early September, FCI convened a meeting in Burkina Faso with 40 high-level officials from the Ministry of Health, local and international NGOs, and national professional societies to share the latest evidence and research and identify strategies for making misoprostol more affordable and accessible for preventing and treating PPH. A room full of champions for improved maternal health in Burkina Faso, the participants called for widespread availability of misoprostol, particularly in regions where women may not be able to reach health facilities for delivery. At the same time, participants identified a number of challenges for making misoprostol more widely available; these included:

  • High cost of the drug: As it is now, women in Burkina Faso cannot purchase a single dose of misoprostol; only larger packages — 4 or 5 doses, depending on whether it will be used for prevention or treatment — are available, and they cost more than US$5, a considerable sum in Burkina Faso.
  • Use for other indications: Some meeting participants were also concerned about the possibility that, if it were made available for PPH, untrained or unskilled health workers could use misoprostol for abortion or to induce labor.
  • Conflicts with health facility deliveries: Participants raised the fear that making misoprostol available in community settings could discourage women from going to a health facility for delivery.
  • Need for more research/data: Meeting participants discussed whether more research in regions like the Sahel — remote, rural areas, where skilled care is unavailable or very far away and home birth is consequently very common — is needed.

Women in my district die from postpartum hemorrhage, so we can’t be against the use of misoprostol [for PPH] in rural areas. In the Sahel only 38% of births are attended by a skilled professional, and it’s not because women don’t want to deliver in a clinic. Here, travelling 2 kilometers takes as long as it would to travel 30 kilometers somewhere else.– Chief Medical Officer, Gorom-Gorom District, Sahel Region, Burkina Faso

Participants identified a number of agreements and strategies for moving forward. They agreed that:

  • The potential use of misoprostol for other indications, including abortion, is not a reason to restrict access to it for PPH. A safe and effective medicine should not be withheld from women who need it simply because it can also be used for other, more controversial indications. Further, evidence suggests that making misoprostol more widely available for PPH does not increase the rate of abortion. Women who want to have an abortion will have one, whether or not they have access to misoprostol.
  •  Misoprostol should be added to the national Essential Medicines List (EML) for use in peripheral health centers. A small group was established to work on a proposal for including misoprostol for PPH in the national EML.
  •  There is a need to lower the cost of the drug, either through government funding or social marketing.

FCI works at the global level and in select countries such as Burkina Faso and Kenya, in collaboration with our partners, to support wider understanding, acceptance, and use of misoprostol for PPH. FCI maps advocacy efforts, publishes case studies, articles, and information briefs, disseminates new information, and brings together experts through online events and conferences to discuss evidence and challenges related to misoprostol’s access and availability.

From Obstetric Fistula Survivor to Empowered Citizen

Alain Kaboré is Program Officer with FCI-Burkina Faso, based at our office in Ouagadougou, whose previous blogs on this obstetric fistula project can be read here and here. This article is cross-posted from the blog of the Frontline Health Workers Coalition.

 

Mariama Boubacar Diallo et son enfant
Mariama Boubacar Diallo's fistula occurred while giving birth to this baby

“Today,” Mariama Boubacar Diallo says, “Thank God, I no longer suffer. I’m healthy; I am healed.” Mariama, a resident of the village of Kriollo Ourarsaba, located in the northern Sahel region of Burkina Faso, reflects on her recent surgery to repair the obstetric fistula she developed while giving birth to her third child four years ago.

Obstetric fistula, an injury to the birth canal resulting from an obstructed or prolonged birth, causes long-term, physical pain. Mariama, like many women suffering fistula, also experienced emotional distress from losing the respect of her family and community.

Burkina Faso, a land-locked West African country, struggles against chronic poverty like many of its neighbors in the Sahel, the southern band of the Sahara Desert that stretches across the width of the African continent. Most recently, Burkina Faso has been working to overcome the severe food shortage that has plagued the region since 2011.

Recognizing the urgency of the food security crisis, USAID has reserved more than $56.5 million to fund projects working in areas of agriculture, livelihoods, health and water, sanitation and hygiene in the region. To counteract the food security crisis and mobilize productive members of society, policymakers should address the unnecessary loss of life that occurs when mothers suffer or die from preventable pregnancy and childbirth complications. Frontline health workers are a key part of the solution, both for preventing fistula from occurring and for ensuring that survivors receive the treatment they need.

Through our programs in Burkina Faso and around the developing world, Family Care International (FCI) has worked to raise awareness of the causes of and treatment for obstetric fistula. FCI-Burkina Faso, with support from the United Nations Population Fund (UNFPA), has worked with communities and partner organizations in the Sahel region to prevent fistula by improving access to and utilization of emergency obstetric care, which is provided by midwives and doctors in health centers and hospitals that are too often inaccessible to women in rural villages.

In order to get these women to the urgent care they need, FCI and our partners have helped more than 700 villages establish emergency procedures for transporting pregnant women to the nearest health clinic when faced with life-threatening complications. We have also trained hundreds of community health and outreach workers to visit people in their communities, hold meetings to raise awareness of pregnancy complications and their treatment, and bring fistula survivors out from isolation so they can reclaim their lives. Mariama is one of those brave women who, thanks to the tenacity and commitment of frontline health workers, has triumphed over her injury and succeeded in becoming a leader in her community.

Community outreach brings fistula survivors out of the shadows

Although Mariama wasn’t rejected by her husband when she suffered from obstetric fistula, her in-laws blamed and abused her. A community outreach worker affiliated with an FCI partner found Mariama and helped her arrange surgery in a hospital in the regional capital, Dori. In the months after her surgery, she received training in modern methods of raising cattle and sheep, the primary economic activity in many parts of the Sahel.

At the end of 2010, Mariama received a grant of 100,000 CFA francs (about $200) to purchase a ram and a ewe, along with some feed, in order to establish her own breeding business. Mariama now owns four head of cattle, making her one of the village’s most prosperous and successful citizens, and she generously shares her new agricultural knowledge with her neighbors. She is fully included in baptisms, weddings, and other social events of the village — something that was inconceivable only a year ago — and has fully reunited with her in-laws. “Today,” she says, “thanks to this program, my in-law family has truly accepted me.”

Policymakers must come to better understand the impact of frontline health workers, with the resources and the know-how to empower women and get them to the care they need , on the lives of women like Mariama.

New lives for fistula survivors: success stories from Burkina Faso

Alain Kaboré is Program Officer with FCI-Burkina Faso, based at our office in Ouagadougou.

In Burkina Faso, as in too many developing countries, giving birth is one of the riskiest things that a woman can do. In this poor and largely rural country, one in 28 women dies from complications of pregnancy or childbirth, and many more suffer from serious childbirth injuries or disabilities. One of the most common and devastating of these injuries is obstetric fistula,an injury to the birth canal caused by obstructed and prolonged labor. It results in a lifetime of pain, humiliation, and social ostracism, as the fistula causes incontinence and odor and makes it impractical or impossible to have more children.

FCI-Burkina Faso, with support from the United Nations Population Fund—UNFPA, is working with communities and partner organizations in the Sahel region, on the edge of the Sahara, to prevent obstetric fistula by improving access to and utilization of emergency obstetric care, to provide treatment for women living with fistula, and to support the reintegration of fistula survivors into their communities. This is the story of two of those survivors.

Maïrama Tamboura, is a 40-year old woman from a village in the Sahel. She married as a teenager, and had her first baby at the age of 17. When she was 25, giving birth for the third time — at home, without the help of a skilled birth attendant, as is typical in this region — a prolonged and painful labor culminated in the loss of her baby and the development of an obstetric fistula. This began almost 15 years of pain and humiliation.

Maïrama­ Tamboura and her neighbors
Maïrama­ Tamboura and villagers, after her fistula repair surgery

Maïrama’s husband banished her, and her neighbors excluded her from weddings, funerals, and the other social events of the village. In these rural West African communities, a woman’s social status depends almost entirely on her marital status: an abandoned woman, who smells bad and is perceived as a failure, quickly becomes an outcast. Luckily, her mother remained loyal to her. Maïrama went back to live in her parents’ home, and her mother tirelessly tried to find a way to help her daughter. She consulted traditional healers, to no effect, and had surgery performed by a medical practice in the nearby town of Djibo, the capital of the province Soum, but the doctor there lacked the skills and resources to successfully address the problem.

Mariama Boureima-Diallo is a much younger woman — she is only 27 — but she too lived with obstetric fistula for more than a decade. Originally from the neighboring country of Mali, Mariama Boureima-Diallo also married young and was pregnant at age 16. Obstetric fistula is most common in adolescents, because a small, undeveloped pelvis increases the risk of obstructed labor, and this is what happened to Mariama Boureima-Diallo. After developing fistula and being banished by her husband, she crossed the border into Burkina Faso and arrived in Djibo. There, she underwent two surgical procedures, both unsuccessful, with the same medical practice. Like the older Maïrama Tamboura, she seemed destined for a lifetime of pain and isolation.

Mariama Boureima-Diallo
Mariama Boureima-Diallo, after surgery

FCI-Burkina Faso’s obstetric fistula program works to find women like Maïrama Tamboura and Mariama Boureima-Diallo, and to help them get their lives back. This is not a simple task, as many women with fistula live quietly and in the shadows. We found Maïrama Tamboura because her mother came to an outreach meeting led by one of our partners, a local grassroots organization. After learning about our program, she asked that her daughter have an opportunity to participate. MariamaBoureima-Diallo became known to us because a fisherman she knew participated in a similar awareness-raising meeting. He took our community mobilizer to visit with Mariama Boureima-Diallo in her isolated hut.

Both women were brought into the program, and both were ultimately taken to Dori, the capital city of Sahel region and site of its only hospital, where they received surgical care and were successfully treated.

Today, Maïrama Tamboura and Mariama Boureima-Diallo both live in the rural village of Djao-Djao, about 10 miles outside of Djibo. Both are now happily remarried, and are healthy, have fully reintegrated with the community, and have gained back their social lives and status. A new beginning awaits them.

La seconde vie des survivantes de la fistule obstétricale : une histoire de succès au Burkina Faso

Alain Kaboré est chargé de programme à FCI-Burkina Faso, basé dans notre bureau à Ouagadougou.

Au Burkina Faso, comme dans beaucoup de pays en développement, accoucher est une des choses les plus dangereuses qu’une femme puisse faire. Dans ce pays pauvre et très largement rural, une femme sur 28 meurt suite à des complications survenues durant sa grossesse ou son accouchement, et beaucoup d’autres souffrent de blessures ou d’handicaps dus à l’accouchement. Une de ces blessures la plus répandue et dévastatrice est la fistule obstétricale, une blessure de la filière génitale causée par un accouchement prolongé ou par son arrêt. Il en résulte une vie de douleur, d’humiliation et d’exclusion sociale car la fistule entraîne l’incontinence et des odeurs qui rendent impossible ou très compliqué pour une femme d’avoir d’autres enfants.

Community outreach
Sensibilisation dans la communauté

FCI-Burkina Faso, avec le soutien du Fonds des Nations Unies pour la Population (UNFPA), travaille en collaboration avec les communautés et des organisations partenaires dans la région du Sahel, au bord du Sahara, pour prévenir les fistules obstétricales en améliorant l’accès aux soins obstétricauxd’urgence ; fournir un traitement aux femmes vivant avec une fistule ; et soutenir la réintégration des survivantes de la fistule au sein de leur communauté. Voici l’histoire de deux de ces survivantes.

Maïrama Tamboura est une femme de 40 ans habitant dans un village du Sahel. Elle s’est mariée alors qu’elle n’était qu’une adolescente et elle a eu son premier bébé à 17 ans. A 25 ans, alors qu’elle donnait naissance pour la troisième fois — à la maison, sans l’aide d’une sage-femme, comme fréquemment dans la région — un accouchement prolongé et douloureux a abouti à la perte de son bébé et au développement d’une fistule obstétricale. A partir de là, ont commencé presque 15 années de souffrance et d’humiliation. Le mari de Maïrama l’a répudiée et ses voisins l’ont exclue des mariages, funérailles et autres événements sociaux du village. Dans les communautés rurales d’Afrique de l’Ouest, le statut social d’une femme dépend presque intégralement de son statut marital : une femme abandonnée, qui sent mauvais, est perçue comme un échec et devient rapidement exclue. Heureusement, sa mère lui est restée fidèle. Maïrama est retournée vivre chez ses parents et sa mère a essayé sans relâche de trouver un moyen d’aider sa fille. Elle a consulté les soignants traditionnels sans succès. Elle a obtenu qu’un cabinet médical effectue une chirurgie sur sa fille dans la ville proche de Djibo, la capitale de la province Soum, mais le docteur n’avait pas les ressources et compétences nécessaires pour résoudre le problème.

Mariama Boureima-Diallo est une femme beaucoup plus jeune — 27 ans — mais elle aussi a vécu avec une fistule obstétricale pour plus d’une décennie. D’origine malienne, un pays voisin, Mariama Boureima-Diallo s’est aussi mariée très jeune et était enceinte à 16 ans. La fistule obstétricale est très commune chez les adolescentes car leur bassin est petit et peu développé ce qui augmente les risques de dystocie. C’est ce qui est arrivé à Mariama Boureima-Diallo. Après avoir développé une fistule et avoir été répudiée par son mari, elle a traversé la frontière pour aller au Burkina Faso et est arrivée à Djibo. Là, elle a eu deux chirurgies, toutes les deux sans succès, avec le même cabinet médical. Comme Maïrama Tamboura, elle semblait être condamnée à une vie de souffrance et d’isolement.

Mariama Boureima-Diallo in front of her home
Mariama Boureima-Diallo en face de sa maison

Le programme de lutte contre la fistule obstétricale de FCI-Burkina Faso cherche les femmes comme Maïrama Tamboura et Mariama Boureima-Diallo et les aide à retrouver une vie normale. La tâche n’est pas facile car beaucoup de femmes ayant une fistule vivent en retrait et dans l’ombre. Nous avons rencontré Maïrama Tamboura car sa mère a assisté à une causerie éducative sur le sujet menée par un de nos partenaires, une association communautaire. Après avoir appris l’existence de notre programme, elle a demandé que sa fille puisse y participer. Mariama Boureima-Diallo a été identifiée parce qu’un pêcheur qui la connaissait a participé à une animation similaire. Il a amené notre animateur pour rendre visite à Mariama Boureima-Diallo dans sa maison isolée.

Les deux femmes ont rejoint le programme et ont toutes les deux été amenées à Dori, la capitale du Sahel où elles ont pu recevoir la chirurgie et les soins nécessaires à leur guérison dans le seul hôpital de la région.

Aujourd’hui Maïrama Tamboura et Mariama Boureima-Diallo habitent toutes les deux le village de Djao-Djao, à environ 16 kilomètres en dehors de Djibo. Toutes les deux sont maintenant remariées, heureuses, en bonne santé et pleinement réintégrées au sein de leur communauté. Elles ont retrouvé leur statut et leur vie sociale. Un nouveau départ les attend.