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Voices From the Field: DR Congo

Yesterday was International Day to End Obstetric Fistula, a serious injury that can occur from complications in childbirth. The World Health Organization used this day to call on the international community to significantly raise awareness and intensify actions towards ending obstetric fistula.

An estimated 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are living with this injury, and some 50,000 to 100,000 new cases develop each year. Yet fistula is almost entirely preventable. 1 Its persistence is a sign that more can be done.

We took a moment to talk with Dr. Esperance Ngondo*, staff in DR Congo, about this injury and our work in DR Congo to treat and prevent fistula.


What is fistula?

Obstetric and traumatic fistula presents as a hole between the tissues of the vaginal canal and bladder, vaginal canal and rectum or all three.

What causes Fistula?

We see fistula caused by a number of circumstances. Obstetric fistula occurs when girls whose bodies aren’t yet fully developed try to give birth. Young girls under the age of 16 are at greatest risk of developing obstetric fistula. Traumatic fistula, however, is typically the result of a violent rape. In the Congo, where rape is frequently used as a weapon of war, we focus most of our work on this type of traumatic fistula.

How did World Relief DRC begin working with women with this injury?

For more than ten years, the World Relief DR Congo office has been active in humanitarian programs and in projects promoting health, agriculture, microfinance, peace & conflict resolution, savings and institution building among churches and communities, 82% of our beneficiaries are women and children – the most vulnerable demographic across the board, but especially in Congo. As World Relief DR Congo implemented its numerous programs in the rural areas, it has been increasingly clear that sexual and gender-based violence (SGBV) against women and young girls (ages 2 to 60) must be addressed.

What are the effects of fistula for a women in DR Congo?

When fistula occurs and is not treated, many women become incontinent and are often cast out by their families as shameful and dirty. Not only do women experience horrible physical effects of fistula, but there are painful social and emotional effects as well. In Congo, women who are raped face terrible rejection and stigmatization. If a woman is married, not only her own family, but her husband and husband’s family cast her out of the home leaving her feeling rejected and humiliated. Oftentimes these women become homeless. In fact, many of our volunteers find these women living hopeless and alone in the forest.

What programs does World Relief DRC offer to support women suffering from fistula?

World Relief has implemented a number of programs to provide medical, psychosocial and economic support to women who are survivors of sexual violence as well as women who have developed obstetric fistula. In partnership with a local hospital women receive treatment, often surgery, for fistula. After the initial surgery, programs are in place to support women; Income generating programs are offered to women to restore their dignity, as well as provide them with the opportunity for economic independence.

How successful are the programs?

In general, fistula repair surgery has an average 80% success, but for World Relief and our partner hospital, we see a 95% success rate. We see God blessing our work again and again. Desperate and hopeless women are finding hope and experiencing a renewed sense of self-worth and dignity.


1. World Health Organization. Retrieved May 23, 2019 from https://www.who.int/life-course/news/events/intl-day-to-end-obstetric-fistula/en/.

*Dr. Esperance Ngondo is a World Relief DRC’s Sexual and Gender Based Violence (SGBV) & HIV/AIDS Health Officer. After completing her degree in medicine from the University of Goma, DRC in 2013 she worked at Bethesda Baptist Hospital in Goma in a program supported by Doctors without Borders, specializing in diagnosing and treating cases of SGBV. She began working as WR’s SGBV-HIV/AIDS Health Officer in 2015. Dr. Ngondo and her husband, Innocent, have three young daughters.


Dana North serves as the Marketing Manager at World Relief. With a background in graphic design and advertising and experiences in community development and transformation, Dana seeks to use the power of words and action to help create a better world. Dana is especially passionate about seeking justice for women and girls around the world.

Hope in the Margins

On International Day to End Obstetric Fistula, we asked Brooke Sulahian, Founder of Hope for Our Sisters, to help us learn more about this tragic injury and the ways in which it might be prevented, treated, and healed.

In June 2010, I read about fistula for the first time. That day, God allowed my heart to break, and my life was forever changed.

For the many of you that have not heard of fistula, let me take a moment to explain the nature and causes of this horrific injury. Obstetric and traumatic fistula presents as a hole between the tissues of the vaginal canal and bladder, vaginal canal and rectum or all three. As a result, women with fistula constantly leak urine, feces or both. Many are shunned and abandoned by their husbands, families and communities. An estimated 2-5 million women worldwide suffer from fistula due to obstructed labor (76-97% of fistula cases), trauma (usually caused by violent rape) or medical error.

Many Americans have never heard of fistula, because it is a condition that is nearly obsolete in the developed world. However, it is a huge problem in developing nations where poverty, malnourishment, early marriage and pregnancy, low education levels, political unrest, use of violent assault as a weapon and lack of access to adequate medical care all contribute to the occurrence of fistula.

Perhaps the most tragic aspect of fistula is the ostracization it causes. Women with fistula are made to believe that they have no value and contribute nothing to their community, larger society or the world. In 90% of obstetric fistula cases, the unborn baby will die. Yet rather than receiving the comfort and love of family during this time, these precious women and girls created in God’s image, are pushed to the margins of society in their loss, and fistula keeps them there.

After first reading about fistula, I envisioned isolated women suffering without dignity or hope. And yes, this is the tragic case for many women with fistula. However, recent trips to Angola and the Democratic Republic of the Congo (DRC) challenged this view as I witnessed the dignity, hope, strength and courage of fistula survivors.

While traveling with World Relief in the DRC, I met my first survivors of rape, many with traumatic fistula. Their stories told of their miraculous transformation, from a desire to die to the desire to live, hopelessness to hope and a lack of dignity to a belief in their priceless value in God. Here was strength and courage in the margins.

In Angola, I witnessed Maria put on earrings before we took her picture. I witnessed Celia, battling an infected colostomy, surprise us with smiles, jokes and confidence. Here was hope and dignity where I believed it could not be found!

We cannot let fistula destroy this dignity, hope, strength and courage. Instead, I believe that our investment of hope, love, prayer and resources will eventually defeat fistula, so that the next generation of girls in developing nations won’t have to face such a life of loss.

At Hope for Our Sisters, we began by funding fistula surgeries and will continue to do so. However, we know that treatment is not enough. We want to invest in our sisters before they become injured and prevent fistulas before they are created. Our answer? Prevention, treatment and empowerment.

Obstetric and traumatic fistula is 100% preventable. And though prevention can be hard to measure, it has the potential for lasting impact. Preventative measures are everything from education and awareness, to prenatal care, to proper nutrition, to assisted delivery, and help covering the costs of each of these treatments. At Hope for our Sisters, we partner with World Relief and other organizations to meet these needs.

In cases where prevention is sadly no longer an option, women suffering from fistula need a variety of interventions and treatments to help restore them to health and wholeness. We help to fund fistula surgeries to restore these women to their optimal physical health status, as well as creating empowerment programs that are key to repairing some of the psychological trauma associated with suffering from fistula. Marketable skills, such as sewing items or weaving baskets to sell in the local markets, equip women to contribute to their families and communities while rediscovering a sense of value.

We are also very proud to partner with World Relief on their Sexual Gender-Based Violence (SGBV) program. These groups provide our beautiful sisters with much-needed community, assistance with owning and sharing their stories, opportunities to give back by providing for women who join the groups and the encouragement to help change their culture one step at a time. SGBV groups teach communities across the DRC that all women have inherent value, no matter their circumstances.

We at Hope for Our Sisters and our partners at World Relief see our sisters’ priceless value. We see the lives they could be living and the contributions they could be making. We envision a world where women are valued, live to their fullest potential, and are positive change-agents within their communities.

Together, we can bring God’s precious daughters out of the margins and back into fullness of life.


Brooke Sulahian – Following a successful thirteen-year career in Human Resources and four years as a stay-at-home mom, Brooke’s eyes were opened to the plight of women and girls around the world who lacked access to medical care and suffered from, or were at risk, for fistula. As a result, she co-founded a volunteer group in October of 2010, which led to the founding of Hope for Our Sisters, Inc. in January of 2012. She is driven by her belief in the inherent value of each person and her hope that women and girls around the world will one day be fully cherished and valued by their families and communities, as God intended. Brooke lives in the Boston area with her husband and two children.

How We Can Make Room for Women

In January, World Relief co-hosted a consultation on “Development, Gender, and Christianity” with Wheaton College and the Imago Dei Fund. Faith-based non-profit staff, church leaders, advocacy experts and academics gathered together to discern why—despite greater awareness that investing in women is good for global development*—things aren’t improving for so many women around the world.

The wise women and men present had decades of collective experience with human trafficking, sexual abuse, women’s and children’s health and developing women as individuals and leaders[DN1] . Before we rolled up our sleeves and got to our important work, we allowed ourselves a moment to lament: “How much longer before every woman, created in the image of God, is free to express the image God has placed in her?”

Realities speak to the shrinking spaces women occupy in countries and communities around the world, even in our churches. Violence against women occurs in countries and communities around the world, and even in our churches. The recent #churchtoo movement proved what statistics already show—the rate of sexual and physical assaults in church communities isn’t less than in the rest of society. Globally, 1 in 3 women—churched or not—have a story to tell. White women in the US earn an average 82 cents to men’s dollar. But in many countries, the pay gap is even wider; women earn an average of only 60-75% of men’s wages despite the benefits a woman’s paycheck has to her family and community. Researchers estimate that this year 12 million girls and young women will marry before their 18th birthday, some as young as 10 years old.

Clearly, much work remains to be done.

As a little girl, my dad, a filmmaker, taught me about the “blue hour.” He would pine for this moment when, on a cloudless sky, the red of day and blue of night make room for one another, intersecting to create an irresistible quality of light.   

Light is not at its most beautiful at midday or midnight, but rather, at the moment when one is making room for the other. The “blue hour” echoes a lesson we find over and over in Scripture: we are to love and prefer one another; we are to make room for one another.

The woman with the issue of blood had no room among the crowd. Rejected by her community—unclean and unwanted—she had to work hard to get to Jesus, to reach out her hand and touch the hem of his garment. Without even turning, Jesus knew that this woman needed his help. He was her last and only hope. Jesus does not turn away from her need because of her status. Instead, Jesus makes room. 

In Luke 22: 25 – 27, Jesus declared: “The kings of the Gentiles rule over their subjects… But I am among you as one who serves.” The King of kings did not come to recline at the table, but to kneel and wash the feet of his disciples. Likewise, Jesus did not come to uphold hierarchies but to break down centuries of injustice.

Jesus comes to us today too, to break down power structures in our communities, to elevate those society overlooks, and to make room for women.

All around us, women are defying the odds. Like the woman who longed to be healed, they’re pressing through crowds toward health and safety for themselves and their children, toward education and into board rooms and pulpits. Some are too tired to press through the crowds. Many don’t see a way through anymore and it is our responsibility to press toward them. 

Men and women—working side by side—can transform the role and experience of women in our societies. The idea of elevating women may be threatening, but men actually benefit when women are empowered to lead. When women and men collaborate in decision-making, households, communities, and institutions become more productive and inclusive. Men’s relationships with their wives, children, and communities become more fulfilling. And, men are able to be who God is calling them to be instead of conforming to what society wants them to be.

We are not all called to become activists. But we can all co-labor toward this transformation in our own communities. It begins with responding to the invitation to think deeply about how we can create more room for women in the spaces we are already in.

At World Relief, we are committed to crafting new spaces for women to flourish. We are doing this in simple, tangible, daily ways—in our programming and throughout the organization.

  • As the most vulnerable in most communities, women are impacted by our programming. We are working increasingly around metrics that measure maximum impact on women and girls to guide our program design.

  • We recently signed the #SilenceIsNotSpiritual Statement in recognition that churches and Christian communities are not exempt from putting women at risk of sexual abuse. Our entire staff and leadership are participating in non-harassment training to ensure that male and female staff work side by side in an equitable, non-threatening way.

  • We are intentionally creating opportunities for women leaders at World Relief. Along with others, we recognize the lack of women in top tiers of leadership in the entire faith-based NGO sector as a problem, and are taking practical steps to correct it within our own organization.

  • We are continuing to partner with the Wheaton consultation and other collaborations. Much remains to be learned about the important roles women must play at all levels of communities and organizations, and we welcome the opportunity to learn and grow with other development organizations.

We can each do one thing today to elevate a girl or woman. Perhaps this means stepping aside and giving some of our space to her. The question is: are we willing to make room?

* “Aid programs that provide women opportunities to better their health, education, and well-being have effects far beyond a single individual. A woman multiplies the impact of an investment made in her future by extending benefits to the world around her, creating a better life for her family and building a strong community.” (USAID: https://www.usaid.gov/infographics/50th/why-invest-in-women )


Eeva Simard is the Project Director of Human Capital at World Relief. For the past ten years, she’s worked with multiple non-profits, where she has been committed to excellence in project management and communication, common sense leadership and the empowerment and training of colleagues, particularly helping women’s voices be heard at top levels of leadership.

The Church in Congo

By James Misner and Marcel Serubungo In the Democratic Republic of Congo, some say that you can find all of Africa’s problems: weak national leadership, eroding rule of law, HIV/AIDS and protracted tribal conflict. Warring militias use rape as a weapon of war and perpetrate other human rights violations. Children are stolen, forced to become soldiers and used as proxies between fighting groups.

Congolese civilians are caught in the vicious cycles of conflict and disease. Millions have died as a result. Refugees and internally displaced people number into the millions.

But even in the world’s most war-torn regions, the power of Jesus can overcome the horrors of conflict. After years of warfare, the Church in DR Congo is the only social structure standing. It is the only hope of true peace for survivors of violence.

This is the reality of the Church in DR Congo:

  1. The Church is traumatized. Many people in the Church have been displaced from their homes. They’ve fled as refugees, survived grave atrocities, lost entire crops and ran through the night in search of safety. Our Christian brothers and sisters in DR Congo face the same situations that their greater communities face — they’re not immune from struggle.
  2. The Church is resilient. Even in the midst of adversity and unspeakable hardship, the church in DR Congo stands strong! Despite ethnic divisions within the nation, the church builds unity and reconciliation. They’ve refused to give up the pursuit of peace. They continue meeting together, praying together and worshiping God together. In some of the worst poverty and injustice on the planet the church gathers to proclaim the greatness of God! We have much to learn from them as they restore their communities.
  3. The Church is redeeming suffering. None of us can explain precisely why God allows suffering. But we do know that God redeems it — through his hands and feet, the Church. When a woman survives sexual violence, the Church will take her in, provide food and shelter and help her to care for her children. When cultural norms say that husbands should abandon their wives after rape — the Church works to debunk this lie and to reconcile marriages. The Church stands in the gap and speaks out against this injustice — teaching boys and men that women are created in God’s image and are to be respected and treasured.

Wherever there is suffering in DR Congo – the Church is right there, too. And World Relief is there to empower the Church to fulfill its mission: to bring hope to the hopeless and restore justice to the oppressed. As the people of the Church endure suffering, they faithfully follow in the steps of Jesus – bringing healing to their communities as they themselves are healed.

Would you consider making a gift to empower local churches to prevent further gender-based violence and care for women survivors? All donations will be matched by One Day’s Wages. Your gift will be used to provide medical care and trauma counseling for the victims of sexual violence and to raise community awareness about violence against women. Give today at onedayswages.org/worldrelief.

James and Marcel are both members of the church team at World Relief. James serves as the Global Director of Church Partnership. Marcel serves as the Director of Church Mobilization and Peace Building in DR Congo.

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