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Operation Fistula uses data to treat childbirth injuries

Aided by an analytics stack developed by Exasol, nonprofit Operation Fistula is working to end obstetric fistula in targeted regions around the world.

After spending nearly a decade struggling to turn its data into a significant driver for change, over the past two years Operation Fistula has transformed its ability to make data meaningful in its battle to end obstetric fistula.

Previously reliant on manual data collection and input, Operation Fistula now uses a software stack that features CommCare for collecting data, Alteryx to pull the data out of CommCare, Exasol for data warehousing and Tableau for data visualization.

"We did everything with paper, and we needed to digitize," said Seth Cochran, founder and CEO of Operation Fistula. "We used weak technology to make something mediocre."

Obstetric fistula is a childbirth injury caused by prolonged obstructed labor without proper medical treatment. It affects about a million women in 55 countries in Africa and Asia, according to Operation Fistula. Days of labor without a needed Caesarean section cuts off the blood supply to both the infant and the mother's internal tissue, resulting in the death of both the baby and the mother's tissue.

After the birth of a stillborn child, the dead tissue results in holes in the mother's intestines that lead to incontinence.

Ultimately, without access to proper medical attention -- specifically, a simple surgery developed 160 years ago -- women with fistula are often rejected by their communities and sent to live in solitude and destitute poverty.

Operation Fistula, meanwhile, is a nonprofit organization working to end obstetric fistula in targeted locations around the world. And less than two years after overhauling its analytics stack, from fighting obstetric fistula on the ground to fundraising efforts, Operation Fistula is now effectively using data in the decision-making process.

The linchpin, according to Cochran, is Exasol.

"Anyone on the team can see the data, can answer questions, they're all trained in Tableau and Exasol is the glue," Cochran said. "It's in every dimension of the organization."

The prevalence of obstetric fistula in 19 African countries is displayed on a dashboard.
A dashboard displays the prevalence of obstetric fistula in 19 countries in Africa.

Joining forces

The combination of Operation Fistula and Exasol came about organically.

Operation Fistula began receiving funding from the Tableau Foundation in 2017, and after viewing the white paper on another nonprofit group the Tableau Foundation was working with at the time -- Visualize No Malaria -- Cochran and his team became aware of Exasol.

Meanwhile, Niccolo Cirone, co-founder and COO of Impact Intel and the former regional data coordinator of the World Food Programme, knew Eva Murray, head of business intelligence at Exasol.

"There was a bit of a personal connection, but [Operation Fistula] was also looking at what another nonprofit was doing with us," Murray said.

Cirone introduced Cochran and Murray, understanding what Operation Fistula needed from a technology perspective and thinking Exasol would be a good fit.

"We loved Seth's story, and we loved his vision and his mission," Murray said. "If we can use our technology to help them improve something in the world, we absolutely will, and we just felt with Seth an instant connection. He has a lot of great ideas and we wanted to help him make it happen."

Cochran, meanwhile, saw that Exasol could help solve Operation Fistula's data problems.

"We needed a data engineer to build our collection and data stack," Cochran said. "Exasol took over and made it work like a dream. They helped set up and structure so the data seamlessly moves from CommCare into Exasol and then into Tableau."

With Visualize No Malaria as a model, Exasol not only had a blueprint for how to build Operation Fistula's technology stack but also could show Cochran and his team how Exasol could help Operation Fistula as it grows and its data collection needs become more complex.

Operation Fistula's operation

Now that Operation Fistula has an analytics system that works, it's expanding.

The group recently launched an initiative to end fistula in 50 communities in Madagascar, which will involve treating all new cases quickly and eliminating the backlog of untreated cases. Also, it will involve an education component to try to normalize fistula as an injury that occurs in childbirth.

Operation Fistula is currently working in 15 countries, with data playing a significant role in each of them.

Most of the data collection is from physicians performing surgeries on patients. The doctors input the data into CommCare, and it then goes through the process set up by Exasol that ends with a Tableau data visualization.

We have people from 15 different countries entering data, and now we have real-time access to all those inputs -- it nearly blew my mind. That's unheard of in the nonprofit sector.
Seth CochranFounder and CEO, Operation Fistula

"We have people from 15 different countries entering data, and now we have real-time access to all those inputs -- it nearly blew my mind," Cochran said. "That's unheard of in the nonprofit sector. We get patient-level data, and we can view it on a map, so we see the village level of where patients are coming from -- we use mapping to determine where to go."

The data, meanwhile, goes beyond merely the number of cases in a given area.

"Fistula only happens where systems are failing women and girls, and now we can look at things like the number of girls who are married before age 15," Cochran said. "We can look at rates of fistula by district within a country and see where a government needs to invest."

The group always had the capacity to track the number of instances of obstetric fistula in a given region, or track indicators of gender inequality like the marriage rates of teenage girls.

What didn't exist for Operation Fistula was the ability to turn all that information into insight. It's the same problem an average business might have -- loads of information but no idea what to do with it. And critically, even if someone was able to make something of the data, others couldn't easily get at it.

"They said they struggled for years, spending money, to get the data out of it to get insights," Murray said. "What they have now on the technical side is that everyone now has access to the data, they can all connect to it, they can connect to Tableau for their reports whenever they like, and on the more personal level for them is they can finally ask other questions and get more answers."

She added that as Operation Fistula has adapted to its new technology, it's become more data literate.

Beyond drawing its own conclusions, Operation Fistula is now better able to use data to change minds.

The data visualizations it now creates are a far more effective way than simple numbers on a page showing graphically where fistula is going untreated and what happens when it goes untreated.

Operation Fistula can take those visualizations to a government agency or to potential donors and more effectively sway them than it could before.

"When we show visualizations, at the end half the room comes up to us; the visualizations are really effective," Cochran said. "With governments, the response is overwhelmingly positive -- visualizations take something abstract and makes it concrete."

Moving forward

As data continues to transform Operation Fistula's capacity to treat obstetric fistula in place and target areas of need, the success it has in Madagascar will become a model, according to the organization.

It plans to share its data with other groups working to treat fistula, with the goal of eventually treating every case worldwide.

Meanwhile, still less than two years from overhauling its analytics technology, Operation Fistula is continuing to extend the data literacy of its people in the field.

"They are working to upskill people in the field to build the ongoing relationships with their surgeons to make sure they can develop surgeries to help more patients," Murray said. "And then they get more data, and it's just a cycle they can perpetuate."

In terms of education, Operation Fistula developed a project called Visualize Gender Equality that will launch on International Women's Day (March 8) in 2020. By using Tableau and Exasol to create data visualizations that demonstrate the inequities women and girls face, Operation Fistula hopes to drive global awareness and collaboration.

"Obstetric fistula is an indicator of inequality in systems that disadvantage women," Murray said, "so what we want to do is bring this to light, and data visualization is a great way to do it."

At the heart of all of Operation Fistula's plans is data, the vastly improved capacity to collect and consume information.

And at the heart of Operation Fistula's capacity to derive insight from collected information is the analytics lineup it didn't have just under two years ago.

"It's transformed the organization," Cochran said.

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