|
Surgical Repair and Counseling Restore Health
Counseling and other social services can help.
Health care systems in developing countries must improve their ability to meet the need for treating obstetric fistulas. The Addis Ababa Fistula Hospital, one of the best equipped facilities in Africa, for example, is able to repair less than 15% of the nearly 9,000 estimated new cases in Ethiopia each year (19). More fistula hospitals and more trained medical staff are needed.
Training more doctors in fistula surgery and encouraging them to maintain their skills should be a high priority, according to the United Nations Population Fund (UNFPA) (42, 62). Team-based training that includes not only surgeons but also nursing and counseling staff can be particularly effective, because postoperative care is important to a patient’s recovery (see Counseling and other social services can help, below).
This report was prepared by Don Hinrichsen. Catherine Richey, Research Assistant. Bryant Robey, Editor. Francine Mueller, Designer.
INFO Reports appreciates the assistance of the following reviewers: Steven Arrowsmith, Maggie Bangser, Abdelhadi Eltahir, Zafarullah Gill, Monica Jasis, Kiersten Johnson, Ruth Kennedy, Julius Kiiru, Barbara E. Kwast, Ann M. Moore, Thomas Raassen, Kate Ramsey, Joseph Ruminjo, Susheela Singh, J. Joseph Speidel, Cynthia Stanton, L. Lewis Wall, Mary Nell Wegner, and Mary Beth Weinberger.
Suggested citation: Hinrichsen, D. Obstetric Fistula: Ending the Silence, Easing the Suffering. INFO Reports, No. 2. Baltimore, Johns Hopkins Bloomberg School of Public Health, The INFO Project, Sept. 2004.
The INFO Project at the Johns Hopkins
Bloomberg School of Public Health
Center for Communication Programs.
Ward Rinehart, Project Director; Stephen Goldstein, Chief, Publications Division; Theresa Norton, Associate Editor; Linda Sadler, Production Manager.
INFO Reports is designed to provide an accurate and authoritative report on important developments in family planning and related health issues. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the US Agency for International Development or the Johns Hopkins University.
Published with support from USAID, Global, GH/POP/PEC, under the terms of Grant No.
GPH-A-00-02-00003-00. |
One expert recommendation is that training for surgeons last between one and two months, during which surgeons observe or assist in 50 repairs and perform a minimum of 10 repairs (42). After training, surgeons should maintain their skills by performing fistula operations at least once a week.
The costs of providing fistula treatment (US$200–$500) are far beyond the means of almost all who need it. To offer widespread access to treatment, developing countries need to subsidize fistula surgery and care, including affordable or subsidized transportation to enable women to reach treatment facilities (62).
Counseling and other social services can help.
Successful reconstructive surgery is only the first step to recovery. After surgery many women need help to reintegrate into their families and communities, particularly if they have been living with fistula for a long time (5, 10). Social and other support services can help women develop the skills and confidence needed to improve well-being as they recover their health (63). Compassionate counseling and support from former fistula patients is especially helpful (23).
In Uganda the Nsambya Mission Hospital counsels not only fistula patients themselves but also their husbands, to stress the importance of three to four months of sexual abstinence following treatment to allow for full recovery (74). Most hospitals that perform fistula repair, however—other than those that specialize in the procedure—do not offer counseling (5).
Obstetric fistula remains “one of the most neglected issues in international reproductive health” (75). To end the neglect requires commitment and action from policy-makers, governments, and the international health community. The more that opinion leaders recognize the scope of obstetric fistula and understand the severity of its medical and social consequences, the more likely that a consensus will develop to take action (63).
|
