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Small Is Not Insignificant
by Jessica Bankes Beattie

Heidi Breeze-Harris is a mother and longtime activist; Katya Matanovic a professional in the nonprofit sector. Liezl Casanova is currently a law student at Seattle University; Mahlet Zeru a senior at Global Connections High School (formerly part of Tyee) in SeaTac. These Seattle-area women share one thing in common – a desire to help women and girls in the developing world (some as young as 12) who suffer from a devastating childbirth injury that for all intents and purposes ends their lives. Their issue: obstetric fistula.

East Gojam, Ethiopia

At 34 years old and recently graduated from medical school, Dr. Hezkiel Petros is the sole surgeon and Ob-Gyn for 3.5 million people living in the East Gojam region of Ethiopia. Of the 120 beds available in his small hospital, his department’s share is 30. Each day, Dr. Petros watches two to three women die under his care due to a lack of basic medical supplies like transfusion bags, antibiotics and intravenous fluids. “I am a doctor, not a coroner,” he laments.

In early March, on a day like any other, a 15-year-old girl arrives at Dr. Petros’ hospital. After laboring at home for three days and spending her fourth day of labor traveling to the hospital, she has finally found help, but it’s too late…her baby has died. The young girl, extremely weak, is vomiting, experiencing respiratory failure and leaking urine. To add to her devastation, her husband blames her father for giving him “such a weak woman,” visits her for only a few days, and then decides never to see her again. Soon, she will learn that she has become another one of the more than 2 million women in the developing world suffering from obstetric fistula.

In the developing world, pregnancy and childbirth are scary propositions. In Africa, 1 in 16 women will die during childbirth as compared to 1 in 3,700 in North America. This young woman has narrowly escaped death.

Obstetric fistula shatters women’s lives. The outcome of prolonged, obstructed labor without access to medical attention, fistula is an internal hole caused by continuous pressure from the baby’s head. Without repair, this hole becomes a passageway to the outside world for urine, feces or both, causing women to leak waste for the rest of their lives. In 90 percent of cases, the mother has also endured the death of her baby. Stigmatized and cast off by family and friends, most fistula sufferers will spend the rest of their lives alone. First referred to as the “lepers of the desert” by Roger Thurow in The Wall Street Journal, they are unable to pray or share meals communally, board buses, and sometimes are prohibited from entering hospitals. Often they are further traumatized by remarks that they are whores (“clean” women do not typically live or move about alone) or that they suffer from some venereal disease or AIDS.

In East Gojam, Dr. Petros will have a chance to explain the injury to his 15-year-old patient and inform her that reparative treatment is possible. He hopes that she will return for treatment and schedules her appointment. In the meantime, she may have nowhere to go.

In most cases, women living with fistula are either unable to access or afford treatment, or don’t realize that treatment is available. Virtually nonexistent in the industrialized world because of our access to emergency medical care, in the developing world there are 73,000 to 100,000 new cases of fistula each year. Yet fistula is preventable and treatable, with the reparative success rate for uncomplicated cases being as high as 90 percent and treatment for one woman costing around $300.

Women living with fistula, discarded members of society who represent the poorest of the poor, epitomize the effects of gender inequality, exemplifying how little value is placed on women’s health issues.

One by One, Seattle and the Magic of Giving Circles

“Obstetric fistula is a public health issue that should not exist,” says Heidi Breeze-Harris. Her hope is to help end fistula and be “out of business by 2015.” Harris discovered fistula while watching Oprah one afternoon in January 2004. “I was shocked,” she recalls … “tired of women and children always getting the short end of the stick.” Rather than feeling disempowered, she chose action. She started by telling everyone she knew about the issue and researching it, eventually finding the United Nations Population Fund (UNFPA) Campaign to End Fistula (started in 2003) which works in 30 different countries where fistula is a problem. “I read every country report,” she says.

Armed with knowledge, she called friend and fellow activist, Katya Matanovic. After 15 months of hard work, the two launched a Seattle grassroots initiative last March called One By One. One By One’s mission: to raise funds through an adapted giving circle model to help support the UNFPA’s Campaign to End Fistula. At the heart of their initiative is the notion that small is certainly not insignificant. “The intention behind giving is every bit as important as the gift itself,” she says.

“A circle of 10 people, each donating $30 equals $300,” Harris states, “enough to pay for one woman’s treatment.” In this instance, an individual’s $30 contribution carries a weighty and poignant meaning … “small” becomes quite significant.

Recently, small businesses have also offered help. One such business, the Dahlia Spa in the Mount Baker neighborhood, contacted One By One in March with the idea for a promotional fundraiser. In July, August and September of this year, they will donate a portion of their sales from selected spa services to One By One. Owners Colleen Gray and Sarah Helm feel this provides their business a way to be a “larger part of the community … to give back.”

As of March 2006, One By One has raised $150,000 from donors in 28 states, six countries and the District of Columbia.

What began as a volunteer grassroots initiative has recently grown into a nonprofit organization. Still Harris, now One By One’s executive director, and Matanovic, president of the board, hope to continue raising money in support of the UNFPA’s campaign, but now also plan to tackle under-funded, fistula treatment and prevention programs.

Harris shares the example of a doctor in Ghana who daily faces hundreds of women awaiting repair. He needs a building, yet the UNFPA’s campaign funds are not earmarked for construction. As a nonprofit organization, it’s One By One’s hope in cases like this to try to find a builder for the hospital so that campaign funds can equip it.

“The work that larger entities like the UNFPA campaign provide is essential,” Matanovic says, “but they can’t always meet every need out there… we can help to fill in the cracks — be the mortar that holds the bigger stuff together. In order to meet the 2015 fistula elimination goal that we share with the campaign, ‘the bottom-up meeting the top-down approach’ is required.”

Like Harris, students Mahlet Zeru and Liezl Casanova learned about fistula on Oprah. Oprah’s show highlighted the work of Dr. Catherine Hamlin in Addis Ababa, Ethiopia, who alongside her late husband, founded the Addis Ababa Fistula Hospital in 1974. The hospital provides free reparative surgery to 1,200 women every year. Separately, Ms. Zeru and Ms. Casanova created fundraising campaigns to support women’s treatment at the Fistula Hospital.

Mahlet Zeru, Reconnecting to Home

Mahlet Zeru, born in Addis Ababa, Ethiopia, immigrated to the United States when she was 11 years old. She was 17 when she learned about fistula. Involved in DECA (Distributive Educational Club of America), and a marketing class in high school, Zeru decided to create a fistula fundraising project to help women in Addis Ababa and to reconnect to her home. Her project would also fulfill a requirement for her marketing class and enable her to enter a DECA-sponsored competition.

She began by writing letters to local Ethiopian business owners, hoping to raise awareness and money inside the community. She followed up her letters with personal visits, finding that most business owners were willing to help with services rather than “cash.” So, she changed her fundraising approach and created a “Fistula Fundraiser Dinner” so that businesses would be able to help with services.

Soon, good friend, Hilina Gebremekel, joined her efforts. Together, they hosted a traditional Ethiopian dinner for friends, family, teachers and Ethiopian community leaders at the Garfield Community Center. The evening generated a net donation of $1,100, providing treatment for more than two women. She has personally received letters from the two girls who were repaired because of their efforts.

Recently awarded a $20,000 scholarship to the University of Washington, Zeru attributes this success, in part, to her project and its first-place result in the DECA competition. Even more important, she says she has found her life’s direction. “My plan is to take business administration and pre-med classes at the university so that I can become a doctor,” she says. “I want to return to rural Africa and open a nonprofit health center to serve those most underserved… women and children.”

Liezl Casanova and the Bean Connection

Liezl Casanova, born in the Philippines, has always been interested in women’s and children’s health issues, particularly health issues affecting the poor. “We live in a society that is very privileged,” she says. “I thought that people would be moved to help women living with fistula because it’s incredibly tragic, but really easy to fix. It’s very powerful to realize that a small donation can literally help save a woman’s life.”

A member of Business and Engineering Activists Network or BEAN, she turned to Howard Wu, its executive director and founder. BEAN, established in 2002, brings 20- and 30-year-old professionals together under the auspices of community work. “As a professional myself, working long hours, I missed the opportunity to meet people,” Wu says. BEAN helps young professionals meet new people through a variety of community volunteer projects. They also offer ways for people to come together to network or share mutual interests such as photography or hiking. Currently, BEAN has about 1,300 members.

By the end of their first meeting, Ms. Casanova and Mr. Wu had created a fundraising plan with a modest financial goal of $1,000. Instead of going after big donors, they opted to take a more personal approach. “Our goal was to spread the word about fistula,” Liezl says. “We started telling as many people as we could.” Both were inspired by people’s heartfelt reactions and willingness to help. After a fundraising campaign that ran almost four months, their efforts generated almost $12,000. They ended their campaign with a gala event that included a live broadcast call from Dr. Catherine Hamlin in Ethiopia.

Liezl, currently a Seattle University law student, says that this experience has solidified her desire to someday start a nonprofit that will work on women’s and children’s health issues. “I don’t have a lot of money,” Casanova says, “but I am inspired by how people can band together to do amazing things and make a greater impact.”

Prevention is Key

Prevention is the key to ending fistula. According to the UNFPA campaign, “the same interventions that can prevent fistula could also save many of the half-million women who die each year from complications of pregnancy and childbirth.”

One By One’s Harris recently returned from Ethiopia where she was part of a congressional delegation researching early marriage prevention. While visiting a rural village in the Amhara region, she met a 15-year-old boy and his younger sister, who by the age of 9, was betrothed. Through community outreach education, her brother had recently learned about the perilous life-path awaiting girls who marry too young. Concerned, he went to the local women’s association which works to empower girls and prevent early marriage, and explained the situation. As a result of his visit, some women from the association visited his parents and explained the dangers of early marriage.

“The later a woman marries, the later she will have children,” Harris explained. The later she has children, the fewer children she is likely to have, thus decreasing her chances of dying in childbirth or suffering childbirth-related injuries like obstetric fistula.” Because of her brother’s actions, his 9-year-old sister is no longer betrothed; she attends school.

Early marriage prevention, continuing education for girls, family planning, the presence of skilled birth attendants during labor, access to quality emergency obstetric care -— these are all essential to preventing fistula.

Fistula, Also a Human Rights Issue

“Is this a public health issue?” Matanovic rhetorically ask. ”Yes…but, it’s also a human rights issue. Doesn’t every woman deserve the right to have a safe pregnancy and a baby that’s born healthy?” I believe this is a very basic human right.”

It’s clear that the efforts of Heidi Breeze-Harris and Katya Matanovic of One By One, and individual campaigns like the one launched by Mahlet Zeru and Liezl Casanova, are essential if fistula is to be stopped by 2015. Their contributions speak to the powerful, creative and resourceful nature of women and the importance of smaller public health initiatives. Still, more needs to be done. As Matanovic said, “we all need to be the mortar.”

Jessica Bankes Beattie is a freelance writer and owner of Seattle’s Cucina Fresca along with her husband Jay. She is passionate about issues concerning women and children and good food.

©2006 Caliope Publishing Company