Letters from Tanzania – International Day to End Obstetric Fistula

23 May, 2015 - Steph Gaut

Today is International Day to End Obstetric Fistula. The World Health Organisation (WHO) estimates that around 2 million girls and women live with untreated obstetric fistula- a hole in the bladder or rectum that causes uncontrollable incontinence –  throughout Aisa and sub-Saharan Africa, but fistula is entirely preventable.

Emelda Lwena is the Head of Nursing Services at CBM’s partner hospital in Tanzania, CCBRT. In this open letter to our supporters, Emelda shares her experiences of working to restore life and joy to women who often live in shame and are rejected by their communities because of fistula.

Emelda Lwena, centre, works with Tanzanian women living with fistula.

Emelda Lwena, centre, brings care and support to Tanzanian women living with fistula.

I have always wanted to help people. It was my dream as a kid. Now, as a nurse my dream has come true. By caring for women with fistula, we really make a difference. They come in totally confused and full of despair, but when they walk out they walk out happy – and that brings me happiness.

Fistula affects a lot of women here in Tanzania. The major issue is that most health facilities are too far from the women who need them. Ignorance is another barrier. Many people are not well informed about safe delivery, pregnancy complications and labour risks. Some tribes believe fistula is a curse so they hide or isolate these women from the rest of the community. They’ll send her to a witch doctor rather than take her to hospital.

In my opinion it is psychological torture to these women. The husbands run away and they become dependent on other family members for support. Some of them hide for years because the services that could help are very far away, or because they don’t know where to go or don’t have the funds for treatment or for transport to a service.
At our hospital, we break all the barriers that hinder women from getting help. If their problem is transport we provide transport. If it is costs for the hospital we help with that. The operations we do are 95% successful.

CCBRT also has mobile teams that go to remote areas educating communities. I know of a woman who was humiliated and isolated because of fistula. A CCBRT team happened to be in her community when there was a big gathering. We used the opportunity to give the group some health information. They realised the woman was not cursed – she just had a medical condition that could be healed. Seven years after getting her fistula she was taken to the hospital for treatment.

What these women go through really touches my heart. If you are giving a donation to CBM to help, I would like to shake your hand and say thank you very much.

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Nepal Earthquake – My first relief camp

4 May, 2015 - CBM International

Ashok Shah is a CBM staff member who lives and works in Kathmandu. Since the Nepal earthquake struck just over one week ago, Ashok has been working tirelessly to contact our partner projects and keep our offices around the world updated on what is happening on the ground. Here is his personal account of working in a relief camp:


It’s 7. 30am, and I’m outside CBM partner Hospital and Rehabilitation Centre for Disabled Children (HRDC) in Banepa, 22 kilometres east of capital Kathmandu. Around me is a stream of vehicles waiting to depart for the second day of the ‘Disability Relief Camp’ scheduled at a remote village called in Sindhupalchowk – the district which has one of the highest number of casualties – after a 7.8 magnitude earthquake struck Nepal on April 25, 2015. The death toll in this district alone has crossed 1300, while that of the country slowly inches toward 7000, with more than 14,000 injured.

As I board the bus, I can see boxes of plaster supplies, stacks of orthopaedic appliances, drinking water, medical equipment, relief supplies and so much more. There are about 20 members in the bus, including two orthopaedic surgeons, two physiotherapists and three nurses among other paramedical and support staff, ready of the mission. As we set off, I’m reminded of the ordeal we had to go through last Saturday when the massive earthquake hit, followed by strong aftershocks lasting for several days. I’m also reminded of how my entire family slept in a hall on the ground floor, waking up several times at night to run out to the street. Then I was at my hometown Rajbiraj, about 450 kilometres from Kathmandu. Although there was no major damage to lives and property, I’ve never experienced anything so horrifying in my life. Nevertheless, I’m glad that a week later, I’m part of an emergency relief camp that aims to provide much-needed medical care and attention to the people in the remote hilly villages of Sindhupalchowk district.

Two hours later, we are at Sipaghat, a village of about 1000-odd population, situated on the bank of Indravati river. All along, I can see mud houses reduced to rubble, with pieces of broken windows and doors strewn around. Sometimes, the areas smelled of decayed flesh. The devastation caused by the quake is much more than I could imagine. People here are in dire need of relief services.


The earthquake reduced many buildings in the district to rubble.

The earthquake reduced many buildings in the district to rubble.

Soon after, as we park the bus in the village and begin to take the tarps out, a huge crowd gathers to know if we have brought relief supplies for distribution. However, they are equally relieved to know we have come to provide free medical care for those who suffered injuries during the earthquake. While we are just setting up the venue and opening the supply boxes, three severely injured victims have already been brought to the camp.

The first client is Deepa, a young woman with a spinal injury and an arm fracture. She has been carried from a village across the river on a makeshift stretcher, waiting for medical attention since last Saturday.

“I thought I had managed to leave the house when the roof came crushing down on me. I fell on the ground, unconscious… Later, my mother came to pull me out of the debris…” recounts Deepa with a heavy voice. “I have been waiting for medical care since then….” she adds as tears run down her face.

Her house has collapsed completely and she had to stay in a tent with all her injuries for the last six days. The earthquake triggered landslides which cut off the only way to her village. It was only on Thursday, April 30th, a rescue team managed to land a helicopter in the village and provided her a spinal belt to hold the backbone in position. At the camp, the doctors decide to transfer Deepa in an ambulance to a private hospital in Kathmandu, where she will be given free treatment.

As the medical team continues to attend to clients at the venue, the HRDC bus is sent out to bring more patients from the nearby villages. There isn’t a moment the medical and support staff can have rest as more and more clients keep coming in. There are patients of all age groups, with broken arms and ribs, severe head and spinal injuries, and many with deep cuts to their heads and other body parts. With minimum surgical equipment, the doctors are also able to suture cuts and wounds – relieving the victims of the burden of travelling to the nearest hospital. There are also people suffering from diarrhea, fever, cold and other communicable diseases. All of these clients are given free medicines – and a relief pack comprising of biscuits and energy drinks, which the support staff have tirelessly packed the previous night.


Support staff worked to treat over 130 patients in one day.

Support staff worked to treat over 130 patients in one day.

By the end of the day, a total of 133 clients from 10 neighbouring villages have been treated at the relief camp, including 13 severe cases who are transported to Kathmandu in an HRDC ambulance. Also, five children with broken limbs, who were provided plaster casts, have been asked to come to HRDC for a follow-up after a week. And just like the camp, they would be treated there free of charge.

“I’m so happy that we could serve as many as 133 cases today, who would otherwise have been left in the lurch. I’m very thankful to all the support staff and volunteers who went out to bring patients from the nearby villages…” says Dr Bibek Banskota, medical director at HRDC. “I believe there are more people injured by the earthquake and are waiting for medical services… I think we need to plan more relief camps in this district.”

It’s 6 pm, and the sun is coming down slowly on the hills of Sindhupalchowk. A district that is barely 100 kilometres from Kathmandu had to bear the brunt of the violent earthquake. Nonetheless, with a caring organization like HRDC in the neighbourhood, there is definitely some hope for the affected communities. All in all, it was an immensely fulfilling day… although I’m exhausted and ready to drop, I’m happy that I could do my bit to support fellow humans in need.

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Surviving the Nepal Earthquake

30 April, 2015 - CBM International

Our latest blog comes from CBM International in the aftermath of the Nepal Earthquake. We all know how frightening and disorienting a disaster would be, but can you imagine what it would be like trying to get to safety when you couldn’t see, walk or move properly? CBM beneficiary Rajendra, a wheelchair user, recounts his trauma maneuvering debris during the disaster.

Rajendra in front of his damaged hut

Rajendra in front of his damaged hut

About Rajendra

Rajendra lives with his family in a makeshift mud hut in the space behind the decrepit stadium in Rajbiraj, the headquarters of Saptari district and Sagarmatha Zone (which includes the Mount Everest) – about 450 kilometres from Kathmandu. Rajendra is unable to walk, having never received treatment for polio. He has been staying at the present shelter for over 12 years. He works as a daily wage labourer in a local restaurant, and his wage is the only source of income to sustain a family of four members.

Can you describe the situation when the first quake hit Nepal on Saturday?

“It was just another Saturday and I was sleeping inside the house. Suddenly, the ground began to shake as if everything was about to collapse. I could hear people shouting and asking everyone to run out of their houses. In the beginning, I didn’t know what to do. I have never been so scared in my life… But just as I tried to rush for the door, I hit a container left on the floor and hurt myself. I somehow managed to crawl out of the house when I saw there was no one around… everyone had left for a safe, open place but me. I was the only one left behind… It took me twenty minutes to reach there. By then, the tremors had subsided and I was almost crying… I could feel the tremors for more than a minute… After that there were several strong aftershocks in the afternoon. Like many others, I decided to sit in the open field and not enter the house at all.

That night I slept in the stadium along with my children. Actually, I didn’t enter the house for two full days after the deadly earthquake. There was a strong aftershock on Sunday afternoon as well. I realized I am not like others who can run easily and save themselves. I thought I shouldn’t leave the open field. Even three days later, I’m scared to go inside my house. It’s only today I have gathered the courage to enter the house for a few hours. But I think I’ll sleep outside tonight as well.”

How does disability affect your access to safety?

“As I heard others shouting, I tried my best to get out of the house. But I couldn’t leave the house immediately. It took me twenty minutes to crawl and reach an open field where I felt I was safe… while others had reached there within a minute.”

In your opinion, what are the major challenges for people with disabilities during such an emergency situation?

“I think the biggest challenge is our difficulty with mobility… For a moment that day, I thought I would not survive to see the next day. The other thing is the lack of awareness about safety measures during such a disaster.”

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WASH and disability inclusion

22 March, 2015 - Kathryn James

Kathryn James is a Senior Technical Advisor in the Inclusive Development Department of CBM Australia. Her role includes supporting and providing advice to non-government organisations to make their programming inclusive of people with disabilities. In this blog, she shares why access to clean, safe water is important for all – including people with disabilities: 

I recently traveled to Western Province in Papua New Guinea to participate in a workshop for a World Vision WASH (Water, Sanitation and Hygiene) project. CBM is partnering with World Vision to support disability inclusion within the four-year project in the Western Province of PNG, the country’s largest and most remote province. With few roads, most villages are located along rivers, accessible only by boat and often many hours away by motor-boat from the capital, Daru.

 By traditional canoe, the journey can take much longer. In this type of environment water rules daily life, as the tides determine when journeys can be taken and a high tide can flood villages temporarily. My visit was during the rainy season, and heavy falls of rain punctuated each day. Yet despite the apparent abundance of water, access to clean, safe drinking water is a big issue.

 In a village two hours’ from Daru by motorboat, community members reported that they mainly sourced water for drinking and cooking from a stream about 20 minutes’ walk from the village. Unclean drinking water can lead to water-borne diseases and is a problem for all the villagers, but for people with disabilities simply accessing water at all can be difficult.

 If a physical or vision impairment means they are unable to travel to collect water, they often have to rely on family members for their water needs. Rain and floods can create a slippery, unsafe environment that is hard for people with disabilities to navigate. And women with disabilities in particular can face stigma or discrimination if they cannot fulfil this essential household task, as the job of collecting water most often falls to women.

 Despite the challenges, the villagers were keen to improve their water, sanitation and hygiene situation. They showed us ‘tippy taps’ they had built to make handwashing simple despite the lack of running water. Tippy taps are built from a plastic bottle and a rope hanging from a stand. Filled with water, the bottles can be ‘tipped’ for handwashing. Simple adaptations, such as ensuring the environment around the taps is not slippery or the installation of a handrail, can help make the taps accessible to people with mobility impairments.


An accessible 'tippy tap', part of the WASH program in Papua New Guinea.

An accessible ‘tippy tap’, part of the WASH program in Papua New Guinea.


The WASH project is working to provide sources of clean water, including via rainwater tanks, in schools and health clinics within villages in Western Province. It is also promoting handwashing and other hygiene practices, and supporting toilet construction.

 Together with the PNG Assembly of Disabled Persons, CBM is providing technical support to help staff understand the WASH needs of people with disabilities, and ensure that the project’s activities are inclusive. Disability inclusion will be considered in many aspects of the project, including the design and location of tanks, taps and other infrastructure, ensuring hygiene promotion materials are accessible to those with hearing, vision and intellectual impairments, and involving people with disabilities in water management committees. The project staff at the workshop were enthusiastic about inclusion, and keen to learn more about how they could ensure the WASH needs of people with disabilities are met.

 Following the workshop, the project’s team of community facilitators spent several weeks journeying by boat to remote PNG villages, gathering information about people’s WASH needs and priorities, as well as data on the numbers of people with disability in the communities.

This is the first step to helping all people – especially those with a disability – to access clean, safe water. 



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Disaster Risk Reduction: a disability focus

18 March, 2015 - Luke Purcell

Luke Purcell is a International Programs Officer at CBM Australia and is this week in Japan at the United Nations World Conference on Disaster Risk Reduction. In this blog, Luke shares his experiences at the conference working with CBM partner organisations and meeting a young woman with disability who now works in her community to ensure people with disabilities aren’t forgotten when disasters strike:

We are now half way through our time at the UN World Conference on Disaster Risk Reduction in Sendai, Japan. The CBM crew here includes
Valerie Scherrer (CBM Emergency Response Unit (ERU) Director), Gordon Rattray (CBM ERU Communications Coordinator), Benjamin Dard (CBM Technical Advisor for Accessibility), Elizabeth Lockwood (CBM UN Advocacy Officer) and myself. Additionally, we are privileged to be accompanied by our valuable in-country partners, networks of organisations and people that support our messages for disability inclusion and inclusive disaster risk reduction.

 One of CBM’s key partners is the Centre for Disability in Development (CDD), a National Disability Organisation from Bangladesh. It’s been wonderful having them here with us and has provided opportunities to learn together, share ideas and reflect on topics that the Centre staff can apply to their work. We also have the pleasure of being accompanied by Kazol Rekha from Gaibandha, Bangladesh, who received support from CDD a few years ago through a disaster risk reduction project. Many of you might recognise Kazol from our End the Cycle video.  

Presenting at the conference alongside CDD, Kazol briefly told her story and spoke about her work and participation in developing resilience within her own community, to better prepare and respond to extreme weather – notably floods. She described how she’s been involved in flood risk planning, raising awareness and promoting the rights of women and people with disabilities in all aspects of community life. But as she exemplified during the conference, women with disability are critically important to building resilient communities and ensuring that no one is left behind. Kazol is now a member of the local government’s disaster risk reduction committee.

Kazol Rekha and  Centre for Disability in Development Assistant Director Gopal Saha Broja present at the UN World Coference on Disaster Risk Reduction.

Kazol Rekha (centre) and CDD Assistant Director Gopal Saha Broja (L) present at the UN World Conference on Disaster Risk Reduction.


It’s incredible to see how far Kazol has come since she first received support from CDD a few years ago. She now speaks with conviction and unwavering confidence, wholeheartedly passionate about her cause.

 Reflecting on Kazol’s achievements, I realise she is testament to the increasing perception and attitudinal shift that’s been evident during the conference. People with disability have previously been thought of as vulnerable groups during emergency and disaster situations. In times of emergency and disaster people with disability are at increased risk, but through inclusive disaster risk reduction you reduce the vulnerability of all people in a community and that includes women, children and people with disability. Through inclusive approaches you reduce the risk of impact from disasters for everyone. 

The increased visibility in disability inclusion at the UN conference is especially timely given the recent devastation brought upon Vanuatu by Cyclone Pam. Many people with disability in Vanuatu found it difficult to reach safety and found themselves in life-threatening situations. Emergency relief  efforts will need to involve people with disability as key stakeholders in planning and implementation to ensure everyone in the community receives support.

 Now people recognise and actively seek the positive contribution people with disability bring to all forms of development, including disaster risk reduction. People with disability are ‘key stakeholders’ in the post 2015 disaster risk reduction framework.

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