Point/Counterpoint on Samahope: Our Two Cents

As promised, here are our thoughts on Samahope’s use of patient profiles to raise money for fistula repair in Sierra Leone:

Although we’re kind of in love with the idea of a Kickstarter for poor women’s vaginas, we’re concerned about the fact that these women are presented primarily in terms of their injury. The key information provided for potential donors browsing through the photographs of possible recipients is “name, age, nature of fistula.” Some of the profiles list a few of the women’s hobbies or interests (“gardening” is a popular choice), but the bulk of the information is fistula-related.

We’re also troubled by the coercive dynamic implicit in the offer of assistance in exchange for public admission of a stigmatizing injury. Even in the best-case scenario, in which the women have no shame about their injuries and aren’t worried about stigma, Samahope is asking women to publicly reveal private information in exchange for help. Leila points out that she has personally spoken with fourteen of the women, and they were all willing to share their stories, but we suspect we’d also be “willing” to publicize our gynecological issues if it meant we would get otherwise unaffordable much-needed treatment. If ladies who aren’t willing to disclose their condition to the global public aren’t eligible for funded surgeries (as Leila’s comments suggest that they’re aren’t), this whole process starts to seem pretty coercive.

Here in the U.S., we don’t think it’s acceptable to force women to publicly describe their vaginas in exchange for vagina-related assistance: We’d never accept it if, say, Medicaid were to require women to post their names, photos, and description of their gynecological problems on a website in order to visit an OB/GYN.  That policy might find a fan in Rush Limbaugh, who famously said that he should be allowed to view the sex acts of young women who received government-subsidized birth control, but that’s hardly indicative of mainstream morality; his comments were (rightly) greeted with horror by the general public.

Both of these concerns (the reduction of a person to an injury, and the potentially coercive nature of the requirement to reveal private medical info) are heightened in the case of the underage girls on the site. We propose that when the question is: “hey, should i post this photo of a 14 year old girl, along with her name, and a description of her broken vagina?” the answer should always be “no.”

Finally, we worry that the setup of the appeal for help – presenting the women and girls almost as if they’re in competition for funding – sets up a disturbing decision process for the potential donor who must choose the most “worthy” (damaged? youngest? prettiest?) recipient for their funds. This mirrors a broader trend that disturbs us, in which NGOs compete for funding and attention by jostling to show the most pathetic victims possible. (Not just a starving woman, but a starving woman who has been raped.  Not just a starving woman who has been raped, but a starving child who has been raped. Not just a starving child who has been raped, but a starving child who has been trafficked into sexual slavery…)  This not only sets up a weird competition for who is “most deserving” or “most in need,” it also contributes to a culture in which no information is too private, and no depiction too demeaning, to demand of victims.

We are not cool with an NGO culture that focuses more on gratifying the egos of donors than on preserving the dignity of recipients. Campaigns like this one contribute to that culture, regardless of their intentions.

None of this is to say that we don’t think Samahope should raise money for fistula repair in Sierra Leone. We’re fully on board with soliciting wealthy Americans for money for poor African women’s vaginas. And actually, we think this has a lot of potential as the next great hipster cause. Think about it: hipsters LOVE to say the word “vagina.” (Look at us, for instance.) And West Africa Fistula Foundation, which performs the Samahope-funded surgeries, seems like a worthy beneficiary. Their focus on recruiting and training local staff is particularly encouraging.

We think there are some pretty easy fixes for the problems we’ve identified above. Nixing the photos of the underage girls would be a great start. We also challenge Samasource to consider whether they could raise money effectively for fistula repair without running photos of pre-operative patients at all. We understand the urge to present real people in need of immediate help – we’ve all seen the research showing that individuals are much more inclined to give when they have a particular person with whom to associate the need for donations. But we think creatively presented profiles (yes, and photos too) of post-op patients would be a more ethical way to establish this connection. Although it would definitely forego some of the urgency of the appeal, showing women who are able to live full, healthy lives as a result of fistula repair would be a moving testament to the value of Samahope’s work, and would clearly underscore the need to fund help for similarly situated women.

Stay tuned for Samahope founder Leila Janah’s response later on…

Amanda and Kate


  1. This is a great idea (your point/counterpoint format, I mean) and I’m excited to read tomorrow’s post. I especially like that you point out solutions to the problems you’ve identified. As a decidedly non-expert in aid, it can be disheartening to constantly see reasons why one shouldn’t support X or Y, without anyone ever identifying how to fix those problems.

  2. Thank you for this post! I love your provocative and satirical writing and it highlights the major issues with campaigns like this whilst providing solutions.
    I would like to add my personal 2 cents to the issue of developing countries and fistula. I am not too familiar with the situation in West Africa, as I work in East Africa. But for our case here, the Government of Tanzania runs a national VVF programme, where the surgery and treatment for women is actually for free. My company enabled one woman the surgery just by providing transport to the hospital and back to her village. Ergo, the issue here is not raising money for the surgery, it is a complicated web of factors including availability of transport, aftercare, stigma, knowledge, commitments etc. Just two quick examples: after a surgery women are required to rest for more than 6 weeks and not supposed to do any work or heavy lifting, which is almost impossible for most, as they are working in subsistence agriculture. No work means no food. They are also required to drink several litres of clean water per day, which is a challenge when you usually collect water from ponds and rivers. It is not just dirty, but due to the surgery they also experience pain and trouble carrying the water back to their homesteads. I could go on like this for another while. But I guess my main point is, that I wish Samahope would also look at those wider issues or at least mention them and not just paint the picture of a quick and easy fix. Problem? -> Money! -> Solved!

  3. “We are not cool with an NGO culture that focuses more on gratifying the egos of donors than on preserving the dignity of recipients.”
    Yes, this this this.

    Thanks for this series of posts and a thoughtful and respectful critique of their donor engagement strategy, with great suggestions for how to more forward.

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