Drawing on experience

Now home and working in the studio on large-scale drawings that will be exhibited in May 2015 at the Royal College of Obstetrics and Gynaecology in London. In August we have another show – this time of smaller works including drypoint prints at a venue in Cardiff. The power of the experiences I had in Tanzania has made itself very obvious while I have been working in the studio… my emotional need to bring the images out of my head and my heart and onto the paper has rarely been so strong. I will write more on this later but here I want to put up a small selection of images that were not created by me, but by the women themselves at CCBRT. As I mentioned in a previous post about the drawing class we put on I was moved and impressed by the creativity and imagination clearly demonstrated in the women’s drawings. The works speak volumes about what they know and, in some cases, what they desire. Once again the communicative authority of visual language is foregrounded, even beyond the clear need for some of the women to use the written word.DSCN0246DSCN0236 DSCN0227 DSCN0234 DSCN0228


at least five…

DSCN0271At least five operations today.

Fatuma, always smiling, laughing, interested in everything,

is today very quiet.

On the ward

On the ward

On the ward

She looks tiny. Very young

as she lay covered in the rough cotton sheet

one thin arm visible

a chin

the sole of a foot

motionless, sleeping

under the window

through which the soft, warm breeze is blowing.

A woman comes

brings her food and wakes her.

She is tiny. But not young.

Drenched in urine

the pale blue gown is soaked through.

The woman who has come helps her up

and she follows

slowly, obediently

out of the ward.

As she passes she glances at me

an old face, careworn

full of emotional pain

all defiance gone

all defences down.

She glances at me but only for a second

before she lowers her eyes.

Urine runs down her legs.

She looks tiny.


Wednesday December 12th

Mabinti in Swahili means ‘girls’. It is a fitting name for a place that gives girls and women who have lived through the trauma of having a fistula a chance of a new life. Mabinti is a centre where each year ten girls recovering from fistula surgery at CCBRT (Comprehensive Community Based Rehabilitation in Tanzania) are given the opportunity to study sewing, beading, crochet, screen-printing and, very importantly, business skills. The course lasts for twelve months and the aim is that the skills learned will equip the women to start up their own small businesses making and selling quality textiles to tourists. The success rate is high, indeed, since Mabinti opened in 2007, many graduates have built thriving small businesses and after, for some, many years of misery and shame, now live happily and independently .

As Katia, the founder and director of the centre, gives Alison and I a guided tour I warm to the place immediately. The facilities are basic but well designed and laid out. There is no hostel here, the women are found accommodation in local family homes around the centre and have to attend regularly each day, and on time. This may seem a reasonable expectation but as Katia tells us often the women come from a way of life in the villages where there is no real concept of keeping to a schedule and the discipline of doing so is something they have to learn.

This from the Mabinti brochure:

The Mabinti women are from very poor families and have rarely had access to education. At Mabinti they learn a range of important skills such as entrepreneurship and English as well as life skills including: decision making, communication, family planning and HIV?AIDS prevention.

At Mabinti the women are taught how to dye the cloth and screen print their own original designs to create textiles that they then use to sew into bags, make-up cases, pencil cases, cushion covers, table runners and various other things that have become very popular with tourists over the years. Katia, a former primary school teacher, is clearly a very astute business woman and has researched the market intensively. She also has high expectations of the quality of the goods that bear the Mabinti logo and is fastidious in ensuring that everything from the least expensive key fob to the most expensive bag comes up to the required standard. This being said Katia also comes across as one of the most enthusiastic people I have met for a long time. Her obvious passion for what she does and her complete satisfaction in her job shines through her easy smile and friendly engaging manner. She makes us feel very welcome and is obviously, and quite rightly, proud of her centre.

In the classroom students sit at sewing machines, however the lesson is not sewing this morning, it is business skills. The teacher expounds in Swahili and the women seem attentive and happy. It is great to see these women looking so healthy and cheerful. They demonstrate their individuality in the vibrantly colourful kangas they are wearing, a far cry from the blue hospital gowns they must have worn, as all the patients do, on the fistula ward. Further on through the low building other students are making cushion covers. Katia inspects the quality of the sewing as she passes, smiling and with a few words of encouragement for the women. Outside two students are working with a teacher learning how to screen print onto square cloth which most likely will later be sewn into more cushion covers. One student is more experienced that the other and waits patiently for her turn to pull the white ink through the screen with the rubber squeegee. I recognise her as the woman who came to CCBRT to teach the patients crochet and Katia told us that she is in fact a graduate of the program who has stayed on to now work at Mabinta helping others. The design is a simple flower petal in white on a silver grey background and the delight on the first woman’s face when she sees the result on her labour is a joy to see.

screen printing at Mabinti

screen printing at Mabinti

Mabinti seems to be a great set up and offers a fantastic opportunity for a small number of women, some of whom may have nowhere to go and once they have been treated for their fistula. Often families and husbands have abandoned their women because of the condition and, as outcasts from society, they have no home or way of life to return to after their time at CCBRT. After graduating from the program each woman is given a start-up kit which includes a sewing machine, scissors a supply of material and a calculator. All the graduates maintain links with the centre visiting once a month for a coaching session and home visits are organised to gather information about how their business is progressing.

Of course not all of the women can benefit from the opportunity that Mabinti offers, but it has been proven without doubt that for many of those who do gain a place on the program the rewards are great.


DSCN0146  DSCN0144 DSCN0152 DSCN0148 DSCN0149 DSCN0145These are portraits of some of the women I am working with…it took me a while to get away from my preconceptions and innate skill base which naturally favours caucasian features. These are sketches – I am still travelling very much along an extended learning curve!

The drawing class and a visit

Friday December 5th

The drawing class at CCBRT

The drawing class at CCBRT

Today is drawing class day. Subila is going to help me and translate, so to tie in with her schedule we need to fit it in between the ward round and a visit from a class of girls from a local secondary school. I begin by introducing the materials I have brought with me, all of which seem new and strange to the women who crowd around me, full of curiosity. I show them graphite sticks, charcoal, chalk pastels and drawing pens. I draw marks on the paper showing them how they can use the materials and I demonstrate how to construct simple faces, and animals. My creative ingenuity is tested when it comes to drawing an elephant, but even so the women seem to think I am performing magic! They grab the sheets of paper eagerly and begin to draw. Most of the women are taking part – a few of them politely refuse with a slow shake of the head, and I can only respect their wishes. I am pleasantly surprised, and not a little impressed by the enthusiasm and the way nearly all of them take to drawing, most of all the way in which they are trying to communicate through their symbolism. This must give credence to the idea that visual language is a very powerful and universal medium. It is very noticeable that all of the women choose to draw ‘something’, and usually something they know such as a fish or a bird or an object they might use for cooking or washing. All things then from their imagination, and from their lives outwith the fistula ward. They love the colours, as I thought they would, and their drawings are lively, spontaneous and dynamic.

Drawing with an audience

Drawing with an audience

I notice one of the women studiously copying onto her own sheet everything that I drew earlier on mine, just to show them the materials. This seems an opportunity too good to miss so I draw some more things, asking her what she wants, and she copies, beautifully, everything I do. The drawings become more and more complicated – it is a game and she is happy and laughing. I end up drawing a colourful parrot in a banana tree and soon there are two colourful parrots and two banana trees! The class comes to a close as the schoolgirls arrive. The women bring me their work, we plan to have an ‘exhibition’ next week.

One of the women's drawings in progress

One of the women’s drawings in progress

There are forty girls in all. They arrive and sheepishly line up against the wall of the seating area (banda). Subila disappears for a while, rallying the troops I believe and getting some literature together, so the situation becomes a bit difficult, even embarrassing. All the girls speak good English and Alison is telling them a little about obstetric fistula but all of the women, the living breathing examples of fistula patients, are left wondering what is happening and feeling perhaps, as I do, very uncomfortable. Eventually I suggest that the girls might like to tell the patients who they are and where they come from and this seems to break the ice a little, but it is not until Subila comes back, along with Caspar, the head of the Fistula program, that the tension begins to lessen. Caspar brings all the schoolgirls into the seating area and extra chairs are quickly found. It is a tight squeeze but everyone’s attention suddenly turns to Rainfrida, one of the women whose portrait I have drawn this week, as she stands up and starts to speak. Rainfrida is a woman of sixty years. She has been faecally incontinent from a rectal tear for thirty years and has suffered greatly. She is a however a strong woman and she speaks with conviction and a passion impossible to ignore. Within just a few seconds she dispels any idea that all these women, though some may be illiterate and all are downtrodden by circumstance, are certainly not passive victims. I cannot understand what this powerful spokeswoman is saying – Caspar says that she is talking about her own experiences – but whatever it is Rainfrida is certainly having an impact on the girls, they are listening intently.

The difference between these girls and the women patients seems vast. On the surface, the fine, fashionable clothes worn by all the girls, their jewellery and their Westernised, idealised appearance, enhanced in some by wigs of long straight hair, are sure signs of their wealthy and privileged lifestyle. Seen together with the patients, all alike and almost regimented in their blue hospital gowns, the disparity is profound. But the difference is not only in the outward appearance, it is in the eyes of the patients, often lowered, in the attitude towards their surroundings, and in their general way of being which, here in the hospital, seems to be one of submission. I feel their sense of abjection very keenly but equally I am very sure that many of them have simply retreated into themselves in order to maintain a reserve of strength. Their separate individualities maybe temporarily submerged within a sea of blue gowns but it resonates in each woman’s determination to recover – even at high emotional cost. They know that they now have a chance of living a normal life, that is the goal, and for the opportunity to achieve that after the horrors that many of them have already been through, a few weeks of being just another patient carrying a washing up bowl for your catheter bag must be at the very least a tolerable proposition.

After Rainfrida has finished there is a slight pause while everybody takes in what she has said, somebody starts to clap, hesitantly, and others, equally hesitantly, join in. Rainfrida looks satisfied. Caspar quickly lifts the mood with his enormous smile and excited manner, and then lowers it again by launching into a very long winded lesson on the causation and nature of fistula. He gets into his stride immediately, and doesn’t forget to remind us all that he spent seven years as a secondary school teacher. Soon he has the whole of the schoolgirl contingent rapt and following every word. The patients in the meantime are showing mixed emotions. Some just look bored, some confused and some are visibly upset, none look as if they feel part of what is going on and indeed Caspar is addressing most of his lecture to the schoolgirls. I am feeling very awkward and actually quite angry at the lack of tact and respect being shown here towards the patients. They know about fistula, they have a fistula! There seems no real need for this kind of ‘lesson’ to happen here in this situation. It is good of course that the girls should learn the things Caspar is telling them but surely it could have gone on before they came to visit the patients. There seems no advantage at all in going over it all, especially at this level of detail, in front of the women, but Caspar is on a roll and there is no stopping him.

Caspar finally finishes but now, and to make matters worse, Subila begins a second lecture! Admittedly Subila has more consideration for the patients position but still they are largely left out of the proceedings and as they are becoming increasingly dejected by it all I am becoming increasingly uncomfortable for them. I feel very protective towards them – perhaps wrongly so – but there is nothing I can do.

Its over, and now everything changes for the better. As it is Friday it is time for the regular discharge ceremony for patients who are leaving having recovered from their operation. This is a joyful occasion of course and the women now come into their own. Their singing is beautiful, with truly African roots and harmony. It moves me very deeply and I want very much to cry. I am surprised at how profoundly it affects me and Subila sees it in me. I say that I love the singing and this is the only encouragement she needs to ask the women to continue. They need no second request and the singing and clapping and drumming begins in earnest as the four leavers are presented with CCBRT kangas (a large colourful shawl) as a leaving present. The schoolgirls then present all of the patients with their own kangas that they have brought as gifts and the singing continues. Some are dancing now and Alison and I join in…the words are simple to pick up, even though I do not understand them. Subila tells me the song is a celebration of womanhood. Alison and I receive kangas too and I feel full of a kind of joy that I have not felt for a long time…if ever, if I am really honest.

Operating across the cultural divide

Thursday December 4th

Women in the outside seating area outside the Fistula Ward at CCBRT

Women in the outside seating area outside the Fistula Ward at CCBRT

The theatre clothes are the same but the environment is very different. I feel strange as I enter the operating theatre at CCBRT, a room not unlike those I have been in in the UK but equipped quite differently.

The most obvious difference was the type of operating table. It was shorter than usual and could come apart in the middle so that the patient lay supported only up to the hips with her legs in stirrups. This was a fistula operation.

The first patient is already on the table having had an epidural to numb everything below her waist. She is to be fully conscious throughout the procedure. Her notes show that she has a very small fistula which it is hoped will be easily repaired. She is a young girl barely into her twenties and she has had four deliveries already, all still born. The operation begins after the anaesthetist repositions the table so that the patients head is now lower than her hips. The surgeon inserts a speculum into her vagina and locates the fistula. I am invited to come close and see for myself, and the surgeon explains the procedure to me every step of the way as he gently and carefully cuts around the fistula and brings the tissues over it to cover the opening. The patient remains silent and very still even in spite of the anxiety and fear she may well be feeling. She coughs obediently when asked some way through the procedure.

All is going very well. There are two surgeons now and the nurses attending. Everybody seems to be very pleased as the fistula is repaired and the last is stitch cut off but then, a problem appears, urine is still leaking into the vagina. The two surgeons work quickly and accurately together to find where the second fistula must be. It is deep and there is nothing they can do vaginally. The patient will need a second, abdominal operation.

The second patient walks into the theatre. She looks afraid, confused by the strange surroundings. She is helped onto the operating table and asked to sit up, she is to have an epidural, and injection into the spine. She sits obediently, her face now expressionless. When the needle enters her spine I watch for a reaction, but she doesn’t flinch, her expression doesn’t change at all. She is lain down on her back and her feet are put up into the stirrups. The surgeon goes to talk to her, just a greeting I think and some reassurance. She murmurs a response but does not meet his gaze and on returning to me he lets me know that “they are unused to people talking to them. They don’t know how to react.” I feel that this might be a little harsh considering the situation that the girl is in, semi-naked and strapped to a bed that is so angled that she is virtually upside down. Holding a conversation with anyone, let alone a white man in authority, is clearly the last thing on her mind.

The operation begins and it becomes clear that it is going to be problematic. Once the surgeon inserts the speculum and opens up the vagina to view the extensive scarring in the tissue becomes obvious. This ensures that the fistula, although easily located is difficult to close because of the lack of elasticity in the surrounding tissue. The surgeon works quietly and confidently. Through his years of experience he has developed the impressive precision and delicacy of touch that is obviously necessary in such an operation. There is lots of bleeding and the second surgeon continuously mops it up using the swabs that I saw the women folding just the other day on the ward. They fold hundreds of these light textile squares which are then sterilised for use in the theatre.

The operation continues for a long time but there is never a sound or movement from the patient. Only at the end, when the table is once more flat and the straps are taken off her legs does she ask for water. The surgeon looks tired, it was a difficult operation but he is not unhappy with his work.

There are two more women waiting outside.