Make Motherhood Safe for Tanzanian Women

by Kupona Foundation
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Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Make Motherhood Safe for Tanzanian Women
Meet Ruth. Photo Credit, Sala Lewis
Meet Ruth. Photo Credit, Sala Lewis

Together, we are making stories like Ruth’s a thing of the past

Thousands of expectant mothers in Tanzania do not have access to high quality maternal healthcare, either because they do not make it to the hospital in time, or, when they do make it, wards are overcrowded, understaffed, and under-resourced. With your generosity, collaboration with the Government of Tanzania and support from other partners, the situation is improving. However, we still have a long way to go.

Ruth, a patient at CCBRT’s Disability Hospital, shared her story with us. “I was 20-years-old when I learned that I was pregnant. I was so excited to welcome my child into the world. When the time came, I had labor pains for a day before I went to the hospital. It took me four hours to get there. When I arrived at the hospital it was too late. My baby didn't survive. I was heartbroken, and it seemed like things couldn’t get any worse. Then, I realized I was leaking urine.”

Ruth developed obstetric fistula during the prolonged delivery. A hole had formed between her vagina and bladder, leaving her with chronic incontinence. “None of my doctors explained what was happening, and I left the facility with no idea what was wrong.”

“My community turned their backs on me. A Good Samaritan let me live with her, and I started to look for treatment. I went to several hospitals, but nobody could help me.”

That was in 1985.

Almost three decades later, Ruth was introduced to one of CCBRT’s volunteer ambassadors, one of 1,600 volunteers around the country tasked with identifying and referring women with fistula for treatment. After surgery, Ruth participated in group and individual counseling sessions and received health education, family planning advice and physiotherapy. At no point did Ruth have to pay for her treatment, food or stay in the hospital. Ruth lived with fistula for longer than she lived without it, but now she says, “I am finally dry and on the path to recovery.”

For Ruth, access to high quality maternal healthcare could have spared her decades of suffering. Thanks to your generosity, we are changing the status quo for expectant mothers in Tanzania. With your help we’ve trained medical teams, purchased critical equipment and refurbished labor wards so that stories like Ruth’s become a thing of the past. Over the next year we will complete construction of our new Maternity and Newborn Hospital in Dar es Salaam, providing high quality care to women at risk of complications, those requiring emergency interventions, and sick newborns, ensuring they have the care they need to survive and thrive.

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Photo credit: Sala Lewis
Photo credit: Sala Lewis

At Kupona, we’re passionate about opportunity. In our 2015 Annual Report, available now, you’ll find stories of individual lives changed, figures that depict the scale of our collective impact, and testimonies from members of our community, encapsulating a year where we embraced opportunities to unlock potential like never before.

Your support is saving lives

In 2015, your donations and grants from institutional partners helped support the safe delivery of 78,000 babies and the distribution of over $90,000 of equipment and supplies to healthcare facilities in Dar es Salaam. Your generosity also helped facilitate training for hundreds of healthcare workers nationwide. These interventions have had a measurable impact on the quality of healthcare available to expectant mothers and their newborns. Since our sister organization, CCBRT, began building capacity in public healthcare facilities in 2010, the maternal mortality rate in the Dar es Salaam region has fallen by 30%.

“Now, thanks to my training from CCBRT, I can deliver babies using the vacuum technique and handle emergencies like eclampsia and post-partum hemorrhage. My facility is performing so well now.”

Nia, Assistant Nurse In-Charge, Buguruni Health Center, Dar es Salaam


We’re shining a light on a silent tragedy

In addition to saving lives, improvements to maternal and newborn healthcare are making a direct contribution to the eradication of impairments like obstetric fistula. In May, with support from our friends at Johnson & Johnson, we co-hosted our first Twitter chat on International Day to End Obstetric Fistula with CCBRT, UNFPA and Fistula Foundation. We made over 3.8 million impressions as we shared our vision of a world without fistula, and some of the lessons we’ve learned from CCBRT’s high impact programs in Tanzania.

On the same day, we launched the Drawing Out Obstetric Fistula exhibition at the New York University Kimmel Center, shining a spotlight on the experiences of women living with and recovering from obstetric fistula.

We’re excited to announce that the Drawing Out Obstetric Fistula exhibition, originally scheduled to close on July 4th, has been extended until December 31st, 2016. We’ve been thrilled by the response to this project, and we couldn’t let it close just yet. Thanks to our friends at Johnson & Johnson, the UNFPA-led Campaign to End Fistula, Fistula Foundation, and New York University for their continued support. You can visit this powerful collection on the 6th floor of the NYU Kimmel Center on Washington Square South in NYC.

“The exhibition is a beautiful reminder that there is dignity and value in every person’s story. Not only does the artist capture the transformative power of a successful surgery, but also the inherent stigma-busting power of a woman who is unafraid to tell her story as someone living with or having lived with a fistula.”

~Zack Langway, Kupona supporter

Lives and communities have been changed by your support. You are the driving force that makes this progress possible. Thank you for standing with us to provide high quality maternal and newborn healthcare to the people of Tanzania.


Kind Regards,

Abbey Kocan

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Abbey meets with women recovering from fistula
Abbey meets with women recovering from fistula

Bringing a silent tragedy into the spotlight

The first time I met a woman who was recovering from obstetric fistula surgery, I was faced with a reality I had been sheltered from for far too long. Four years later, while the level of awareness around this condition in the developed world has grown, there is still a lot of work to be done before this critical global health challenge is given a permanent place in the spotlight.


Imagine if, while giving birth, you or your partner faced a complication requiring emergency medical care. Imagine if that care was unavailable, and you lost your baby. You grieve for the loss of the child who was so close to living. You, or your partner, suffer silently, trying to find a way to cope with the physical trauma that leaves you incontinent, unable to work and further devastated by judgment and abuse at the hands of your friends and family.

“I lived like this for 10 years, with my mother. My neighbors told me I smelled, and forced me to stay inside. When my mother passed away, I had no one left to talk to, and nobody to look after me. I went to my father’s sister for help, but she told me I was cursed. She chased me away from her house and refused to let me live there. I was fired from two jobs, both times because of the smell.” – Hadidjia, fistula survivor

A Silent Tragedy

At Kupona Foundation we often refer to obstetric fistula as a silent tragedy, affecting members of our global community who struggle to make their voices heard even before they are faced with unimaginable trauma. It is made even more difficult to endure by the myths and misconceptions that are held up as fact in their communities. The women living with this condition are hidden from view. As a result, those with the power to change things are oblivious to their struggle.

Today, International Day to End Obstetric Fistula, Kupona Foundation, in partnership with Johnson & Johnson, UNFPA’s Campaign to End Obstetric Fistula, Fistula Foundation, New York University’s Kimmel Center for University Life and the College of Global Public Health, launch the Drawing Out Obstetric Fistula exhibition at the NYU Kimmel Center in New York City. The collection of work by artist Jac Saorsa is designed to shine a light on the experiences of women living with and recovering from obstetric fistula, to raise awareness about the condition, and to mobilize support for the programs and partnerships that work to restore women’s dignity. The women featured all received treatment from CCBRT, Kupona Foundation’s sister organization, at its Disability Hospital in Dar es Salaam, Tanzania.

Since 2009, Kupona Foundation supporters have contributed over $1.3 million to the treatment and prevention of fistula.Together, we have rebuilt the lives of 3,987 women, and with our support CCBRT has grown to become one of the largest providers of comprehensive fistula treatment in the world. Our hope is that these drawings will open your eyes not only to the reality facing the women living with obstetric fistula, but also to the opportunity facing every one of us to change the status quo.

We imagine a world free from fistula, can you?

Fistula can be treated, prevented and ultimately eradicated. All it takes is a community of individuals and institutions coming together and taking action. By attending this exhibition you will become a vital part of this community.

Thank you for your support.


The Drawing Out Obstetric Fistula exhibition is free to the public from May 23rd-July 4th, Mon-Fri 9am-8pm, Sunday 1pm-8pm (closed Saturday) at the NYU Kimmel Center, Washington Square S, New York, NY. All visitors must present photo ID at reception.Learn more about the exhibition:

On May 23rd at 11am ET, Kupona Foundation will host a Twitter chat with support from Johnson & Johnson to mark International Day to End Obstetric Fistula. Please join this important global conversation by following the hashtag #FistulaDay

by Jac Saorsa
by Jac Saorsa
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Photo credit: Mark Tuschman
Photo credit: Mark Tuschman

Dear Friends,

In 15 days, Kupona's sister organization, CCBRT, will celebrate the 15th anniversary of the opening of their Disability Hospital. 

Since 2001, the hospital has conducted hundreds of thousands of life changing surgeries, equipped medical teams to provide high quality care, and dedicated countless hours to build capacity in partner healthcare facilities. Today, CCBRT is Tanzania’s largest provider of disability and rehabilitative services, and thanks to your support, CCBRT is now changing the lives of over 1 million people every year.

The next chapter promises to be even more exciting. Together, we are moving closer to a Tanzania where access to quality healthcare is universal. Together, we are unlocking new opportunities for people like Malela.

Help us raise $150,000 by March 26th.

Over the next 15 days, Kupona will support CCBRT’s efforts to raise $150,000 in celebration of the last 15 years of life changing service. We need your help!

As a Kupona supporter you have an incredible opportunity to amplify your impact. Give through our GlobalGiving Microproject on March 16th, and our friends at GlobalGiving will match your donation with Bonus Funds. Help us continue serving people like Malela  for the next 15 years:

  • $25 provides 5 physical therapy sessions for one patient. 
  • $50 provides food for 20 patients at our Disability Hospital for one day
  • $150 provides corrective treatment for a child with clubfoot, enabling them to walk to school.
  • $710 provides corrective surgery and comprehensive rehabilitation for a woman living with obstetric fistula.

Thank you for your support along this journey.

Warm regards,

Abbey Kocan

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Photo credit: Benjamin Eagle
Photo credit: Benjamin Eagle

Dear Friends, 

In February 2012, Kupona Board member Dr. Yoni Barnhard visited Amana Hospital in Dar es Salaam, and shared his experiences in a series of GlobalGiving reports.

An American OBGYN, Dr. Barnhard found himself in an overcrowded, under-staffed, under-equipped delivery ward, and reported that, despite the desire to save their patients, the staff at Amana didn’t have the resources they needed to do so. The consequences were often tragic.

“Amana. Second largest district hospital in Dar es Salaam. 29,000 deliveries each year. Do the math. Teeming with births. Just 6 birthing beds. Not actually birthing beds. Metal tables with a hole at one end. Fresh blood dripping through. A bucket underneath. No full-time OBGYN. No full-time anesthesiologist. No air conditioning. 92 degrees outside. Hotter inside. This is where we start.”

Four years later, we’ve come a long way from where we started. Thanks to the tireless efforts of CCBRT’s Maternal and Newborn Healthcare team, in close partnership with the Government of Tanzania, Amana is unrecognizable. Kupona’s dedicated donors joined a committed network of supporters and partners including Vodafone Foundation, Global Affairs Canada (GAC – formerly DFATD), and CBM Australia. Today, thanks to your generosity, expectant mothers are entering a very different hospital.

“The challenge is not practicing good obstetrics. The challenge is practicing better obstetrics with limited resources.”

Relieving the Pressure

Dar es Salaam’s healthcare system was designed to support a city of 750,000 people; hospitals and clinics now serve a population of over 4.4 million. Severe overcrowding hampers healthcare workers’ ability to give every patient the attention and quality of care they deserve. When Dr. Barnhard visited Amana four years ago, the hospital conducted 2,000 deliveries a month. He counted three nurses helping 41 women in labor.

Capacity building and training at smaller pre-referral healthcare facilities across the region means that families now place their trust in a greater number of facilities, decongesting wards at district and regional hospitals and relieving the pressure on healthcare teams. Today, Amana Hospital conducts 1,000 deliveries a month, giving staff more time to focus on each patient and respond efficiently to emergencies. In 2012, the labor wards were so crowded women were delivering five to a bed, or on the floor. Today, more women deliver one to a bed, though there are still space constraints in some of the wards.

“When it comes to saving a life, one can do far more with a single unit of blood than an ultrasound machine.”

The Tools to Save Lives

In 2012, Anna1, a 29-year-old pregnant woman, and mother of 6, arrived at Amana displaying severe preeclampsia symptoms. Her attending healthcare worker ran from room to room borrowing the medication needed to save her life. It wasn’t enough, and she died a few hours later. Anna’s death could have been prevented. Today, eclampsia and emergency kits are readily available, stocked with the medication and supplies needed to avoid preventable tragedies. Today, her six other children would still have a mother.

The leading cause of maternal death in Tanzania is post-partum hemorrhaging, and this is unlikely to change without addressing the severe shortages of safe blood supplies. In 2012, little was being done to overcome these challenges. In 2015, CCBRT’s Capacity Building Program began working with the Regional Health Management Team in Dar es Salaam to establish four satellite blood banks, increasing the availability of clean blood in the region. In addition, there are now two full-time OBGYNs at Amana, and training is available for surgical and medical management, giving staff the knowledge to confidently and competently save lives.

Lasting Change You Empowered

Improvements2 across the board at Amana mean that staff are equipped, trained, and available to tackle emergency cases, prevent birth injuries like obstetric fistula, and identify and refer newborns with impairments like cleft lip or clubfoot. A healthy child born to a healthy mother is less likely to be caught in the cycle of poverty, and more likely to pursue education and employment later in life.

In 2012, Amana Hospital’s delivery ward was a sea of women in all stages of labor, with an overwhelmed staff fighting an uphill battle to treat and save the patients in their charge. Today, with your support, we are seeing a new reality for the women of Tanzania, and in turn, for their children. There is still room for improvement and growth, particularly in early labor wards which are still crowded. There is also an emerging need for a space where mothers can nurse their sick newborns. However, CCBRT is ready to meet these challenges, spurred on by the success you’ve supported. Four years later, the future for Tanzanian families looks much brighter.

  1. Name changed to protect patient’s identity
  2. Following a recent assessment, Amana achieved 78% of quality standards for Basic Emergency Obstetric Care, measured by Standards-Based Management and Recognition (SBMR) assessments, developed by Jhpiego, an affiliate of Johns Hopkins University” compared to Amana’s baseline score of 9% in 2010. 
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Organization Information

Kupona Foundation

Location: Washington, DC - USA
Facebook: Facebook Page
Twitter: @KuponaFdn
Project Leader:
Susana Oguntoye
Executive Director
Washington, DC - District of Columbia United States
$144,433 raised of $400,000 goal
2,048 donations
$255,567 to go
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