Date of Graduation

Spring 5-30-2026

Document Type


Degree Name

Doctor of Psychology in Clinical Psychology (PsyD)


School of Nursing and Health Professions




Clinical Psychology (PsyD)

First Advisor

Dr. Brent Ferm

Second Advisor

Dr. Michelle Montagno

Third Advisor

Dr. Dellanira Garcia


Background – Obstetric fistula is a childbirth injury caused by prolonged labor that leads to stillbirth and incontinence, spurring social exclusion and isolation. These layers of trauma put women with fistula at great risk for psychological suffering, which has profound negative socioeconomic impacts on them, their families, and communities. This study captured treatment as usual at Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), the country’s largest provider of fistula care.

Method – Improving holistic fistula treatment requires engaging the clinicians who care for women with fistula. This study aimed to investigate the training, beliefs, and treatment approaches of nurses and doctors (N=9) at CCBRT. Semi-structured interview data was qualitatively analyzed to decipher how clinicians make meaning of fistula mental health and how it influences their treatment strategies.

Results – Several themes grouped into five domains were identified. Participants understand the importance of mental health for fistula patients and clinicians. They acknowledge how stigma shapes patients’ experience and crafts biopsychosocial treatment geared towards women’s reintegration. Treating patients affects clinician’s experience of self.

Conclusions – Evidence-based mental health programs should be codified to protect both patient and clinician mental health. Further research is necessary to evaluate the efficacy of these interventions.