The following is an interview with Angela Deane, a Canadian nurse who volunteered at the Clinica CEML in Lubango, Angola for three months earlier this year. Angela dedicated a significant amount of her time to strengthen an obstetric fistula program at the clinic.
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Adam: What caused the spark that moved you to begin your work with fistula patients?
Angela: 99% of them are illiterate. When I arrived at CEML in March 2010, I realized how many fistula women were here. On an ongoing basis there are probably about 15 to 20 that stay in the neighbouring patient’s village. There are just over 30 women currently in the healing process. These women spend so much time at this facility. They stay in our patient’s village day in and day out because the clinic is in a somewhat isolated location. Some patients spend up to two years in our patient’s village, essentially creating for themselves a temporary home beside the clinic. It was with this in mind that I began a daily program for these women.
Adam: So you wanted to work with these women. You had seen them daily in and out of the clinic for consults, treatments, tests and surgeries. What kind of a response did you receive from these patients when you approached them with this idea?
Angela: My first step was to ask them what they wanted to learn. No matter which woman I asked, the answer was the same – mathematics. I am not sure where the idea of developing math skills arose. However, I can speculate that this skill will help these women become local-budding entrepreneurs. And after math, the women wanted to learn how to sew.
Adam: So you started by teaching them math. Where were these women in terms of math knowledge?
Angela: I have seen fistula patients from seventeen to forty years of age. Some of them have had the opportunity to go to school. The highest grade level I have found, out of any of these women, is the equivalent of a Grade 4 level. Before our classes, two or three of them had never even held a pencil. Holding a pencil for the first time, these women could not help but laugh with excitement. They held the pencils right side up and upside down, experiencing the feel of these writing utensils with great curiosity and interest. The first day we spent going through numbers. They knew how to count, but there was no visual representation about what a number was on paper. The more advanced math students are adding double-digit numbers up to 40. The progress these women have made to date is amazing!
Adam: Wow! Although some women have a Grade 4 level education, the learning gap is quite substantial. Have you been teaching these women other skills as well?
Angela: So some of them are learning how to write numbers. However, one of the most shocking moments for me was when I realized that these women cannot put their names on paper. Some are now learning how to write their names.
As the world becomes more global and urbanized, I feel for these women who come from these remote tribal locations. They come to our clinic in the city and have no idea how to write their names. They don’t even know their birthdates. Writing their names is an opportunity for them to regain their identities. Society has labelled these women as outcasts who smell as a result of their conditions.
That was one of the most important things I could teach them – giving them the ability to write their names. We are also at the point where women can now write the date and identify, in words and on a map, where they live.
Adam: I saw it for myself earlier today. The women are energetic and eager. There appears to be such a drive to learn and you seem to have gained the love and affection of these women. Have there been any special moments for you through this process?
Angela: They love to come to our classes. They are so thirsty and hungry for learning. When the women arrive in the early afternoon, they are eager to do math, write and sew. We are also starting to read a little bit as well.
One girl came to our morning service a few weeks ago and she was trying to sing by reading from the song book. She sat there gazing at the sheet but could not read any of the words. She started crying, and approached me with the hope of learning to read. She was deeply saddened because she felt her inability to read meant she was unable to sing to God.
Adam: You are truly providing these women with opportunities to recreate their identities and find their places in society. They live in regions, usually isolated from the rest of the community. The stories of some of these women outline the struggles they face dealing with their fistulas. What is it about these women that you find surprising?
Angela: I am still surprised at how traumatic their stories are. Some of them were at such young ages when they lost their first child and had their first fistula. Others have lived for about fifteen years with fistulas, having been abandoned by their families and communities. It is quite a life of suffering.
Adam: The stories really are quite eye-opening. Being able to talk to some of these girls to hear their stories has been rather emotional. These women will leave the clinic and return to their homes after all their treatments and necessary surgeries are complete. What do you hope these educational opportunities you are providing to these women will allow them to do in the future?
Angela: I hope they will find physical and emotional healing and that they will be stronger to return to their communities. I try to teach them about what it means to live with a fistula and the importance of sharing this information with others. I want them to understand that pregnancies are not wise at the age of thirteen or fourteen, and that there is nothing wrong with visiting a hospital when pregnant.
I want these women to be able to make meaningful contributions to their communities again. If they are here for a year or a year-and-a-half, they can learn skills that will allow them to go back to their communities and impact the lives of others.
Adam: And where do you see this vision moving in the years to come?
Angela: I don’t think this country is going to improve until women are empowered and are able to make their own decisions. Women need to have the opportunity to learn about family planning and safe birth practices. There also needs to be accessibility in rural areas for safe pregnancies.
In the near future, I would love to have sewing machines for these women at the clinic. I have taught them hand-sewing and they have made beautiful purses, skirts and headscarves. If they have sewing machines, this could develop into an employable skill.
In the long run, I think it would be beneficial to start a school for them, so that they can be developed as individuals. By educating these women, you are also empowering them.
Adam: Thank you Angela for sharing your work and vision. The work that you do is truly magnificent and very meaningful for the women you have worked with. There is no doubt that your work with these young women will transform them into involved members of their communities. I applaud your work and thank you, on behalf of the women you have taught and shared your time with. Thank you.
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Over the past few weeks, I have shared the stories of young women dealing with obstetric fistulas. I encourage you to continue learning more about this issue. The World Health Organization estimates over two million women have untreated obstetric fistulas in sub-Saharan Africa and Asia.
Some ways that women develop fistulas - like the women in the stories I've shared with you - are completely preventable. Many organizations work closely with fistula patients and education is one of the best ways to empower these women. I encourage you to learn more about this issue and the stories of other fistula patients. It is only through educating ourselves that we can provide a voice to some of the voiceless.
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