These women and girls, forsaken so often by their loved ones, their societies and the global philanthropic community at large, are the people whom Maggie Bangser '81 has dedicated herself to aiding for the past 10 years. Bangser is the founder and director of Women's Dignity Project (WDP), a non-governmental organization based in Dar es Salaam, Tanzania. WDP tackles the problem of fistula on political and economic levels, seeks to enhance the dignity and rights of those living with the condition and promotes gender and health equity.
Bangser has also published material that is quoted extensively on the subject of fistula. Presently she resides in Dar es Salaam with her husband, an activist from Tanzania, and their two children, a six-year-old son and a four-year-old girl they adopted from India.
Education Here and There
Bangser originally hailed from the suburban village of Larchmont, N.Y., about 20 miles outside of Manhattan. When Bangser enrolled at Amherst, it was merely the College's second year of coeducation, and she recalls often feeling alienated.
"It was a pretty tumultuous time particularly around the fraternities and women's roles at Amherst," Bangser explained. "It was a very bizarre time at Amherst, I found. I think there were a lot of women there who flourished, but I found it a very challenging environment to be a woman and to be a feminist."
Nonetheless Bangser persevered and earned her bachelor's degree in political science. And it was during her junior year at Amherst that Bangser first became acquainted with the African landscape.
"I took a semester of my junior year and lived and studied in Kenya and that's kind of where it all began for me," Bangser said. Referring to her subsequent decision to work and ultimately settle down halfway around the world, she added with a laugh, "My parents used to say had they known then the choices I would have made, they would have burned my passport."
After graduation, Bangser spent four years working on domestic public policy and advocacy issues such as special education in New York City public schools and handgun control. She then proceeded to the Yale School of Organization and Management, where she received her masters degree in public and private management.
Small World
During the course of her graduate studies, Bangser spent time in South Africa doing work with none other than College President Tony Marx.
"Tony's an old friend of mine," said Bangser. "It was really exciting for me when he was appointed president of Amherst because it made me proud of Amherst in a way that I had never been proud before-that they had appointed not only a scholar but a political activist on the issue of political rights in South Africa."
Long before Marx's arrival, Bangser resumed ties with her alma mater, and received an appointment to the Amherst board of trustees. As a trustee, Bangser said, "I was very involved in the work that the College was doing to be both a place that was more welcoming to women and a place that was more politically responsive to what was happening in Africa." It was during her years on the Board that the College abolished fraternities and divested its investments from South Africa in opposition to the apartheid regime.
Following graduate school, Bangser sought to take on global development issues, and worked for a number of years in international reproductive rights and reproductive health. After five years in the field, Bangser moved to Kenya in 1992 to work for the Ford Foundation, an independent non-profit grant-making organization. There she created the foundation's reproductive health and gender program for eastern and southern Africa. By this time, Bangser had heard about the issue of fistula but failed to find others who were interested in taking active measures to address the problem.
"It's not that there weren't people working on it-there were some and always have been extraordinary Africans deeply committed to this issue who were working on it, but I didn't meet them," she said.
Until its recent ascension to the realm of "sexy" issues in public health, fistula was a low-status issue, Bangser explained.
"It wasn't until I left the Ford Foundation three years later and I got out of that kind of elitist environment that I started finding people who were actually working on fistula," she said, "because basically you're talking about extremely poor women who are leaking urine and feces-nobody wants to pay attention to them. They can't pay for the care."
Tanzania
In 1995 Bangser picked up and moved to Tanzania, a country she described as "blessedly peaceful and calm."
When she initially founded WDP approximately 10 years ago, the focus of the initiative was primarily on service delivery: training doctors and nurses to perform surgical repair of fistula, transporting victims from very remote areas of the country to the hospitals where such procedures were available, conducting public education campaigns on fistula, trying to secure international attention of the issue and assisting colleagues in other countries to combat fistula.
The program has since flourished and expanded its charge to include measures that scrutinize government expenditures and hold the national and local administrations accountable when either fails to deliver on its policies. WDP has become increasingly involved with budget analysis because, as Bangser explained, "At the end of the day, if you're going to try and prevent this kind of condition or maybe someday eliminate it altogether, you have to make sure that governments are allocating the financial resources and the human resources to improve women's basic health and certainly emergency obstetric care."
Bangser noted, for example, that the Tanzanian government mandated a policy of free services for pregnant women. The policy also stipulated that women are not required to bring what is called a delivery kit (typically comprised of gauze, sutures, razor blades, rubber mats, etc.) with them to the health facility; all of those items should be provided for free. However, Bangser said, the medical personnel complained of inadequate quantities of supplies, delayed receipt of the supplies or simply no provisions at all. Moreover, the obstetric patients reported being ridiculed by health workers if they didn't come prepared with their own delivery kits. Sure enough, when WDP examined the national budget, they discovered that there was no line item for these supplies.
One major milestone for WDP-that Bangser "never dreamed would happen"-was that two major U.N. institutions, the United Nations Population Fund (UNFPA) and the World Health Organization (WHO), have adopted major initiatives on fistula. According to Bangser, the British government and a number of other donor countries, particularly in Europe, have also endorsed fistula initiatives and helped to break the silence on the issue. The U.S. government has also recently joined the group of major donors to address fistula.
"I'm not saying that Women's Dignity was solely responsible for launching this campaign," said Bangser, "but we've been a partner of theirs (UNFPA) and certainly we're one of the instigators of UNFPA getting behind this issue as well as international health organizations like EngenderHealth based in New York, and getting some of the major donors to commit themselves to fistula like USAID, which has come on to fistula in a very strong way, as well as some members of Congress who have backed funding allocations for it."
In addition to propelling fistula onto the international health agenda, WDP has succeeded in framing the problem of fistula as a human rights issue. Rather than approaching fistula as any other medical condition, WDP recognizes fistula for its complex socioeconomic elements.
"This is a problem that happens to poor and marginalized girls and women living in developing countries who don't have access to basic or emergency health care. They are systematically excluded from getting quality health services by virtue of their social and economic marginalization," explained Bangser. "To have it out there as a human rights and a health equity issue-so that fistula is not just seen as a medical condition, but a lens onto the broader issues of women's health and health equity-I think has been the greatest success and the greatest challenge for Women's Dignity Project."
Advice for Activists
Bangser anticipates remaining in Tanzania at least for a while. "My husband is an educationalist and activist as well. He has been very active in civil society and on issues of governance and accountability, so he's involved in some very exciting work here. And I'm still doing what I do, so I think we'll be here for another couple of years."
For Amherst students interested in pursuing a similar path, Bangser advised, "Go for it. Don't obsess on getting the right degrees and the right credentials. Find something that inspires you and challenges you. Figure out a way to just get in there and do it for a while. And figure out if that's what you really want to do. I think it's perfectly legitimate to try it and say, 'You know what, this doesn't work for me.'"
Bangser also cautioned, "If you're from the United States and your family and your friends are there, it's not easy to pick up and move halfway around the world and make a life someplace else. It's extraordinary to be able to do that, but it also has its downsides ... if people are interested in getting involved in international development, try to figure out a way to just, even for a couple of weeks, a couple of months, a semester or a summer-to get overseas, do something, test it out and see whether it's a lifestyle and a career that really seems to fit."