In the midst of Hurricane Sandy activity last week, it was nice to see the Global Fistula Map—published by Direct Relief, the Fistula Foundation, and the United Nations Population Fund (UNFPA)—cited in the U.N. Secretary-General Report, “Supporting Efforts to End Obstetric Fistula,” presented by UNFPA Deputy Executive Director, Anne-Birgitte Albrectsen, at the United Nations.
As the report notes, obstetric fistula is often a severely debilitating and tragically ostracizing condition for each woman with the condition, and a deeply compelling humanitarian objective exists to provide necessary care that enables women with fistula to regain their lives. The condition results from broader causes including poverty and severely limited access to either information or appropriate care during pregnancy and delivery.
The fistula map is really not about mapping, but rather about knowing and understanding the many dimensions related to obstetric fistula so we can mobilize the right charitable resources and direct them to the right people in the right places in a thoughtful, focused way that addresses a problem appropriately. The map and the information that lies beneath it is a good example how modern geographic information system (GIS) tools and mapping technology can be useful in humanitarian health work.
Among other things, these tools enable us (and anyone else) to see at the same time both the “big picture” public-health context of a situation and very specific localized information needed to take action. For fistula, the big picture includes the global incidence of the condition, the root causes, general awareness of the condition and its causes, the availability of access to a skilled birth attendant, and moving the large gears and prioritizing big funding pools of government and international organizations.
Understanding this big picture is every bit as essential for Direct Relief and the terrific colleague organizations we work with, such as One by One and The Fistula Foundation, even though our respective day-to-day efforts tend to be focused more narrowly. These organizations do excellent advocacy and educational work, yet, they (like Direct Relief) focus primarily on providing direct support and resources to expand and improve access to both surgical care and the supporting services for women living with fistula. It’s important to see how individual efforts fit into and affect the larger issue.
But so too is the specific information about the actual places, facilities, patients, conditions, and experts that are doing the frontline work actually providing the care for women. They need resources and support to do more of their essential work. Dr. Hillary Mabeya—who with his wife founded and run Gynocare, a fistula hospital and support program in Kenya—for example, is exactly the type of person and program of which more are needed to help women with fistula that Direct Relief supports. In the conversation about the big, global issue of obstetric fistula, Dr. Mabeya needs to be “on the map” since it is he and his many colleagues, often working in relative isolation from each other, that are doing the actual work caring for women.
Driving with a map is better than driving without one. The general approach that led to the global fistula map also enables a much more focused and pragmatic use of charitable resources to “intensify resources to bridge the large gap” in treatment that exists, as the UN report states. In gathering information from all the various individual sites, for example, we learned that among the trained fistula surgeons who are providing this specific, life-restoring surgery, a very particular type and size of suture is preferred. It is an expensive item, obviously far beyond the means of a destitute fistula patient and most often beyond those of the facilities and surgeons who are caring for the patients. In seeking either general charitable support for fistula or this and other particular items without which restorative surgery is impossible, it is essential to explain why it is needed, where it will be used, who will use it, and how many are needed.
That’s why it was good to see the Global Fistula Map highlighted in the UN report. For similar reasons, but with respect to different issues, Direct Relief continues to push ahead and publish various maps, which also really aren’t just about mapping either. These maps, like any map, help us know where we are and where we’re going.