Upload
prographics-inc
View
225
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Campaign to End Fistula - Dispatch, November 2010
Citation preview
AfricaFistula is key component of maternal health campaignpage 2
Women DeliverFistula survivors meet Danish Crown Princess
page 6
November 2010
T C E F
On 20 October
2010 high-ranking
national officials,
including ministers,
parliamentarians and
development partners,
brought good news
to women in the
Republic of Congo.
This happened when
they participated in
the national launch
of the Campaign on
Accelerated Reduction
of Maternal Mortality in Africa (CARMMA), attesting to the commitment to
improve maternal health in that country.
In the Republic of Congo, maternal death is above the regional average
at a dire rate of 580 deaths per 100,000 live births. This prompted the cam-
paign launch, which was presided over by Congo First Lady Ms. Antoinette
Sassou Nguesso, a champion for maternal health and CARMMA in the
country.
Speaking on behalf of the United Nations, UNFPA Regional Director Mr.
Bunmi Makinwa assured the Government of the UN’s support to acceler-
ate the improvement of maternal health in Africa. The Minister of Health,
Prof. Georges Moyen, reaffirmed the Government’s commitment to tackle
maternal death as a top priority in the country, and he is following up his
words with action.
“The Government has initiated a series of measures to reverse the
trend,” said Minister Moyen at the launch. “We have established a mater-
nal health observatory and we are promoting public awareness about the
importance of women and children’s health. Caesarean sections will be
carried out for free in the public health system and we are also committed
to the Campaign to End Fistula and the extension of the UNFPA programme
on this issue.”
With as many as 140 cases already identified in the country and poten-
tially many more likely to be found, obstetric fistula is considered a serious
public health issue in the Republic of Congo, a country in sub-Saharan
Africa with an estimated population of more than 4 million.
Since 2007, UNFPA has invested over $400,000 in the prevention and
treatment of this problem in the country, where precarious conditions and
poor access to maternal health services contribute to high rates of maternal
death and disability.
The extension of the fistula programme to two additional treatment
centers, one in Pointe Noire and the other in Owando, is a key part of
UNFPA’s contribution to CARMMA in Congo.
Fistula treatment is currently provided free of charge at two major
health centres in Brazzaville. With additional resources, the hope is that
more fistula centres will open in the coming months. The addition of these
new centres will significantly reduce the distance that women with fistula
need to travel for treatment.
Good news for women in AfricaBrazzaville, Republic of Congo
2
COVER PHOTO: After a successful fistula repair operation, Shamim, 26, is released from a hospital in Qatar. She developed fistula during her first pregnancy at the age of 16. Her difficult labour, assisted only by a traditional birth attendant, ended with a stillborn baby and a fistula. After two other unsuccessful pregnancies, she and her husband now have adopted a baby girl. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Pakistan, 2009.
Senate’s First Secretary Ms. Philomène Fouty Soungou, designated by the Health Ministry and UNFPA as the Goodwill Ambassador for CARMMA in Congo. She will work with the First Lady to promote maternal health in the country. Photo: UNFPA, Congo-Brazzaville, 2010.
Filling the information gapLibreville, Gabon
A recent survey carried out in 55 health facilities in Gabon is helping
to fill the information gap about obstetric fistula in the country. It also
highlights that fistula is a public health problem and should be viewed as
a priority by Gabonese authorities. Although previous studies had already
highlighted the lack of emergency care for women with complications
during delivery, as well as early pregnancy and lack of skilled profession-
als as leading factors of disabilities, some experts denied the existence of
obstetric fistula in Gabon.
“There are many factors leading to the occurrence of obstetric fistula
in this country. Since the survey, we can name a few, from adolescent
pregnancy to the lack of access to health services. But we can’t ignore
structural issues like poverty and socio-cultural factors, including the
notion that real women should be brave and endure the pain when giving
birth,” explains UNFPA Country Director for Gabon, Mr. David Lawson.
During the survey, which identified 90 fistula cases in the country, 15
women living with the condition were interviewed. In 50 per cent of the
interviews, the women were aged 15-24, the majority of whom had little
education. More than half of them live in remote rural areas difficult to
access by the most common means of transportation. Their main source of
income is agriculture.
“In these remote areas, it is only to produce the basics, just for subsis-
tence. That’s why these women are so vulnerable – most of them live under
the poverty line,” explains demographer Mr. Mbadu Muanda, the survey’s
lead consultant.
All the fistula survivors interviewed had their first pregnancy before
they had turned 19 and almost half of them even before they had turned
16. One out of every three fistula cases occurred after the first childbirth.
For most of the interviewed women it took more than 12 hours before
they arrived at a hospital after labour began and a complication was identi-
fied. Three of them spent almost 24 hours getting to a health facility. The
majority of them delivered a still-born baby.
“The fact that more than 50 per cent of the fistula cases occurred
after childbirth and the rest after a surgical intervention may reflect poor
emergency obstetric care. And since the majority of the women delivered in
a health facility, it leads us to think that more training is needed, as well as
more adequate equipment and supplies in case of complications,” says Mr.
Mbadu Muanda.
To help eradicate fistula in Gabon, the Campaign and its partners
advocate for the establishment of free delivery services and more skilled
care in the country, says Mr. David Lawson. “We are working to enhance the
capacity of health personnel and to improve the maternal health services
available to the population. This goes together with efforts to sensitize the
population about obstetric fistula and early pregnancy, as well as provide
better access to family planning and help empower women.”
dispatch3
Obstetric fistula, associated with incontinence and social isolation, is hardly
glamorous. But two African beauty queens – Miss Ghana@50 and Miss Liberia
2009 – are using their glamour and recognition to raise awareness about this
issue, which affects some of the most marginalized women in their countries.
Miss Frances Tekyi Mensah began talking about obstetric fistula through-
out 2007, the 50th anniversary
of her country’s independence,
and the year she reigned as
Miss Ghana@50. And she hasn’t
stopped talking about it since.
In view of the commitment
she demonstrated, the Ghana
Government nominated her as
an Ambassador for Obstetric Fistula. She accepted the mission with a strong
drive to make a difference across the country.
Initially Miss Tekyi Mensah selected obstetric fistula as the project to take
on during her reign because she realized that it affected the poorest, least
educated and most marginalized women in her country and elsewhere in
Africa and Asia. “They’ve got nothing except faith and hope and urine-soaked
clothes,” she said of the women who suffer the indignities of fistula. “Some
of them claim ‘even death would be better than this.’ If I could help just one
of these women, to me, it is literally, giving that woman her life back.”
Miss Tekyi Mensah spent most of her year as Miss Ghana@50 raising
awareness about obstetric fistula in the most remote parts of Ghana. She
met tribal chiefs, religious leaders, opinion leaders, men’s groups and several
community representatives spreading the message about the importance
of prevention and about the possibility of treatment. She also appealed to
women with the condition to get treatment and raised funds to support the
treatment of about 20
women in the regions
she visited.
In addition, she
encouraged 60 other
Ghanaians to become
local advocates. The
group includes fistula
survivors, community,
religious and traditional
leaders, as well as
men’s groups represen-
tatives and social workers. With the support of the Ghana Ministry of Health,
the advocates have drawn up action plans, which were implemented in 2010.
A compelling presentation by Miss Tekyi Mensah at the 2008 Miss World
beauty pageant convinced Shu-rina Wiah, who was crowned Miss Liberia
2009, to take on the issue as her project for the year. Throughout 2009, Miss
Wiah participated in outreach campaigns to prevent the injury, as well as in
projects aimed at empowering survivors.
After that, she has frequently spoken to fistula survivors, praising them
for their “resilience and courage” in seeking help, and paid tribute to UNFPA
for helping to restore respect and dignity to women affected by fistula.
Two beauty queens on a missionUNFPA Global Website
More global support needed
A report released in October by the United Nations Secretary
General, Mr. Ban Ki-moon, calls for intensified support for cost-
effective interventions to address the problem of obstetric fistula.
The report Supporting Efforts to End Obstetric Fistula says that
considerable progress has been achieved in addressing obstetric
fistula. The document draws attention to the links between
poverty, income inequalities, gender disparities, discrimination
and poor education, as these factors contribute to poor health in
women and girls. It points out, however, that despite achieving
some positive developments, many serious challenges remain.
“Obstetric fistula is one of the most devastating consequences
of neglect during childbirth and a stark example of health inequity
in the world. Although the condition has been eliminated in the
developed world, obstetric fistula continues to afflict the most
impoverished women and girls, most of whom live in rural and
remote areas of the developing world,” the report states.
Thoraya Ahmed Obaid, Executive Director of UNFPA, the United
Nations Population Fund, has welcomed the new report. In a video
statement prepared for the recent summit on the Millennium
Development Goals, Ms. Obaid emphasized the importance of
tackling obstetric fistula in line with global agreements to improve
the health and rights of women.
“Every year millions of women suffer from pregnancy and
birth-related complications, as well as injuries. And one of them
is fistula, which is an injury that affects women and leaves
them incontinent and thus ostracized from their families and
communities. By working together we can ensure that fistula
is something of the past. And we have to restore the dignity of
millions of women,” said Ms. Obaid.
The struggle to improve health-care systems and reduce the
rate of maternal death and disability, including obstetric fistula,
must not only continue but intensify, as recently published
estimates show that the progress made in maternal mortality
reduction has been slow. Also, there is an urgent need to scale
up well-known, cost-effective interventions in order to reduce the
high number of avoidable maternal deaths and disabilities, the
report points out.
The report cites examples of successful interventions in various
countries and calls for specific actions to improve maternal health
and address the issue of obstetric fistula. It also highlights that
the condition can be prevented as part of broader efforts made to
achieve MDG 5, the one related to maternal health.
As part of its recommendations, the document points out that
funding should be predictable and sustained support should be
provided to countries’ national plans, United Nations entities,
and other global initiatives dedicated to tackling the problem,
including the Campaign to End Fistula.
Read more: www.endfistula.org/dispatch.html
Miss Ghana@50, Frances Teyki Mensah, and fistula survivors.
Miss Liberia 2009, Shu-rina Wiah, and fistula advocates.
The political crisis that
began in Madagascar
almost two years ago has
heavily impacted the imple-
mentation of assistance
programs in the country
and has now taken a toll
in the fight against fistula.
Without a formal national
strategy on the issue or
even the possibility of
carrying out major advocacy
projects, most of the activi-
ties are being implemented
by non-governmental
organizations and contacts
with the government are
restricted.
“We have faced some
technical problems, which hamper the smooth implementation of activi-
ties,” says UNFPA Maternal Health Technical Advisor, Dr. Eugene Kongnyuy.
“However, despite the crisis in the country, we continue to do our work. It
seems like a long time, but we only started the programme in 2008 and,
even with the crisis, we can see considerable progress.”
Before joining the Campaign to End Fistula in 2008, Madagascar con-
ducted a study to assess the magnitude of obstetric fistula in the country.
As part of the findings, the study revealed that knowledge about the
condition among health-care providers was low and that harmful traditional
practices contributed significantly to the occurrence of fistula.
Rural residence, poverty, lack of education, adolescent pregnancies, a
poor referral system and low quality of care during delivery were among
the determinants of fistula in Madagascar, the study pointed out.
Based on this a set of priorities was identified, including surgical repairs
and psychological care, together with social reintegration of fistula patients
and fistula prevention. To address these priorities, the programme designed
activities to empower women and mobilize community leaders.
Since joining the Campaign, the country has introduced the activities
in phases. Currently six reference hospitals are involved in surgical repair
while six NGOs are undertaking social reintegration of fistula survivors and
prevention of obstetric fistula using successfully repaired patients as role
models and advocates.
“We try to ensure that providers are able to properly handle emergen-
cies. This is another aspect of prevention that complements community
sensitization with former fistula patients.”
When asked if he believes that the Campaign will continue in
Madagascar, Dr. Kongnyuy is firm: “We have many accomplishments to
celebrate, including the de-stigmatization of fistula. We’ll just continue to
scale up our activities and develop a national obstetric fistula strategy as
soon as the socio-political situation improves. We are not adrift.”
Eritrea on the road to be ‘fistula free’Asmara, Eritrea
Efforts to end fistula go on despite crisis Antananarivo, Madagascar
A 17-year-old woman from Madagascar, recently operated upon for fistula, her mother and a fistula specialist. Photo: UNFPA Madagascar, 2009.
The government of Eritrea, in collaboration with partners, has embarked
on a project to make the country ‘fistula free’ by the end of 2011. An
intensive campaign to identify and treat women living with obstetric fistula
is being implemented in the country. To encourage women to come out for
treatment, the Ministry of Health is providing free services and reimbursing
related expenses, such as food and lodging. Also, transportation costs are
being paid for or refunded.
“It is a government priority to clear the waiting list of existing fistula
cases in the country, which means that Eritrea would be close to achieving
the national objective of eliminating fistula,” says the UNFPA Representative
in the country, Mr. Barnabas Yisa.
Although the number of existing cases in Eritrea is not yet known, teams
of international experts and national fistula surgeons are working hard to
clear the backlog. While the treatment is going on in several health facilities,
prevention measures are being put in place simultaneously in communities.
The ‘fistula free’
initiative is considered
rather advanced in a
country which has so
many challenges related
to the condition of
women, such as early
marriage, low social
status, fewer educa-
tion opportunities and
economic prospects
compared to men.
Besides the high
number of maternal
deaths —280 per 100,000
live births, according
to the most recent UN estimates— Eritrea also faces a high number of births
carried out without the support of a skilled health professional, reflecting
some reluctance to seek adequate health care during childbirth.
“Culture and tradition can explain this reluctance to deliver with
skilled birth attendants. Such practices increase the risk of complications,
maternal death and disability,” explains the Campaign Coordinator, Ms.
Gillian Slinger. “We also need to think very carefully about how to tackle
these challenging issues.”
Eritrea joined the Campaign to End Fistula in 2003, when a needs
assessment was carried out to detect the magnitude of the disability at
national level. Since then, obstetric fistula has been addressed as part of a
comprehensive package of interventions to overcome the serious reproduc-
tive health problems faced by the country, including an agreement with
Stanford University to provide technical assistance for on-the-job training of
local surgeons and midwives, specialized care for complicated cases, trainee
follow-up and community mobilization design, monitoring and evaluation.
4
Ms. Yirgalem Isaac, nurse midwife in charge of the fistula ward at the Mendefera hospital with a patient. Photo: UNFPA Eritrea, 2010.
Read more: www.endfistula.org/dispatch.html
Professionals trained to deal with fistula Karachi, Pakistan
Pioneer struggles to tackle fistulaConakry, Guinea
One of the first countries to join the Campaign to End Fistula in 2003, Guinea
is still struggling to tackle obstetric fistula. With a population of 10 million and
24 ethnic groups, the country faces one of the highest maternal death ratios in
the African continent —680 per 100,000 live births— and has not yet been able
to establish a coordinated response to disabilities such as fistula.
“This has been a long-lasting fight,” explains the chief of the Ministry of
Health Division for Reproductive Health in Guinea, Dr. Madina Rachid. Following
the International Conference on Population and Development held in 1994,
Guinea, as well as other developing countries, convened a national forum,
which defined the elements of reproductive health that should receive priority
in the country.
“Back then, obstetric fistula had been already identified as a central
component of maternal health in Guinea. However, despite the inclusion of
the condition in the national health policy and programs, little effort had
been made to tackle the problem in the country,” says Dr. Rachid.
After an awareness campaign launched in 2003, the Ministry of Health
conducted a situation analysis in collaboration with UNFPA, leading to the
establishment of a project for the prevention and treatment of obstetric fistula
in Kankan, Guinea’s largest city.
Since then, the project has allowed for the training of health professionals
and community workers and the promotion of public awareness on how to
prevent fistula, including messages disseminated through public and private
radio stations in urban and rural areas, as well as through peer educators.
More than 110 surgical repairs have been successfully carried out thus far
and 29 fistula survivors have received training on income-generating activities
in the country. However, despite the results achieved and lessons learned,
many challenges remain, including the lack of skilled human resources,
insufficient treatment services and low utilization of health services by the
community.
“Most of all, we need a strong national leadership to establish a coordi-
nated response and to strengthen partnerships. With that we can perhaps
foster changes in society and promote the de-stigmatization of fistula,” says
the UNFPA Representative in Guinea, Dr. Marcelle Chevallier.
dispatch
A new programme initiated by UNFPA in Pakistan is providing a 30-week
training course for community midwives on fistula prevention and treat-
ment. The programme, which already benefited more than 70 midwives,
has been developed to train trainers, help prevent obstructed labour and
provide quick referral when emergency obstetric care is needed.
According to experts, having more midwives in the communities will
also help raise awareness among women about the importance of spacing
births, seeking skilled attendants at the time of delivery and providing
proper nutrition for pregnant girls and women.
One of the lead fistula surgeons in the country, Dr. Shershah Syed
believes that more health professionals should be trained to help
improve maternal health. “We don’t have enough skilled birth at-
tendants. Moreover, some of the existing attendants are improperly
trained,” says Dr. Syed.
The initiative to train community midwives complements a broader
strategy to build capacity to treat fistula, developed and implemented
since January 2006, when the Campaign to End Fistula was launched in
Pakistan. As part of the strategy, Pakistani doctors have been encour-
aged to exchange knowledge and share experiences with internationally
renowned surgeons in the field of obstetric fistula.
“Our surgeons are having more opportunities to learn about cost-
effective surgical interventions that can be used to repair fistula patients,”
tells Dr. Faaria Ahsan, UNFPA’s Reproductive Health and Fistula specialist in
Pakistan.
Since the launch of the Campaign in the country, more than 38 surgeons
have been trained on fistula repair surgeries, and an estimated 78 com-
munity midwives and nurses have been trained on pre- and post-operative
management of obstetric fistula. Currently, seven regional and six referral
centres are providing free services to women in need; more than 2,000
fistula cases have been repaired with a success rate of 90 per cent.
5
Students from the Nursing and Midwifery Tutor Training course during their graduation ceremony. They completed a 30-week course that aims to ensure more qualified midwives and nurses, who can then teach other professionals and thus provide better care. Photo: Wendy Marijnissen, Campaign to End Fistula/UNFPA, Karachi, Pakistan, 2009.
Women gathering at the village of Bate Nafadji to hear an educational talk on fistula organized by a local NGO, the African Family Support. Photo: UNFPA Guinea, 2010.
Read more: www.endfistula.org/dispatch.html
One of the highlights of the Women Deliver
Conference in Washington D.C. in June
2010 was the meeting between Her Royal
Highness Crown Princess Mary of Denmark,
and two fistula survivors and advocates.
The Crown Princess, who was accompanied
by the Danish Minister for Development
Cooperation Søren Pind, was deeply moved
by their stories.
One of the women the Crown Princess
met was Ms. Sarah Omega, a fistula survivor from Kenya, who became
pregnant in her late teens. After hours of obstructed labour and losing her
baby in the process, she developed a fistula —a condition she then lived
with for 12 years before receiving treatment. Since 2007 Ms. Omega has
traveled Kenya and the world as a maternal health advocate. She wants to
ensure that other women with fistula know that treatment is available.
“In Kenya, it is estimated that we have 3,000 new fistula occurrences
each year, but only 7 per cent of these women get treatment, leaving us
with a huge backlog of cases. For this reason,
I have been going to the communities, getting
women who are suffering in silence and refer-
ring them to a health facility where they can
receive treatment,” Ms. Omega explained.
Ms. Awatif Altayib, the other advocate
who met the Crown Princess, came from
Furbaranga, West Darfur State, Sudan, where
she works as the village midwife. Also a
fistula survivor, she was married and pregnant
with her first child at the age of 16. Sadly, her baby did not survive an
obstructed labour, from which she developed obstetric fistula. Determined
to ensure that other women do not suffer as she had, Ms. Altayib decided
to become a midwife. She now recruits women living with fistula and
helps them access the care they need.
“It was an important opportunity for me to learn more about the
maternal health challenges that persist in the developing world. Sarah and
Awatif lent a face to all women who have suffered due to the lack of access
to skilled attendants during pregnancy and childbirth. This is something
industrialized nations take for granted but is still very much a luxury in
many countries in the developing world,”
said the Crown Princess of Denmark.
During the meeting, Ms. Thoraya Obaid,
UNFPA Executive Director, expressed her
sincere appreciation that the Crown Princess
accepted to be patron of UNFPA. The
announcement made in June 2010 called
attention to Denmark’s support of UNFPA’s
efforts to promote maternal health and safer
motherhood in developing nations.
6
As part of the fistula-related events during
the Women Deliver conference, UNFPA and
Family Care International (FCI) launched
a new advocacy publication and interac-
tive CD-ROM Toolkit – Living Testimony:
Obstetric Fistula and Inequities in Maternal
Health. The publication aims to contrib-
ute to broader efforts to reduce maternal
mortality and morbidity, to bring obstetric
fistula to the fore, and to highlight specific actions to reduce its
incidence and prevalence.
The main objectives of the CD-ROM Toolkit are to:
• Provide guidance and tools to carry out advocacy for improv-
ing maternal health, and to highlight how attitudes about
pregnancy and delivery affect maternal death and disabilities,
including obstetric fistula.
• Present new strategies for addressing the social norms and
cultural practices that impede access to sexual and reproduc-
tive health-care services in order to increase their availability.
Fistula survivors meet the Danish Crown Princess Washington, D.C., U.S.A.
Toolkit promotes advocacy on fistula
During the same week the Women Deliver Conference was held, fis-
tula survivor and advocate Sarah Omega had the opportunity to brief
members of the U.S. Congress on issues related to obstetric fistula.
The briefing was organized in coordination with the offices of U.S.
Representatives Carolyn Maloney, from New York, and Mike Castle,
from Delaware, sponsors of a bipartisan legislation on fistula: The
Obstetric Fistula Prevention, Treatment, Hope and Dignity Restora-
tion Act of 2010, H.R. 5441.
Earlier in the same week,
Sarah Omega also participated
in an advocacy effort on Capi-
tol Hill, aimed at encouraging
U.S. funding and support for
maternal health and MDG 5.
Ms. Omega, who was joined
by television and film star
Ms. Jennifer Beals, shared her
personal story with several
representatives.
Congressional briefing discusses fistula
UN Foundation representative Tamara Kreinen, fistula survivor and advocate Sarah Omega, Rep. Mark Kirk and television and film star Jennifer Beals. Photo: Sam Hurd, Women Deliver, Washington, D.C., 2010.
Read more: www.endfistula.org/dispatch.html
H.R.H. The Crown Princess of Denmark. Photo: Steen Evald, 2010.
Ms. Sarah Omega. Photo: Moises Saman/Panos, 2010.
Ms. Awatif Altayib. Photo: Moises Saman/Panos, 2010.
For additional information or to obtain copies of the CD-ROM Toolkit, contact: [email protected] or [email protected]
dispatch7
Gillian Slinger, a British-trained nurse and midwife with a BSc Degree
in Health Management and an MSc Degree in Public Health, recently
joined UNFPA to coordinate the global Campaign to End Fistula.
As a midwife, Ms. Slinger has always been deeply moved by the
many obstetric fistula cases she has cared for in the field. Since
starting her MSF post in Geneva in 2007, her involvement in fistula
work has increased enormously, fueling her commitment to address
global maternal death and disability.
Asked about her plans for the future, Ms. Slinger talks about a new
vision for the Campaign.
“There will be a gradual scaling up of training and treatment
services in response to the significant number of existing cases, with
a shift away from ‘vertical’ fistula campaigns organized as occasional
interventions, and towards more permanent fistula services,” explains
Ms. Slinger.
According to Ms. Slinger, the idea is to promote a more holistic
approach to services, as they will be incorporated into existing health
structures and firmly anchored in sustainable health programmes at
the national level. “There will also be greater emphasis on prevention,
including the work with maternal health partners and looking at
preventive measures immediately after prolonged labour and for new
fistula cases,” she complements.
As part of the new vision that is emerging, a greater focus on
quality, more research —including on the reintegration of recovering
fistula patients after treatment— and improved communication
channels will also be integral to the Campaign, Ms. Slinger says.
“One of the expected outcomes is a greater information flow from
global to project level and vice versa, and between key practitioners
and organizations working together to move this agenda forward as
part of the well-established partnership spirit of the Campaign.”
Dispatch: How did obstetric
fistula come to be a priority
health issue in Cameroon?
Dr. Fouda: In 2004, Cameroon
recorded particularly alarming
indicators of maternal health.
It was thus legitimate to think
that, despite the absence of
data, obstetric fistula was a
reality in Cameroon. A few
years ago, UNFPA supported the
Ministry of Public Health to evaluate the situation in two provinces (North
and Far-North). This study allowed us to gain basic knowledge of the fistula
situation in that part of the country, to learn that there are a lot of cases in
these regions and to realize that the existing health facilities did not have
the capacity to deal with the problem.
Dispatch: Can you share with us some of the challenges related to obstetric
fistula that you have faced in the country?
Dr. Fouda: There are many. To begin with, how can we eliminate stigmatiza-
tion? You can see these women abandoned by everybody, and rejected by
the community because their condition is seen as a “curse” or result of
infidelity. They are considered shameful and forced to live apart from the
community, all the while mourning their babies who have died. Raising
funds is another challenge. Women usually cannot pay for the services
because they are extremely poor. The exclusion of the community is not
only social and cultural, but also economic. And since we don’t have the
means and resources for everybody yet, their treatment is not possible
without foreign support. There are also the difficulties involved in following
the patients who have been operated on once they return to their villages,
since most of them are from remote areas where even motorbikes cannot
get to, especially during the raining season.
Another issue is the social reintegration of the patients into their communi-
ties. We also need to improve our health system, and the occurrence of ob-
stetric fistula is an indicator of that. It means training health professionals
in the management of obstetric fistula, which is another challenge. Finally,
treating obstetric fistula is good, but prevention is even better. Sensitiza-
tion has to continue, but it also needs to be improved. It should never be
forgotten that it is the man who makes decisions in African society, and
that he is generally under the influence of his community when he makes
his decisions. Read the full interview online.
A fistula champion and a pioneerYaoundé, Cameroon
Dispatch interviewed Dr. Pierre Fouda, one of the pioneers of fistula
treatment in Cameroon. A urologist and long-term partner in the country,
Dr. Fouda talks about the challenges of fighting fistula.
Gillian Slinger, the new Coordinator of the Campaign to End Fistula, with a fistula survivor in the market close to the Kamuli Mission Hospital in Uganda. Photo: Brian Hancock, FRCS, founder Uganda Childbirth Injury Fund, 2010.
Dr. Pierre Fouda. Photo: UNFPA Cameroon, 2010.
Read more: www.endfistula.org/dispatch.html
Campaign has new coordinator
UNFPACampaign to End Fistula605 Third Avenue, New York, NY 10158email: [email protected]
dispatch is a biannual newsletter highlighingdevelopments in the Campaign to End Fistula
Why the Campaign?
10–15 million women suffer severe or long-lasting illnesses or disabilities caused by complications during pregnancy or childbirth, including obstetric fistula.
Obstetric fistula is a preventable and, in most cases, treatable childbirth injury that leaves women incontinent, ashamed and often isolated from their communities.
There are at least 2 million women living with obstetric fistula in the developing world and up to 100,000 new cases occur each year.
In 2003, UNFPA and its global partners united to launch the Campaign to End Fistula.
The Campaign is now present in 49 countries, having raised over $40 million toward the goal of eliminating fistula.
The Campaign, with its many partners around the world, focuses on three key areas: preventing fistula, treating affected women, and supporting women as they recover from surgery and rebuild their lives.
For more information or to learn how you can help, please visit: endfistula.org.
Editorial Process: Etienne FrancaDesign and Printing: Prographics, Inc.
Contributors: Faaria Ahsan, Yves Bergevin, Luc de Bernis, Nicole Carta, Marcelle Chevallier, Cheikh Tidiane Cissé, Sarah Craven, Akinyele Eric Dairo, Apollinaire Delamou, Triana Dorazio, Nicole Eteki, Pernille Fenger, Calixte Hessou, Sennen Hounton, Esther Huerta, Katja Iversen, Patricia Keba, Hugues Kone, Eugene Kongnyuy, David Lawson, Bunmi Makinwa, Emilie Maurice, Elsabeth Mengsteab, Robert Mensah, Aline Piedecocq, Shafia Rashid, William Ryan, Cecilia Schubert, Alain Sibenaler, Klaus SimoniPedersen, Sandy Singer, Gillian Slinger, Kadiatou Sy, Etta Tadese, Margherita Tinti, Barnabas Yisa.
Campaign Donors (since 2003)
UNFPA wishes to acknowledge with gratitude the multi-donor support generated towards strengthening and improving Maternal Health in the world. Our appreciation is also extended to the many partners and individual donors for their collaboration and support to the Campaign to End Fistula since its inception.
Americans for UNFPA
Arab Gulf Programme for UN Development Organizations
Bill & Melinda Gates Foundation through EngenderHealth
European Voice
Government of Australia
Government of Austria
Government of Canada
Government of Finland
Government of Iceland
Government of Ireland
Government of Japan (through the UN Trust Fund for Human Security)
Government of Luxembourg
Government of New Zealand
Government of Norway
Government of Poland
Government of the Republic of Korea
Government of Spain
Government of Sweden
Government of Switzerland
Johnson & Johnson
Kingdom of Spain, Autonomous Community of Catalunya
One by One
United Nations Foundation
Virgin Unite
Women's Missionary Society of the African Methodist Episcopal Church
Zonta International
ISOFS started from the recognition among prominent fistula surgeons working in Africa
and Asia that there are more than two million obstetric fistula survivors in the world,
yet there are not enough skilled surgeons to operate on them. According to specialists,
surgical attempts by inexperienced surgeons can lead to further damage to the women
living with fistula.
The previous conference, held in Nairobi, Kenya, in 2009, covered topics ranging from the
role of community midwives to the effectiveness of social reintegration and community
partnerships. Organized in collaboration with the African Medical and Research
Foundation (AMREF), the event hosted a diverse assembly of government ministers,
medical professionals, and delegates from charitable and aid organizations and academic
institutions. In 2010, the organizing institutions expect an even larger participation.
Immediately prior to the conference, on 5-6 December, obstetric fistula specialists
from various countries will gather in Dakar for the International Obstetric Fistula
Working Group (IOFWG)* annual meeting. They will discuss priorities and exchange
experiences in the field of obstetric fistula.
What: Third Annual Conference of
the International Society of
Obstetric Fistula Surgeons
(ISOFS)
Annual Meeting of the
International Obstetric Fistula
Working Group (IOFWG)
Where:Both the IOFWG meeting (5-6
Dec) and the ISOFS conference
(7-9 Dec) will be held at the
Hotel Des Almadies in Dakar,
Senegal.
Campaign to End Fistula countries
Mauritania
SenegalGambiaGuineaBissau Guinea
Mali
GhanaTogo
Benin
Nigeria
Niger Chad
Congo
Sudan Yemen
India
Nepal
Bangladesh
Pakistan
Afghanistan
Djibouti
Eritrea
Somalia
Kenya
BurundiRwanda
Uganda
Ethiopia
AngolaZambia Malawi
MozambiqueMadagascarZimbabwe
SouthAfrica
Lesotho
Swaziland
DemocraticRepublicof Congo
UnitedRepublic ofTanzania
CameroonCentral African
Republic
Gabon
SierraLeone
EquatorialGuinea
Liberia
Côted’Ivoire
BurkinaFaso
Haiti
CARIBBEAN
The Third Annual
Conference of the
International Society
of Obstetric Fistula
Surgeons (ISOFS) will take
place in Dakar, Senegal,
from 7-9 December 2010.
As an annual summit of
health-care providers and
activists from some of
the world’s most affected
nations, ISOFS provides a
valuable forum to share
key lessons from the
work on the front lines of
obstetric fistula.
*Among its many partners at international, national, regional and local levels, the Campaign to End Fistula also counts on the support of the many institutions and practitioners who are part of the International Obstetric Fistula Working Group (IOFWG). The group aims to ensure global collaboration and coordination of efforts for all issues relating to fistula, including prevention and management, and to guide the secretariat of the global Campaign. Learn more online.
Disclaimer: The opinions expressed by the persons interviewed do not necessarily reflect the newsletter editorial position or the official position of UNFPA.