BABIES GET TRAPPED IN THE BIRTH CANAL AND IF THE MOTHERS ARE NOT RELIEVED IN TIME, BLOOD SUPPLY

TO THE TISSUES OF THE BIRTH CANAL DIES LEAVING A HOLE. THE WOMAN THEN LOOSES POWER TO CONTROL URINE AND STOOL, SAID ONDARI. THE TBAS ARE NOT SKILLED TO BE ABLE TO DETECT VVF AND RVF THAT MAY OCCUR AFTER DELIVERY. VAGINAL FISTULAS CAN ALSO RESULT FROM VIOLENT RAPE AND DEFILEMENT VVF IS AN ABNORMAL FISTULOUS TRACT EXTENDING BETWEEN THE BLADDER AND THE
VAGINA THAT ALLOWS THE CONTINUOUS INVOLUNTARY DISCHARGE OF URINE INTO THE VAGINAL VAULT. IT IS OFTEN CAUSED BY CHILDBIRTH (OBSTETRIC FISTULA), WHEN PROLONGED LABOUR PRESSES THE UNBORN CHILD TIGHTLY AGAINST THE PELVIS, CUTTING OFF BLOOD FLOW TO THE VESICO-VAGINAL WALL. THE AFFECTED TISSUE MAY NECROTISE (DIE), LEAVING A HOLE.

The problem: VVF and RVF are holes resulting from the breakdown in the tissue between the vaginal wall and the bladder or rectum caused by unrelieved obstructed labour. The consequences of such damage are urinary or faecal incontinence and related conditions such as dermatitis and erosion of the skin and other tissues in the vulva and vagina from the constant leaking of urine or faeces. In e treme cases the urethra! bladder and vaginal wall can be completely eroded. If nerves to the lower limbs are damaged women can develop foot"drop! a loss of co"ordination with one or both of the lower limbs. In addition to these physical problems! VVF and RVF cause acute social problems. #ue to constant leaking of urine or faeces and the accompanying smell! most communities consider these women outcasts and cut them off from all social activities. $ommuting in public transport and engaging in social activities such as weddings and naming ceremonies becomes difficult. If the fistulae are not repaired! their husbands may divorce the women. %ome leave their families to roam in the cities where they are not known as the outlook for them remain bleak in the community.

Conducting an In-depth Interview

What is an In-depth Interview?
In-depth, qualitative interviews are excellent tools to use in understanding your customer. An in-depth interview is an open-ended, discovery-oriented method of information capture. The goal of the interview is to deeply explore the respondent's point of view, feelings and perspectives. In this sense, in-depth interviews yield information. Key characteristics of in-depth interviews include
Open-ended

Questions. !uestions should "e worded so that respondents cannot simply answer yes or no, "ut must expound on the topic. Semi-structured Format. Although you should have some pre-planned questions to as# during the interview, you must also allow questions to flow

naturally, "ased on information provided "y the respondent. $ou should not insist upon as#ing specific questions in a specific order. In fact, the flow of the conversation dictates the questions as#ed and those omitted, as well as the order of the questions. Seek understanding and interpretation. $ou should try to interpret what you are hearing, as well as see# clarity and a deeper understanding from the respondent throughout the interview. Conversational. $ou should "e conversational, "ut your role is primarily that of a listener. There should "e smooth transitions from one topic to the next. Recording responses. The responses are recorded, typically with audiotape and written notes %i.e., field notes& Record o servations. $ou o"serve and record non-ver"al "ehaviours on the field notes as they occur. Record re!lections. $ou record your views and feelings immediately after the interview as well. In essence, in-depth interviews involve not only as#ing questions, "ut the systematic recording and documenting of responses coupled with intense pro"ing for deeper meaning and understanding of the responses. Thus, in-depth interviewing often requires repeated interview sessions with the target audience under study. 'nli#e focus group interviews, in-depth interviews occur with one individual at a time to provide a more involving experience.

Conducting an In-depth Interview

1. Schematising This is the first stage of the process where"y you clarify the purpose of the interviews and determine what you want to find out. (nce you have decided on your general purpose, then you can pinpoint the #ey information you want to gather through the indepth interview process. 2. Designing After you determine what you want to #now, you must design a way to find it out. A #ey part of this process is designing an interview guide. An interview guide is a list of questions and pro"ing follow-ups that guide you through the interview. As you prepare this guide, you should anticipate and organise the issues you plan to explore. )owever, if the discussion warrants it, you must "e willing to transition or change directions during the interview. The interview guide helps you stay on trac#* helps insure that important issues+topics are addressed* provides a framewor# and sequence for the questions* and helps maintain some consistency across interviews with different respondents. 3. Interviewing The actual interview consists of three main parts. The first part involves introducing yourself and the study. It is critical that you esta"lish a good rapport with the respondent. $ou also should put the respondent at ease. $our main responsi"ility is to

listen and o"serve as you guide the respondent through a conversation until all of the important issues on the interview guide are explored. This, of course, is one of the most difficult aspects of the in-depth interviewing process. )owever, there are some strategies that have "een used "y researchers to improve the quality of the in-depth interview experience for "oth the researcher and the respondent. ,ome strategies include
"ctive listening.

-isten and rephrase what was said to insure that you completely understand the meaning the respondent intends. #atience. .o not rush the respondent and allow him+her to spea# freely while guiding the conversation to cover important issues. Fle$i ilit%. /e open to slight deviations from the topic, which may require rearranging+reordering the questions or coming up with new questions. If the respondent deviates too far from the topic, then carefully return him or her to the topic at hand. "udio recording. 0hen possi"le, audiotape the interview for later reference and increased accuracy. Always as# permission of the interviewee "efore audio recording. ,ome researchers even videotape interviews in order to capture "oth the ver"al responses and nonver"al cues -- after receiving the interviewer1s permission, of course. 4. Transcribing Transcri"ing involves creating a written text of the interviews. This step involves "ringing together all of your information-gathering approaches into one written form. Thus, you would write out each question and response %ver"atim& from the interview using your recorded audiotape and notes including your side notes %o"servations, feelings and reflections&. 5. Analyzing This important step involves determining the meaning in the information gathered in relation to the purpose of the interview. $ou would study the important information and loo# for themes, commonalities, and patterns to try to ma#e sense of the information. If more questions are raised that need clarity in order to serve the purpose of the study, then another in-depth interview is warranted to examine the issue more thoroughly.