Thank you for your thoughtful and thorough feedback - we appreciate it! Your questions have spurred many lively discussions and brainstorming sessions where we've learned quite a bit. Below are some answers for you:
-Feedback from participants from the pilot program and other former fistula patients all strongly lean toward having the program away from home. When a woman is close to home, her attention can easily be diverted from learning and healing. Because of feedback from those close to the program, we think it is best to continue with the model for now and continue to evaluate as we implement a more robust program. Additionally, while in the reintegration program, women have regular conversations with our fistula coordinators surrounding what to expect upon their return to the village and planning for their startup business.
-Through another facet of our fistula programming, we engage former fistula patients to conduct educational outreaches about fistula (UVP Fistula Ambassadors). They aim to conduct three outreaches in communities and meet with their local health center staff twice per year. Also, fistula patients are not generally within close proximity to one another, so having hubs of women is a challenge; the cost of transport can be a deterrent for participation. We tried to incorporate more locations in our idea's newest iteration, so we tried to apply this suggestion in a way that could work contextually.
-Many community members in rural places feel that fistula is a death sentence. Upon return to their communities, women tend to become ambassadors (either formal through the UVP program, or informal) and talk about the treatment and how to prevent fistula. When a women returns from surgery, whether successful or not, providing her with the confidence to talk about her experience in addition to having the ability to improve her economic condition is a powerful way to educate people about fistula and show that it is not a death sentence, but something that anyone's mother, sister, or daughter can experience and rise above.
Again, many thanks for your time reviewing our idea so we can better serve this disadvantaged community. We welcome additional comments or questions.