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one by one

While S continues her permanent job search, she accepted an opportunity to contract with One by One, a Seattle-based non-profit where she worked as a volunteer in 2008-9. Established in 2005, One by One was founded with the singular mission of contributing to the elimination of fistula worldwide. Obstetric fistula is a birth injury that most often occurs as a result of prolonged labor, where the protracted compression of the baby’s head against the soft tissue of the uterus causes a hole between the uterus and the bladder or rectum, or both. As a result, women leak urine or feces uncontrollably, which as you can imagine has devastating psycho-social ramifications. The first fistula hospital was founded in 1855 in New York City. It closed its doors at the end of the 19th century and the site is now home to the Waldorf Astoria Hotel on Park Avenue. Now virtually unheard of in most of the world, fistula is unfortunately still a reality in sub-Saharan Africa and South Asia.


One by One funds fistula treatment and prevention programs in Tanzania, Niger, Ethiopia, and, as of 2010, in Kenya. The organization has established a comprehensive model for fistula care – one that starts with outreach to increase access to basic and emergency obstetric care while also connecting women with fistulas to health care and free surgical repair.


S spent a week in Nairobi prepping for the first Regional Representatives’ training and a weekend in Eldoret assisting with the training and evaluations. She set up contracts with a translator and printing company and then procured various materials, including polo shirts, buttons, binders, poster-sized canvas teaching aides, and over a thousand photocopies of program materials.


The night before her 6:30am flight to Eldoret, the printer came to the house with all the finished materials. Only then did the realization sink in that S had to find a suitcase large enough to fit the 60 t-shirts, 40 binders, 40 poster-sized canvases, and all the photocopies. Luckily, we have bodybag-sized LLBean rolling duffels, and with some effort we were able to pack everything but the posters into one of them. There was no piece of luggage big enough for the posters, so we wrapped them in packing paper and plastic. All said and done, the materials alone weighed 154 lbs. Fortunately, the airlines here do not charge exorbitant overweight fees and S was able to check everything for roughly $30.


Thirty-one participants, 27 women and 4 men, traveled from 20 counties to Eldoret to become trained as outreach volunteers in their communities. Twenty-one were fistula survivors and several shared their stories during the training. Each morning started with prayers and songs led by the trainees. The various modules were discussion-oriented and allowed ample time for questions and comments, of which the Regional Representatives had no shortage. One such discussion was about the myths associated with obstetric fistula held by community members. These included the idea that fistulas were caused by unfaithfulness, devils, genetic inheritance, witchcraft, curses, AIDS, poverty, and not sitting properly (with legs crossed) after giving birth. The most transforming activity during the training was when trainees broke into small groups and gave a short presentation to their group members on fistula. It was here that individual personalities came out and those who had not spoken aloud once during the whole training suddenly found their voices.


The last day of the training, each of the Regional Representatives was given a cell phone to enable them to communicate with one another, community members, women living with fistulas, and the Outreach Manager in Eldoret, as well as to receive money via m-pesa [See directors’ cuts] to provide transport for women traveling to Eldoret for repair surgery. After one last celebratory lunch together, the participants boarded matatus back to their respective communities, putting an end to a long and productive four-day weekend.



3 Comments Post a comment
  1. Dad #

    A very worthy cause. When you said “fistula” I was thinking of the more common fistula prevalent in the West (anal…). Hopefully, better L+D care will avoid this, largely, unnecessary birth complication. I’d like to send a contribution to One By One. Send me a link?
    May we all be inscribed in The Book of Life for 5772, BH.

    October 7, 2011
  2. Anyone interested in donating to One by One and supporting their grantees can learn more here:

    October 7, 2011
  3. Sasha #

    Posts like this confirm for me how perfectly matched you two are.

    October 10, 2011

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