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Lessons in Resilience

In Africa, students learn how fistula survivors turn tragedy into hope.

By Nick Houtman

Photos by Joni Kabana

WHEN three Oregon State students signed up for a project in the university’s new humanitarian engineering program, the first question was, Have any of you made soap? Nervous laughter broke out when each one said “no.”

“Ok, this will be fun,” Brianna Goodwin recalls thinking.

But a year and hundreds of bars of goat-milk soap later, Goodwin, one of the students and a mechanical engineering graduate from Seattle, and her teammates — Grace Burleson of Beaverton and Brian Butcher of Portola Valley, California — took their expertise and curiosity to Africa, where they learned how the act of making this simple product can smooth the way for social justice and empowerment.

[aesop_image img=”” credit=”Joni Kabana” align=”left” lightbox=”on” caption=”Akello Loy lives in Ogweto Village in the Amuria district of Uganda. She suffered paralysis and a fistula while giving birth to her fourth child. Oregon State students and faculty are working with TERREWODE to learn from and to empower women like Loy.” captionposition=”left”]


Under the guidance of professor Kendra Sharp, the Richard and Gretchen Evans Professor of Humanitarian Engineering, the students completed their capstone project for their degrees by working with a nonprofit organization, TERREWODE in Uganda. Last summer, they travelled to the East African country to conduct additional field research on a soap-making operation.

As engineers, they focus on process, technology and cultural communication. But their efforts are part of a larger relationship between Oregon State and TERREWODE. In 2011, Bonnie Ruder, a midwife from Eugene and now an Oregon State Ph.D. student in medical anthropology, met Alice Emasu, the group’s founder. Ruder traveled to Uganda that fall, and others followed: Lauren Caruso (then Lauren Baur) in public health in 2012 and students in the College of Business in 2015 and 2016.

Extended Labor

Based in Soroti, Uganda, TERREWODE aims to improve the lives of women suffering from a medical condition known as obstetric fistula. This devastating problem occurs when, during prolonged childbirth and without adequate medical care, tissue in the birth canal is damaged. The resulting fistula, or hole, allows urine or feces to leak uncontrollably. Victims may be shunned by family members and reduced to a life of poverty and isolation.

Globally, the World Health Organization estimates that more than 2 million women live with untreated obstetric fistula, most of them in Asia and sub-Saharan Africa. Fortunately, effective medical treatment is available.

With support from the Worldwide Fistula Fund, TERREWODE educates women about the risks and raises money for medical care, which is often out of reach in rural areas. In the course of several trips to Uganda, Ruder interviewed health-care providers, fistula survivors and representatives of the Uganda Ministry of Health. In 2014, she created the nonprofit Uganda Fistula Fund for TERREWODE to raise money for a new fistula hospital in Soroti.

For her Ph.D. in medical anthropology, Ruder is delving into more complex and persistent problems in fistula treatment — residual incontinence after surgery. “There are estimates that between 7 and 60 percent of women suffer from ongoing urinary incontinence even after a successful fistula repair, but the problem has not been well studied,” she says.

While grants and donations can help women rebuild their lives, Ruder and TERREWODE aim to establish a source of income for the women that is sustainable. “Women who have suffered from fistula need meaningful, locally appropriate work that can lift them out of the circumstances they have endured,” she says.

Through their work with TERREWODE, Oregon State students are learning first-hand about the strength and determination it takes to recover from such a life-changing medical condition. In return, they are working side-by-side with fistula survivors to prevent other women from suffering the same fate. They strive to improve health-care access, to understand women’s needs and to create sustainable, locally based businesses.

Market Access

When they visited Uganda in 2015 and 2016, students and faculty in the OSU College of Business aimed to learn more about TERREWODE and contribute to its success. They met with survivors and with Emasu and her colleagues and asked them what would be most useful in assisting the Ugandan women’s endeavors to become financially independent.

With the help of generous gifts from alumni, the College of Business has provided support through a student group, 16xOSU, a social venture club that provides start-up funds for student-led businesses. In an academic program known as Innovation Nation, first-year students create their own businesses and contribute the profits to a shared fund that is managed by the student community to benefit humanitarian organizations like TERREWODE.

That approach to social entrepreneurship resonated with Taryn Lowes, a business student from the Douglas County town of Yoncalla. She has traveled twice to Uganda and was inspired by the positive energy shown by many of the women she talked to. “A lot of them have gone through so much — their heartbreaking stories, their past. But they are so happy and excited, they didn’t let it get them down. They are working with TERREWODE and getting their lives back on track.”

As students, Lowes and her peers had started their own businesses and contributed funds to the microloan program. On her own initiative, Lowes continued to run her home-cleaning business and raised enough money to pay her way to Uganda.

Trip to Soroti

Last June, after a 48-hour trip from Seattle via Dubai, the three OSU engineering students — Goodwin, Burleson and Butcher — arrived at Entebbe, Uganda’s largest airport, where they were met by a TERREWODE representative. The road trip to Kampala, the capital, had its anxious moments as drivers “like playing ‘chicken,’” Goodwin wrote in her blog. “There are cars, people, and bota botas (motorcycle taxis) on the road, all trying to get to different places as fast as possible.”

The students had come to Uganda to learn more about what it would take for TERREWODE to help fistula survivors launch a goat-milk soap business. The initiative had begun a year or so before, when Oregon photographer Joni Kabana visited Uganda. She devotes part of her creative work to humanitarian organizations such as Oregon-based Mercy Corps and had come to Uganda to take photos for TERREWODE. In her luggage, she had brought a gift of soap made by a friend in Spray, Oregon. Alice Emasu, the director, wondered if local women could also make the soap as a commercial product.

McKinsey Starguard, a homesteader in Spray, Oregon, makes goat milk soap in her kitchen. Starguard's recipe and bars of soap were gifted to the TERREWODE women and inspired the soap-making project, (Photo: Joni Kabana)
McKinsey Starguard, a homesteader in Spray, Oregon, makes goat-milk soap in her kitchen. Starguard’s recipe and bars of soap were gifted to the TERREWODE women and inspired the soap-making project. (Photo: Joni Kabana)

One problem that had to be overcome was a source of milk. Goats in Uganda are typically raised for their meat and do not produce much milk, so Emasu worked with Heifer International to bring Saanen goats from Ireland and to instruct fistula survivors in taking care of them.

Making Soap

The students had three objectives for their stay in Africa: identify a practical, local source of electricity so soap makers wouldn’t have to worry about periodic interruptions to Uganda’s power grid; find ways to improve efficiency and scale-up the soap-making process; determine if enough locally available ingredients were available to increase soap production.

“The more the soap is made by the women with local ingredients, the more sellable it will be as a humanitarian product,” says Burleson.

The previous year, back in Corvallis, as they first pondered their task, the students assumed they would need to create a device to make soap. “We didn’t understand at first how the cultural context would affect our design process, but it’s relevant with anything you’re designing,” Goodwin says. “We had to understand who we’re designing for. The cultural context is huge. You can’t just bring something from America and expect them to use it.”

To put themselves into the shoes of soap makers in Uganda, the students decided they had to make goat-milk soap. They interviewed Ruder and got instructions from Kabana and her colleague Dardi Troen, soap-making trainer during a pilot project in Uganda and now the packaging and branding coordinator. The students bought goat milk and fragrances at the local food co-op and other supplies online — shea butter (made from nuts produced by the African shea tree), sunflower oil, lye.

Grace Burleson, left, and Brian Butcher test a soap mixture in preparation for their trip to Uganda. (Photo courtesy of Briana Goodwin)
Grace Burleson, left, and Brian Butcher test a soap mixture in preparation for their trip to Uganda. (Photo courtesy of Briana Goodwin)

One cold November night, outside Butcher’s garage, they hunched over two small cook stoves, the kinds commonly used in households in developing countries, and set to work mixing and heating the ingredients. In the light of their headlamps, they watched for the liquid to reach a critical stage at which it gains a consistency like whipped cream. The frothy liquid could then be poured into molds and aged for about two months, but the students wanted to speed things up. By keeping the soap mixture at a constant temperature of 155 degrees Fahrenheit for two hours, they could cut the aging process to one day.

“We sat outside for about three hours collecting temperature data to decide if it would work,” Burleson says. “But in the end, we decided that was impossible.”

In subsequent trials, they refined their approach, experimented with other mixing methods and even hooked up a mixer to a solar-charged battery. Solar panels are available in Uganda, they reasoned, and might provide the solution for a sustainable source of power.

They produced a lot of soap. While only some of it was useable, they chalked up the rest to experience. But more importantly, they understood what it might take to produce a product with commercial potential.

Learning on the Ground

As they learned how TERREWODE operates and what it takes for a new business in rural Uganda to succeed, the Oregon State business and engineering students fulfilled their own educational goals. Each student is committed to making a positive difference in the world. Working with TERREWODE “allows me to do what I love but have an impact on peoples’ lives,” says Goodwin.

Burleson lived in Egypt for five years and studied drinking water treatment in Uganda for her undergraduate thesis in mechanical engineering. She worked briefly with TERREWODE in 2015 during an internship with an Oregon-based nonprofit, MAPLE Microdevelopment of Eugene, which was co-founded by Ron Severson, an instructor at the University of Oregon. She entered Oregon State’s mechanical engineering master’s program this fall with a humanitarian emphasis.

Before attending Oregon State, Butcher traveled to Bolivia and Chile where he volunteered for community organizations. Last summer, after he returned from Uganda, the mechanical engineering graduate interned with the firm CH2M.

Goodwin aims to combine engineering with biology. She wants to develop biomechanical systems that can assist people with practical, everyday tasks and is starting her master’s at the University of Washington this fall.

“Our program aims to inspire students to do work that they feel makes an impact on society,” says Kendra Sharp, a leader in developing Oregon State’s humanitarian engineering program. “We stress the importance of learning collaboratively in community to solve real-world problems. This is a skill these students will take away no matter where their careers take them.”

[aesop_video width=”500 px” align=”right” src=”vimeo” id=”160133746″ caption=”In 2015, when OSU students visited TERREWODE, our video crew rode along. See their report.” disable_for_mobile=”on” loop=”on” autoplay=”on” controls=”on” viewstart=”on” viewend=”on”]


Students also take away lasting memories of the people. “When you see TERREWODE interact with the fistula survivors, it’s pretty incredible,” says Caruso. “We would come to a village and pull up to a field under a tree, and there would be this group of people who would start singing and dancing when we arrive.”

When Taryn Lowes returned to Uganda last summer, a friend she had met the previous year traveled an hour by bota bota to greet her. “Seeing everyone’s smiling faces and embracing them with hugs really let me know the impact of our partnership,” she adds. “I’ll never forget the people I’ve met and the friendships I’ve made.”

TERREWODE is in the process of seeking government certification as a soap-making business and has a commitment from one customer. Through MAPLE Microdevelopment, the Portland-based vacation home rental company Vacasa ( has agreed to buy 1,000 bars of goat-milk soap for distribution through its homes in Italy.

Editor’s Note: Students interested in doing an internship with TERREWODE can contact Bonnie Ruder,


By Nick Houtman

Nick Houtman is director of research communications at OSU and edits Terra, a world of research and creativity at Oregon State University. He has experience in weekly and daily print journalism and university science writing. A native Californian, he lived in Wisconsin and Maine before arriving in Corvallis in 2005.