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Thursday, November 4, 2010

Sudan: Breaking a Taboo, A Message From Within

November 4, 2010
Medecins sans Frontieres 

For the communities of Port Sudan, discussions on reproductive health were often taboo. But with community members taking a leading role in health promotion, things are changing and people are starting to talk more openly.

Miriam Osman, MSF health educator, is taking a patient's information during her first antenatal visit to Tagadom Hospital. Port Sudan, Sudan, December 2009 Photo by Asia Kambal

Under blue skies reflected on the azure, salty waves of the Red Sea, A’m (uncle) Tita, a grandfather, health promoter and one of the community leaders amongst the Beja people of Port Sudan, recalls the days when he was mocked and his words were not accepted, “I was told to respect my grey hair by people because I was speaking frankly about the medical effects of female genital cutting.”
A’m Tita is part of the  team of ten health promoters - eight women and two men - working in a reproductive health unit, supported by the international, medical humanitarian organisation, Médecins Sans Frontières (MSF) in the Sudanese city of Port Sudan. MSF is providing free services for the women and communities of Tagadom and its vicinities, where the majority of the people do not have access to reproductive healthcare.
In the last three years, MSF’s health promoters have been knocking on doors five days a week, visiting people to discuss reproductive and general health issues in Beja and Arabic languages. They speak with the community about the benefits of delivering in the hospital, family planning, breastfeeding, sexually transmitted infections (STIs) and vaccinations, as well as discussing the sensitive topic of female genital cutting (FGC).
In 2006 about 69% of females in Sudan and 80% of females in the Red Sea state had undergone some form of FGC (Sudan Household Health Survey. Ministry of Health: 2006, Khartoum, Sudan). In Tagadom and neighboring areas the numbers were even higher, with 98% of females undergoing some form of FGC (Safe Motherhood Survey – National report 1999, Central Bureau of Statistics, Khartoum, Sudan).
The women of Tagadom and nearby areas endure the most harmful form of FGC: type 3 orpharaonic. This involves the removal of the outer female genitals, and infibulation or the stitching of the remaining outer vaginal labia, leaving but a small hole for urine and menstrual flow to pass through. The painful procedure of FGC and infibulation is often performed on babies as young as seven-days-old, and affects a female from childhood, into puberty and adulthood, with serious consequences for motherhood.
MSF health promoters explain that female children and adults who have undergone this procedure may face fatal bleeding, and infections such as tetanus. They are likely to develop cysts, experience painful menstruations and recurrent urinary tract infections. Many women will also suffer acute pain during sexual intercourse. If they give birth, their labours are likely to be prolonged, increasing the medical risks for the newborn.
“We find abscesses and cysts even in female children. For future new-born baby girls we explain to the mothers all the possible complications of genital cutting,” said Medilyn Guevarra, MSF Gynecologist.
De-infibulation, the de-stitching of the vaginal outer lips, is performed when preparing an infibulated woman for delivery. MSF’s gynecologist does not re-infibulate, or stitch back, the mother after delivery because of the grave medical consequences.
The trauma of living with FGC is great: “My organ is not complete because my family circumcised me, but now I am better because I am not closed (infibulated),” said Muzna, one of the thousands of women that chose to deliver in MSF’s reproductive health unit.
As FGC is a deeply ingrained cultural practice, MSF health promoters, who are from the very communities they reach out to, play a unique role in transmitting medical messages on this subject. At first the female health promoters were thought of as beggars, and the team was considered indecent for speaking openly about reproductive health issues. But in the face of strong criticism they were resilient and persisted in relaying their important health messages. In time, the health promoters gained the interest of the first few people and began to form discussion groups to talk about various health issues.
“Whenever a woman comes to us and gives us her trust, we make sure we give her complete information, so she can make an informed choice about her health,” says MSF counsellor Awadia Siddig.
Now the community is talking about the benefits of delivering in the hospital, the medical consequences of genital cutting, sexually transmitted infections (STIs), and family planning with the health promoters and the counselling team. Three years ago this was unthinkable.
The health promotion team also collaborates with community members, including local imams, community leaders and singers, to convey health-related messages or raise awareness about STIs and the harmful medical effects of FGC.
Most of the residents of Tagadom and the neighboring areas are from the Beja community. Before MSF opened its reproductive health unit - the only one in the area - the majority of the women delivered in their homes with the assistance of a traditional birth attendant. Now more and more women are coming to deliver in the hospital.
In collaboration with the Ministry of Health, MSF provides a range of free services in the reproductive health unit, including antenatal and postnatal care, delivery services, family planning, sexually transmitted infection (STI) treatment/counselling and other counselling services. Earlier this year MSF built and furnished an operating theatre to assist women with complicated deliveries and cesarean section surgeries. Since January 2010, Tagadom Hospital’s medical teams have conducted 54 cesarean sections and helped deliver around 1500 babies.
In September 2010, the Sudanese National Committee on Traditional Practices organised training sessions for the health promotion team to increase their skills. At the end of the year, MSF will hand over the reproductive health unit to the Ministry of Health, which will continue assisting the women of Tagadom and its surroundings.

MSF has been working in Sudan since 1979, and currently has projects in Warrap, Jonglei, Upper Nile, Unity, Western and Northern Bahr El-Ghazal, Western Equatoria and Central Equatoria, the transitional area of Abyei, North and South Darfur, Red Sea and Al-Gedaref states.
Médecins Sans Frontières (MSF) is an independent medical humanitarian non-governmental organisation, and works in more than 70 countries. MSF teams assist people in distress irrespective of their religion, race or political beliefs.