Abandoned by her father at birth, Agnes, from south west Tanzania, lived for 15 years on the fringes of her community simply because of the way she looked.
Born with a cleft lip, her father could not bear to bring up a child who did not look ‘normal’ so he left. Agnes’s mother tried to get treatment for her daughter but nobody could tell her where to go so she gave up.
Then in 2009, at the age of fourteen, Agnes went to find work in Dar es Salaam. It was there that someone gave her the address to a disability hospital that might be able to help her. Shortly after, Agnes was able to have surgery to correct her cleft lip.
The transformation is dramatic.
“I am very happy with the way I look now. I don’t think I will be afraid anymore and I can look forward to a future when I am not laughed at. My dream is to go to school and get an education like my brothers and sisters and maybe one day start a business selling things at the market. I would have been too frightened to think of that before.”
But Agnes's immediate wish post-surgery was to go back home and show her new face to her mother. “She would hardly be able to recognise me; I think she would be happy and proud of me now.”
Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) is a Tanzanian health care organisation - the largest provider of disability and rehabilitation services in the country.
People travel from across Tanzania to undergo life-changing operations including surgeries and rehabilitation for cleft lip, clubfoot, visual impairments and obstetric fistula, and receive prosthetics. Every year about 120,000 adults and children with disabilities - and their caregivers - realise a better quality of life through CCBRT’s services.
With a waiting room that teems with life and colour (women in kangas, men in kikois), what really impresses people most about CCBRT is how kind and helpful the staff are despite the huge numbers of patients at the hospital and the long waits.
Through advocacy, training, and clinical services, CCBRT empowers people with disabilities and their families, improving their quality of life by ensuring access to medical and rehabilitative treatment.
Recognising the critical relationship between quality accessible healthcare at birth and disability prevention, CCBRT also provides maternal and newborn healthcare services.
Changing Lives, Changing Communities
CCBRT relies on the support of many partners and has been supported via the Small Grants Programme (SGP) through multiple rounds of grants. Since 1992, the SGP, funded by the Global Environment Facility (GEF) and implemented by UNDP, has been supporting projects around the world that conserve the global environment while enhancing people's well-being and livelihoods.
CCBRT was awarded an SGP grant in 2009 - around the same time that Agnes was linked with their life-changing services - and again in 2011 to provide Environmentally Sustainable and Efficient Solutions to Power and Water Challenges at CCBRT Hospital.
In the absence of a reliable national grid, CCBRT needed to secure its own reliable and sustainable source of electricity, water supply, and hot water infrastructure at its disability hospital.
With SGP support for the implementation of solar technologies, results included an increase in uptime for critical hospital functions, and minimisation of damage to vital equipment and water pumps which had previously been impeded by irregular power and heating.
Beyond simple utility supply increases, the SGP initiative improved operating theatre services, lighting in wards – now immune to frequent municipal power outages – and water heating for laundry and bathrooms with a constant supply of high quality water using a stored rainwater backstop and solar water pumping apparatus.
These results were not limited to hospital facilities. The initiative also provided alternative lighting solutions to local families through the distribution of solar lamps to disadvantaged children treated at CCBRT, which had the further benefit of helping vulnerable children avoid prolonged exposure to indoor air pollution caused by sooty kerosene lamps.
At the organisational level, CCBRT’s services are now more reliable, more sustainable, more environmentally friendly, and more responsive to patient needs. At the individual level, these improvements to CCBRT services can mean the difference between disfigurement and disability and lifelong productivity.
In 2009, Anna*, a 34-year old mother, experienced firsthand the transformative effect that timely, effective, accessible medical care can have on an entire family.
Anna’s first pregnancy, at age 21, was calamitous. Living in a rural area, she had contractions for two days at home without successfully delivering, and was forced to walk for two hours to the nearest dispensary.
‘I was crying with pain at this time,’ says Anna. ‘There was nothing to take away the pain and I became very afraid.’
At the dispensary, they said they couldn’t help her – by now she had eclampsia – but they allowed her to travel in their supply vehicle to the district hospital. By the time she reached the district hospital, Anna was unconscious and the baby was delivered by vacuum extraction, stillborn.
Her travails didn’t end there.
Her prolonged labour had resulted in obstetric fistula, a disabling condition resulting from the loss of tissue between the birth canal and bladder, and/or rectum, causing a hole to form. It was beyond the abilities of the district hospital to treat.
Anna was told to go to a government hospital in the capital, but with no money for treatment – or even for transport – Anna went home with a heavy burden to bear.
‘My mother looked after me at home but my other relatives and friends stopped coming to see me. They said there was a bad smell and they were ashamed to be associated with me. I couldn’t even help the family in fields. We are farmers so we depend on the food we grow. For many months I stayed like this. Just inside the house. It was a horrible time.’
Obstetric fistula is a childbirth injury caused by prolonged, obstructed labour.
As many as 3,000 Tanzanian women develop obstetric fistula each year, a condition that leaves them incontinent, leaking urine and/or faeces uncontrollably. As a result, they are often ostracised from their families and communities.
CCBRT’s mobile outreach unit was alerted to Anna’s circumstances when they visited the area, and arranged for her transportation and treatment at their disability hospital.
After her three week treatment to repair the fistula, she was able to return to her village and resume her life of happiness and productivity. More happily, she became pregnant three years later and gave birth to a healthy child.
Today, Anna reflects on the turning point that her CCBRT treatment represents:
‘I don’t want to go back to those days after my first child was born. Now I have a healthy daughter and everything is good. I am so grateful for the kindness I found here at CCBRT’.
Small Grants = Big Impacts
In total, since 1996 when SGP support in Tanzania began, there have been 367 projects undertaken across the country.
By providing financial and technical support to projects that conserve the global environment while enhancing people's well-being and livelihoods, SGP demonstrates that community actions can maintain the fine balance between human needs and environmental imperatives.
For more information on SGP-supported projects in Tanzania, visit the SGP Tanzania Country Page.
For more information on CCBRT, please visit Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) and click here to offer directsupport.
Visit the SGP website for details on the overall Small Grants Programme.
Original story posted by UNDP.
Story by Andrea Egan, CCBRT and UNDP GEF-SGP team / Photos: © Dieter Telemans and CCBRT